Migraine, Allodynia, and Central Sensitization

During your Migraine attack your hair literally hurts. Your child reaches out to caress you in empathy and it makes you cry. The air from the ceiling fan hurts you. The feel of your bedsheets is more than you can stand and you cry out in pain.

No, you’re not a hypochondriac or going crazy. You probably have Allodynia, a symptom of Migraine related Central Sensitization in the brain.

Pain actually occurs in the brain, not the area you feel it. When you touch a hot stove, specialized nerves in your hand send signals to your spinal cord, then on to your brain. They tell the brain that you have touched something hot. The brain recognizes the stimulus as pain and triggers the sensation we recognize as pain so you will pull away from the object that is burning you. Pain is your brain’s way to protect your body from harm. This is basically how things work when they are functioning correctly.

Sometimes our brains don’t work like they should though:

Allodynia is a medical term used to describe a patient who is experiencing pain from something that normally shouldn’t cause pain — like bedsheets, or air movement. It can occur anywhere there are pain receptors in the body, but in Migraineurs is most frequently seen as cutaneous (related to the skin) allodynia. Some of the most common places to see cutaneous allodynia in Migraineurs are the scalp, face and neck. Allodynia is a neurological phenomenon that is frequently very confusing to Migraineurs and their loved ones alike, and it is a result of the neurological processes of our Migraine Disease.

Central Sensitization is a medical term used to describe the brain’s neurons becoming hyperexcitable. The central nervous system has become unnaturally sensitized due to ongoing stimulation. An easy way to describe it is that the neurons develop a “memory” of the pain signals that are present during a Migraine attack and it changes accordingly to make the pain signals travel more easily. Some of these changes are related to neurotransmitters that relay messages between cells, especially glutamate and GABA. When these changes have been occurring for a while, allodynia can result.

The fact is, the better the pain memory, the easier it is for those pain signals to travel from neuron to neuron to the brain. Think of it like the evolution of a highway:


200 years ago a cattle path had a few cows coming and going. One day the farmer decided to use the cattle path as a road to get his family to town. He used it as a road for some time, it developed characteristic wagon ruts and soon the neighbors were using the new road too because it was easier than their less used route. Eventually the wagon ruts became a dirt road and lot of people were using it. The more people that used it, the easier it became to drive on it. The road is paved so even more could use it to go back and forth, and it eventually becomes a highway. If no one stops it, things get busy enough and it will turn into a freeway with thousands of cars each day traveling at high speeds.

In the case of our brains and central sensitization, a freeway is a bad thing because it represents changes within the brain that have lowered our ability to abort the Migraine attack. We want lightly-used cattle paths instead.

Migraine is being recognized now as a potentially progressive condition. Central Sensitization is one reason it is vital for Migraineurs to properly manage their Migraine disease (find and eliminate triggers, consider taking a preventive) and take their abortive as soon as they know an attack is happening. The abortive is one lonely cowboy. He can chase the cows away if there are only a few, but he is no match for the freeway full of speeding cars (pain signals). The longer (or more frequently) the Migraine attack occurs, the more difficult it is to stop the traffic traveling along the neuronal highway.

Once allodynia has set in, it is notoriously difficult to treat with any type of medication including NSAIDs and narcotics. Avoiding allodynia then is vitally important to us if we are to avoid the progression of our Migraine Disease and live productive lives.

Understanding central sensitization and allodynia is important because it can help us find better ways of managing our Migraine attacks.

For example, if you recognize your symptoms as that of central sensitization and allodynia and triptans are no longer as effective for you, this is important for your headache specialist to be aware of. Having this information may encourage him or her to look at a change of medications or other treatment strategies before the condition progresses and worsens. Knowing this information also gives you the power to begin a thoughtful conversation with your physician and the knowledge to ask the right questions.

Triptans are now considered first line treatment drugs for Migraine attacks, but typically have a relatively short window to work effectively against Migraine attacks. Triptan effectiveness generally occurs if it is less than two hours into the attack, especially in those susceptible to allodynia — sometimes less or more depending upon the individual patient. Once that mark is passed and allodynia has set in, triptan therapy may no longer be sufficient to stop the pain of the attack and other more aggressive approaches may be necessary.

