scholarly journals Interictal habituation deficit of the nociceptive blink reflex: an endophenotypic marker for presymptomatic migraine?

Brain ◽  
2007 ◽  
Vol 130 (3) ◽  
pp. 765-770 ◽  
Author(s):  
L. Di Clemente ◽  
G. Coppola ◽  
D. Magis ◽  
A. Fumal ◽  
V. De Pasqua ◽  
...  
Keyword(s):  
Blink Reflex ◽  
Nociceptive Blink Reflex

scholarly journals Preventive Treatment With CGRP Monoclonal Antibodies Restores Brain Stem Habituation Deficits and Excitability to Painful Stimuli in Migraineurs: Results From a Prospective Case-control Study

2021 ◽  
Author(s):  
Anne Thiele ◽  
Lara Klehr ◽  
Sebastian Strauß ◽  
Anselm Angermaier ◽  
Ulf Schminke ◽  
...  
Keyword(s):  
Disease Activity ◽  
Brain Stem ◽  
Substantial Reduction ◽  
Preventive Treatment ◽  
Blink Reflex ◽  
Peptide Ligand ◽  
Headache Frequency ◽  
Global Test ◽  
Nociceptive Blink Reflex ◽  
Disease Modifying

Abstract Background & ObjectivesCalcitonin gene-related peptide ligand/receptor (CGRP) antibodies effectively reduce headache frequency in migraineurs. It is understood that they act peripherally, which raises the question whether treatment merely interferes with the last stage of headache generation or, alternatively, causes secondary adaptations in the central nervous system and might thus possess disease modifying potential. This study addresses this question by investigating the nociceptive blink reflex (NBR), which is closely tied to central disease activity, before and after treatment with CGRP antibodies.MethodsWe enrolled 22 episodic migraineurs (21 female, 46.2 ± 13.8 years of age) and 22 age-/gender-matched controls. Patients received assessments of the NBR (R2 component, 10 trials, 6 stimuli/trial) before (V0) and three months (V3) after treatment with CGRP antibodies started, controls were assessed once. The R2 area (R2a) and habituation (R2h; gradient of R2a against stimulus order) of the stimulated/non-stimulated side (_s/_ns) following repeated supraorbital stimulation provide a direct readout of brainstem excitability and habituation as key mechanisms in migraine.ResultsAll patients showed a substantial reduction of headache days/month (V0: 12.4±3.3, V3: 6.6 ± 4.9). R2a_s (Fglobal=5.86, p<0.001; block 1: R2a_s: -28%, p<0.001) and R2a_ns (Fglobal=8.22, p<0.001, block 1: R2a_ns: -22%, p=0.003) were significantly decreased, and R2h_ns was significantly enhanced (Fglobal=3.07, p<0.001; block 6: R2h_ns: r=-1.36, p=0.007) from V0 to V3. The global test for changes of R2h_s was non-significant (Fglobal=1.46, p=0.095). Changes of R2h significantly correlated with improvement of headache frequency (R2h_s, r=0.56, p=0.010; R2h_ns: r=0.45, p=0.045). None of the NBR parameters assessed at baseline predicted treatment response.DiscussionWe provide evidence that three months of treatment with CGRP antibodies restores brain stem responses to painful stimuli and thus might be considered disease modifying. The nociceptive blink reflex may provide a biomarker to monitor central disease activity. Future studies should evaluate the blink reflex as a clinical biomarker to predict treatment response at baseline and to establish the risk of relapse after treatment discontinuation.Trial registrationThis trial was prospectively registered at clinicaltrials.gov (ID: NCT04019496, date of registration: July 15, 2019).

