Defeating migraine pain with triptans: A race against the development of cutaneous allodynia

@article{Burstein2004DefeatingMP,
  title={Defeating migraine pain with triptans: A race against the development of cutaneous allodynia},
  author={Rami Burstein and Beth Collins and Moshe Jakubowski},
  journal={Annals of Neurology},
  year={2004},
  volume={55}
}
For many migraine patients, triptan therapy provides complete pain relief in some attacks but not in others. Here, we tested whether the success of triptan therapy is hindered in the presence of cutaneous allodynia (pain resulting from a nonnoxious stimulus to normal skin), a phenomenon we previously described develop gradually during the course of the migraine attack in more than 70% of patients. We studied migraine patients repeatedly on three visits to the clinic: in the absence of migraine… 
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TLDR
Based on available randomized controlled trials, the recommendation prevails to initiate abortive treatment as soon as possible after attack onset when pain is still mild and the true relationship between allodynia and treatment response is resolved.
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TLDR
Both divalproate and amitriptyline significantly reduced the frequency and severity of allodynia at 3 and 6 months compared with baseline though there was no group difference.
A Comparison of Migraine Patients With and Without Allodynic Symptoms
TLDR
Rizatriptan resulted in better relief of headache at 2 hours compared with ibuprofen in allodynic patients with moderate-to-severe headache, which need further confirmation in larger study.
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