This is one reason there are different kinds of triptans available to Migraineurs to abort their attacks. Some hit hard and fast. Others take longer to work, but hang in there for a much longer time period. Others are coupled with NSAIDs to further fight central sensitization. Each triptan is a little different and may or may not work for different people… or even for different Migraine attacks!

Do you suffer allodynia? What does your allodynia feel like? How do you treat your allodynia? Consider telling us about your Migraine story in the Share Your Story portion of the Migraine.com community!

Sharing our experiences with other Migraineurs is vital so we can all understand our disease better.

Understanding = empowerment.

Empowerment = better lives for patients and their families.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (39)
  • fabulousfish
    2 years ago

    I’ve been dealing with allodynia few years and I have a tip. Try jersey knit sheets, they are like tee shirts. They are the only sheets I can use with out irritating. Even clothing irritates! I tried percale sheets during a particularly hot spell and it was like rubbing my skin with sand paper. Duh! I get my jerseys at walmart online “Luxury Modal Cotton Jersey Knit Sheet Set”.They are consistently the same. (Warning) the pillows will be wonky, the sheets will wrinkle and stretch. DON’T expect perfection with jersey. FYI-the Mainstays were thinner. Sounds like alot of cons, but for me, my skin often burns from calves up so things like that no longer matter. Also Ladies- Jockey Modern Tactel Cami #2051 is nice to exist in. I wear mine 24/7 depending on the week. ;( Does have a small seam on both sides. Lingerie bag/air dry=6years and still looking great. Hope this helps someone.

  • DonnaFA moderator
    2 years ago

    Hi fabulousfish! Thanks for being part of the community and for sharing a tip that works for you with us!I love the feel of the jersey sheets against y skin, but I find that they cling when I move and then get lumpy. My fiance calls me the princess and the pea, lol. -All Best, Donna (Migraine.com team)

  • Candy
    2 years ago

    I’m so glad to read about this! I’ve had people (other migraineurs) look at me like I was crazy when I mention the intense scalp and facial pain I get. I can’t wash or brush my hair, and it hurts to touch my face. Every so often I also get pain in my legs that feels almost like the muscle ache you get when you have the flu. I thought it was a really unusual symptom, since no one else I knew had heard of it, but now I know it’s not.

  • Goosiegoo
    2 years ago

    I have been having a horrible time trying to figure out why I have bilateral thigh sensations of coldness or burning under my skin.
    I went to Mayo and they said I don’t have neuropathy and that since I have had a few horrible migraines I may have central sensitization! I am currently on lyrica and starting up Effexor. I was on amitriptyline and it helped prevent headaches.
    This is just awful – I soak in Epsom salt baths frequently and love my heated blanket that I put on my lap. This has been going on since April!!
    I haven’t had a migraine in over a year.
    Does this sound like anyone else?
    Thanks,
    Amy

  • Yamihere
    2 years ago

    After Maxalt and painkiller, I have no choice to be lay on the bed and wait it out. I have benzodiazepines for insomnia, so if it’s after 8 PM I try to go to sleep.

    But I have the most amazing cat God ever created (and I’ve had cats for over 50 years, every one of which non-family members agreed were awesome, it’s not just us bragging) who helps my headaches. He knows whether or not I want to feel him and how much. Only God could give a cat that ability!

    So when people ask whether I get upset when he claws furniture, I just laugh. Everyone in this forum would buy a sofa every year for the relief my cat gives. (Nimrods.)

  • Joanna Bodner moderator
    2 years ago

    Well that is one special kitty! You are lucky you have such a great one! It truly is amazing the comfort they can provide. Thanks for sharing!
    -Joanna (Migraine.com Team)

  • Devin C
    3 years ago

    This is a great educational article for both migrainuers and our friends. If only the doctors would read it . I suffer from hemiplegic migraines and get allodynia pain on the whole affected side, making it very painful when I need to go to the ER and NSAIDs are completely ineffective! I recently found something that helps reduce the pain though and wanted to share with the community. Frankincense, either under the tongue or diffused helps tremendously. Personally I diffuse it as it has strong taste but smells very good . I hope this helps someone out there.