Sumatriptan and Corneal Reflexes in Headache-Free Migraine Patients: A Randomized and Placebo-Controlled Crossover Study

Cephalalgia ◽  
2007 ◽  
Vol 27 (2) ◽  
pp. 165-172 ◽  
Author(s):  
V Busch ◽  
S Kaube ◽  
W Schulte-Mattler ◽  
H Kaube ◽  
A May
Keyword(s):  
Oral Administration ◽  
Crossover Study ◽  
Blink Reflex ◽  
Trigeminal System ◽  
Healthy Controls ◽  
Free Interval ◽  
Nociceptive Blink Reflex ◽  
Before And After ◽  
Corneal Reflex ◽  
Baseline Response

A temporary sensitization of central trigeminal neurones in migraine patients during acute attacks has been described in previous studies using the electrically evoked nociceptive blink reflex. The cornea is innervated by small myelinated A-delta and unmyelinated C-fibres only. Stimulation with air puffs activates peripheral nociceptors and allows the investigation of peripheral trigeminal nerve structures. Our objective was to investigate whether corneal reflex examinations with air puff stimulation detect abnormalities in migraineurs during their pain-free interval and if the corneal reflex may be modulated by the administration of an oral triptan. After validation of the nociceptive air puff technique by investigating the corneal reflexes before and after a local anaesthesia of the cornea, we recorded corneal reflexes in 25 migraineurs during their pain-free period and 25 healthy controls before and after the oral administration of 100 mg sumatriptan in a randomized, placebo-controlled, crossover study. Baseline response areas under the curve (AUCs) and latencies of the R2 components of the corneal reflexes did not show any significant differences between patients and controls. Patients did not show any significant differences regarding their headache and non-headache side. The use of an oral triptan had no significant influence on latencies or AUCs in both patients and controls. Our data suggest that there is no facilitation of the trigeminal system in the headache-free interval among patients with migraine. The stable corneal reflexes after the oral administration of 100 mg sumatriptan suggest that there was no inhibition of the trigeminal system, both in patients during their headache-free period and in healthy controls.

Differences of Anti-Nociceptive Mechanisms of Migraine Drugs on the Trigeminal Pain Processing during and Outside Acute Migraine Attacks

Cephalalgia ◽  
2004 ◽  
Vol 24 (8) ◽  
pp. 657-662 ◽  
Author(s):  
Z Katsarava ◽  
V Limmroth ◽  
O Baykal ◽  
D Akguen ◽  
H-C Diener ◽  
...  
Keyword(s):  
Migraine Attack ◽  
Healthy Subjects ◽  
Blink Reflex ◽  
Acute Attack ◽  
Pain Processing ◽  
Acute Migraine ◽  
Double Blind ◽  
Nociceptive Blink Reflex ◽  
Nociceptive Processing ◽  
Acute Migraine Attack

The aim of this study was to investigate central anti-nociceptive mechanisms of i.v. acetylsalicylic acid (ASA) and oral zolmitriptan (ZOL) in migraine patients and healthy subjects using the ‘nociceptive’ blink reflex (nBR). Twenty-eight migraine patients received ASA ( n = 14, 1000 mg i.v) or ZOL ( n = 14, 5 mg p.o) during the acute migraine attack and interictally. Thirty healthy subjects received either ASA or ZOL vs. placebo using a double blind cross over design. nBR was recorded in all patients and subjects before, 60 and 90 min after treatment. ASA and ZOL did not inhibit nBR responses in healthy subjects. Both ASA and ZOL suppressed nBR responses (ASA by 68%, ZOL by 78%) only during the acute attack but not interictally. The data suggest, that the anti-nociceptive effects of migraine drugs on the trigeminal nociceptive processing are different during and outside an acute migraine attack.

scholarly journals Effects of Visual Cortex Activation on the Nociceptive Blink Reflex in Healthy Subjects

PLoS ONE ◽  
2014 ◽  
Vol 9 (6) ◽  
pp. e100198 ◽  
Author(s):  
Simona L. Sava ◽  
Victor de Pasqua ◽  
Delphine Magis ◽  
Jean Schoenen
Keyword(s):  
Visual Cortex ◽  
Healthy Subjects ◽  
Blink Reflex ◽  
Nociceptive Blink Reflex

Nociceptive Blink Reflex and Visual Evoked Potential Habituations Are Correlated in Migraine

2005 ◽  
Vol 45 (10) ◽  
pp. 1388-1393 ◽  
Author(s):  
Laura Di Clemente ◽  
Gianluca Coppola ◽  
Delphine Magis ◽  
Arnaud Fumal ◽  
Victor De Pasqua ◽  
...  
Keyword(s):  
Visual Evoked Potential ◽  
Evoked Potential ◽  
Blink Reflex ◽  
Nociceptive Blink Reflex ◽  
Visual Evoked

