Treatment Implication of Trigeminal Sensitization in Acute and Chronic Migraine: A Review

It has been proposed that, early in the course of a migraine attack, sensitization of the first order trigeminal nerve occurs manifesting itself in throbbing pain. In 75% of migraine sufferers, eventually sensitization of the second order trigeminal neuron occurs (central sensitization [CS] manifested by cutaneous allodynia [CA]. Studies show that the efficacy of triptans and other acute treatments is much higher if they are given while pain is mild. Other studies suggest that it is the presence of CS/CA that predicts treatment response. Repeated development of CS has been identified as a candidate risk factor for the development of transformed migraine. If so, avoiding CA (therefore avoiding CS) may provide a strategy for preventing headache progression. In this article, we discuss the therapeutic implications of CS in episodic and transformed migraine.