  • Angela
    4 years ago

    This article has been really educational. I’m not sure if my symptoms are from my migraines since It’s usually my upper legs that I get the worst pain, that it hurts for anything to touch them. I do get it on my arms just not as frequently. But as my husband said I should at least take note as to whether it comes around the time of my migraines, something I hadn’t noticed before. I had never heard of Allodynia before. I just thought I was weird that my SKIN would hurt like that. So I never even bother to bring it up to anyone.

  • Yamihere
    2 years ago

    Margo & Angela: my husband used to get migraines, so I don’t hear dumb stuff from him. But my cat knows by supernatural gift whether I want his touch and how much.

  • MargoW
    3 years ago

    I’m glad to hear someone else gets upper leg pain. I thought I was crazy! I can’t stand to have my neck, shoulders, arms, back, or hair touched which my whole family thinks is weird. It physically hurts with even the lightest touch and nothing helps my leg pain except waiting it out. I never thought to bring it up either. Thank you!

  • ChadsSis
    4 years ago

    I have suffered for 20+ years with migraines. I have been in agony for the past 5 years with this “other” pain and no one could explain why. Multiple doctors have told me it is sinus drainage or ear fluid. I saw an ENT doctor who said it was TMJ. I decided today to casually mention it to my neurologist and I was diagnosed with cutaneous allodynia. It has a name and I’m not crazy! There is no pattern, rhyme, or reason to it. The side of my head will hurt SO bad. I can’t wash or brush my hair without wanting to cry. My temple and ear will ache. I can’t stand to lay my head on the painful side. It even hurts to chew on that side. I’m more light sensitive during these flair ups too. I feel nauseated and overall just awful for at least a couple of days. It used to happen on the right side of my head only but now it can be on either side. This occurs more frequently as time goes on. I take Tylenol and if lucky will get relief for 2-3 hours. My neurologist has prescribed me Sumatriptan to take when this happens. I’m hopeful this will alleviate the pain. I take Topamax twice daily to help control my migraines. Thank you, Ellen, for this very insightful reading! It helped explain in more detail what my neuro dr explained in short order.

  • nicolaxoxo
    4 years ago

    Twice I have undergone an EEG and both times the pain was excruciating as she rubbed the gritty substance into my scalp. It felt like shards of broken glass to me. The first time the tech was sympathetic, but said she had never seen a patient so sensitive. The second tech was a real B**** and it felt like she rubbed even harder after I told her it hurt. I suffer from chronic daily migraines, so of course I had a headache during both tests. No one ever explained the concept of allodynia to me, but now that I have read this it explains a lot. It is pretty discouraging to read that the pathways of pain become more entrenched as time goes on, but that does seem to be true in my case as well….it certainly has become a progressive condition.

  • kateymac
    4 years ago

    I have a question:
    During migraines (and before&after) I can’t tolerate the stimulus of having too many other people in the room with me. Even if my ear plugs are in and it’s not the NOISE that’s hurting me, I find that the MOVEMENT of people all around me is almost painful to me. Watching them move and FEELING them move in my vicinity, makes me hurt as light and noise do, and I start to feel nauseated. I have to leave the room, the gathering, the holiday, etc., when this happens. It’s always with migraine and at no other time.

    Does anyone else experience this sensitivity to the presence & movement of people around them? I don’t see it mentioned anywhere. Would it fall under the category of “Allodynia”? It’s a very strong and disruptive symptom for me.

  • MargoW
    3 years ago

    I totally do! I almost feel like I’m going to have a panic attack in those situations. It’s stimulus overload. I get no relief until I can be alone someplace quiet and dark.

