Central sensitization mechanisms in chronic migraine with medication overuse headache: a study of thalamocortical activation and lateral cortical inhibition

• Published in: Cephalalgia 2023-10, Vol.43 (10), p.3331024231202240-3331024231202240
• Main Authors: Sebastianelli, Gabriele, Casillo, Francesco, Abagnale, Chiara, Renzo, Antonio Di, Cioffi, Ettore, Parisi, Vincenzo, Lorenzo, Cherubino Di, Fazio, Federica, Petricola, Fausto, Mattia, Consalvo, Serrao, Mariano, Schoenen, Jean, Coppola, Gianluca
• Format: Article
• Language: English
• ISSN: 0333-1024; 1468-2982
• DOI: 10.1177/03331024231202240

Background It is unclear whether cortical hyperexcitability in chronic migraine with medication overuse headache (CM-MOH) is due to increased thalamocortical drive or aberrant cortical inhibitory mechanisms. Methods Somatosensory evoked potentials (SSEP) were performed by electrical stimulation of the median nerve (M), ulnar nerve (U) and simultaneous stimulation of both nerves (MU) in 27 patients with CM-MOH and, for comparison, in 23 healthy volunteers (HVs) of a comparable age distribution. We calculated the degree of cortical lateral inhibition using the formula: 100 – [MU/(M + U) × 100] and the level of thalamocortical activation by analyzing the high frequency oscillations (HFOs) embedded in parietal N20 median SSEPs. Results Compared to HV, CM-MOH patients showed higher lateral inhibition (CM-MOH 52.2% ± 15.4 vs. HV 40.4% ± 13.3; p = 0.005), which positively correlated with monthly headache days, and greater amplitude of pre-synaptic HFOs (p = 0.010) but normal post-synaptic HFOs (p = 0.122). Conclusion Our findings suggest that central neuronal circuits are highly sensitized in CM-MOH patients, at both thalamocortical and cortical levels. The observed changes could be due to the combination of dysfunctional central pain control mechanisms, hypersensitivity and hyperresponsiveness directly linked to the chronic intake of acute migraine drugs.