Reliability of the nociceptive blink reflex evoked by electrical stimulation of the trigeminal nerve in humans

2017 ◽  
Vol 21 (8) ◽  
pp. 2453-2463 ◽  
Author(s):  
Yuri Martins Costa ◽  
Lene Baad-Hansen ◽  
Leonardo Rigoldi Bonjardim ◽  
Paulo César Rodrigues Conti ◽  
Peter Svensson
Keyword(s):  
Electrical Stimulation ◽  
Trigeminal Nerve ◽  
Blink Reflex ◽  
Nociceptive Blink Reflex ◽  
Stimulation Of

Central Sensitization of The Trigeminal and Somatic Nociceptive Systems in Medication Overuse Headache Mainly Involves Cerebral Supraspinal Structures

Cephalalgia ◽  
2006 ◽  
Vol 26 (9) ◽  
pp. 1106-1114 ◽  
Author(s):  
I Ayzenberg ◽  
M Obermann ◽  
P Nyhuis ◽  
M Gastpar ◽  
V Limmroth ◽  
...  
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Blink Reflex ◽  
Episodic Migraine ◽  
Upper Limbs ◽  
Trigeminal Nociception ◽  
Simultaneous Registration ◽  
Nociceptive Blink Reflex ◽  
Before And After ◽  
Stimulation Of

Trigeminal and somatic nociceptive systems were studied in controls ( n = 15), episodic migraine ( n = 16), analgesics ( n = 14) and triptan-induced medication overuse headache (MOH) ( n = 15) before and after withdrawal. Patients with MOH and comorbid depressive symptoms and depression without headache were studied to investigate the influence of depression. Trigeminal nociception was studied by simultaneous registration of pain-related cortical potentials (PREP) and nociceptive blink reflex (nBR) following nociceptive-specific electrical stimulation of the forehead. Somatic nociception was evaluated using PREP of upper limbs. We found facilitation of both trigeminal and somatic PREP but not of nBR in MOH, which normalized after withdrawal. No differences were found comparing analgesics vs. triptan MOH. No differences were observed between controls and patients with episodic migraine and depression without headache. A transient facilitation was found of trigeminal and somatic nociceptive systems in MOH, which was more pronounced on a supraspinal level.

Low-Frequency Short-Time Nociceptive Stimulation of the Greater Occipital Nerve does not Modulate the Trigeminal System

Cephalalgia ◽  
2008 ◽  
Vol 28 (8) ◽  
pp. 842-846 ◽  
Author(s):  
TP Jürgens ◽  
V Busch ◽  
O Opatz ◽  
WJ Schulte-Mattler ◽  
A May
Keyword(s):  
Low Frequency ◽  
Blink Reflex ◽  
Trigeminal System ◽  
Nociceptive Stimulation ◽  
Drug Induced ◽  
Occipital Nerve ◽  
Nociceptive Blink Reflex ◽  
Greater Occipital Nerve ◽  
Short Time ◽  
Stimulation Of

Occipital stimulation in a small group of refractory chronic migraine and cluster headache patients has been suggested as a novel therapeutic approach with promising results. In an earlier study we have shown that a drug-induced block of the greater occipital nerve (GON) inhibits the nociceptive blink reflex (nBR). Now, we sought to examine the effects of low-frequency (3 Hz) short-time nociceptive stimulation of the GON on the trigeminal system. We recorded the nBR responses before and after stimulation in 34 healthy subjects. Selectivity of GON stimulation was confirmed by eliciting somatosensory evoked potentials of the GON upon stimulation. In contrast to an anaesthetic block of the occipital nerve, no significant changes of the R2-latencies and R2-response areas of the nBR can be elicited following GON stimulation. Various modes of electrical stimulation exist with differences in frequency, stimulus intensity, duration of stimulation and pulse width. One explanation for a missing modulatory effect in our study is the relatively short duration of the stimulation.

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