  • Shannon
    4 years ago

    I get this all the time. I can’t stand having people around me – even in the same room.
    It makes me frustrated and angry at them because it hurts even though I can’t explain why.
    I mentioned it to the doctor but he brushed it off, but I’m booked in for a few weeks to see another doctor about my migraines so may mention this again.
    x

  • kateymac
    4 years ago

    During and around migraines, I get very sensible to the air, as mentioned in the article. All of the air conditioners and fans running this time of year – they don’t “hurt”, exactly; they physically irritate me such that I physically cringe at the feel (and sound) of it, and often need to leave the room. Everyone else in the room is totally relaxed, and I’m cringing and fidgeting and recoiling from the air movement.

  • Ellen Schnakenberg author
    5 years ago

    The Headache Connosiour

    I’m so sorry. It’s likely that you’re not seeing the right kind of doctor. Are you seeing a Migraine and headache specialist? Here is a link to help you find one: http://migraine.com/blog/looking-for-a-migraine-specialist/

    ~Ellen

  • The Headache Connosiour
    5 years ago

    Thankyou for this info. I have been called “a drama queen” for being so sensitive to touch. It actually HURTS! Why haven’t doctors Ive seen acknowledged this? I have felt like a nut on many occasion & that its my fault somehow.

  • Gina
    5 years ago

    I have had migraines since I was 2, which is 62 years now. They started right after I had polio, but they also run in my family. I never heard of Allodynia til now, and I have always experienced scalp and ear pain during migraine and cannot tolerate being touched on my face or head area. The migraines are chronic now and are more frequent than they were when I was younger. I have tried many doctors and drugs over the years and many alternative methods. I have tried different diets and different supplements. I am sorry to say that nothing has ever helped prevent the migraines. Triptans have been the best for migraine attack.My skull will even bulge in different places during a severe attack, especially the ones that happen in the middle of the night. I am so happy to have located this site for the information on articles, experiences, and treatments for us migraineurs! Thanks! Things have come a long, long, way since the ’50’s!

  • 08trish
    5 years ago

    Thank you for this informative website. I always look forward to your new information. 11years I was hit by a rogue wave and crack went my head and neck and instantaneous surgery. Since that day I have been plagued with different migraines. The bigger problem is I also have occipital neuritis, atypical neuralgia, and the migraines. I been through every drug known to man for all 3 symptoms, to the point I couldn’t remember where I was. Then I had nerve decompression on the greater occipital nerves. Wow, I can actually take a shower and not have pain. I am getting Botox for the migraines plus I use Imetrex. There lies the problem. Sometimes until the pain has started I realize I really have the atypical trigeminal neuritis. My face gets so bad I would like to pull it off. The 29th I’m going in for gamma knife radiation. I feel like I have tried everything possible with a plethora of Neurologists and Neurosurgeons. It is so difficult when they overlap. Of course the pain is horrendous and pain meds do nothing. Just a trip to urgent care for a shot then I’m no good for 2-3 days and afraid of doing anything that can trigger this. My heart goes out to each and every person with migraine. Hopefully one day it will be better understood by all.

  • Ellen Schnakenberg author
    5 years ago

    08trish – There are many causes of occipital and trigeminal neuralgia – I believe that’s the diagnoses you’re probably talking about here. Both can be the result of Migraine.

    Decompression of the nerves involved in neuralgia like that can be successful with specific patients. The first time I had heard of this treatment years ago, was when I met a friend of my mom’s who had the surgery done for trigeminal neuralgia. Thank goodness it worked.

    The problem is that no matter what is causing the problem, the pain is severe. When it is the result of inflamed trigeminal and occipital nerves as a result of the Migraine process, the pain can be difficult to discern from other causes.

    Neuralgia is a tricky subject and we’ve talked about it on this site before. Here Dr Mauskop explains the difference between Migraine facial pain and neuralgia: http://migraine.com/blog/migraine-and-trigeminal-neuralgia/

    I’m a neuralgia patient myself. One of the top surgeons and researchers in this field treated my mom’s friend. He created an online program for patients to go and get an idea of a diagnosis. It is done in such a way that it is physician friendly. When you’re done answering the questions, you are given the option of printing out your results to take to your doctor. I highly recommend checking out the patient diagnostic tool here: https://neurosurgery.ohsu.edu/tgn.php

    One other thing worth mentioning… burning pain, like hot lava or hot water poured over a body part, is often something similar, called neuropathy. Please seek the help of a physician in any case, as these are all severe situations that can be helped. Unfortunately, sometimes time is of the essence though, so waiting is not necessarily in the patient’s best interests.

    ~Ellen

  • Michelle Stenner
    5 years ago

    My entire head feels like it’s on fire down to the roots of each and every hair shaft! It hurts to touch it in any way, and even just to lay on the softest pillow feels like I’m laying of bricks!

  • 08trish
    5 years ago

    Check out occipital nerve pain. It has every single one of those symptoms. Good luck and hope you find relief soon.

  • zxcv
    6 years ago

    I have experienced this pain in frequently for many years but not necessarily with a headache or other auras, and well before my diagnosis of complicated migraines a few years ago. Therefore not associating it with anything except the thought that my hair caused it – when at sleep my hair must have been gotten turned around or twisted somehow to cause my scalp pain. It is a very sharp and pronounced pain and hurts without even touching my hair. When touching my hair, it is as if by moving or bending the hair causes more pain. It usually occurs without other migraine symptoms or auras.

  • Marilyn Bailey
    7 years ago

    I thought I was going mad lol…I can feel pain when someone rests their arm on me or around me…also I dread washing my hair, because my hair hurts and starts off a migraine everytime..I ts a bad time for me at moment with the cold weather, if I get my head cold, I start getting shooting knife pains round my ears and head, and in the summer the heat from the sun, also triggers my migraine!

  • Pamela Patterson
    7 years ago

    this makes so much sense to me ~ I have been saying for years that my hair was hurting and this years nothing seems to work on my migraines.. thank you for all the info you post ~ it sometimes help to have things validated so you know that you’re not crazy : ).

  • Holly Clark
    7 years ago

    I feel the same way! It’s an epiphany!

  • Donna VanSant
    7 years ago

    I’ve had migraines for over 40 years and I’m just learning about alloydinia. It’s a stabbing, burning sensation in my head.

  • Kas06019
    6 years ago

    A perfect description, it’s the same for me.

  • Dina Issa
    7 years ago

    Wow, I’ve learnt something new about my migraines. I do get a creapy crawly feeling on my skin esp. my face, neck and scalp but not pain as such. I’ve always thought it to be an allergy of some sort and antihistamines do sometimes help. How interesting. Never heard of allodynia.

  • Ellen Schnakenberg author
    7 years ago

    Sam,

    You’re welcome!

    You are right about some of the basics of Medication Overuse Headache aka Rebound or MOH and I hope Tonya gets a chance to read a deeper explanation about them here: http://bit.ly/ijgOEO and here: http://bit.ly/p3yBfP Additionally, the forum has a discussion re: MOH where you can ask additional questions to help you learn about them http://bit.ly/q3Oh6u However, since Triptans are the only drug class developed to date specifically for the treatment of Migraine (abortive) I chose to use it as an example in the article, not in a reply to a specific Migraineur and their circumstances. Without further information, I stand by my advice to Tonya to see a Headache Specialist for appropriate diagnosis, treatment and management strategies. The dizziness and lightheaded symptoms may need to be addressed separately, but it may take the expertise of a specialist to discern the fact.

  • Sam
    7 years ago

    Thanks for sharing your advice Ellen. Migraines can be really hard to manage, especially in conjunction with a painful condition like Allodynia. The only issue with triptans is that they can cause rebound migraines, which may be what Tonya’s describing. The best way to break out of a cycle of medication overuse is to prescribe prophylactic therapies that prevent headaches before they happen. Read more: http://axonoptics.com/what-causes-migraine-headaches/rebound-migraines/

  • Jennifer Collins-Gonzalez
    7 years ago

    yes, I do have this painful experience and the triptan I use, Maxalt will stop the aura but not the oncoming pain that can last up to 3/4days! It is quite awful!

  • Ellen Schnakenberg author
    7 years ago

    Tonya, My suggestion is to get to a headache specialist as soon as you can. Any time you have a change in your headache pattern is a reason to get to your doctor. The best to see is a specialist who deals in these disorders and diseases all day every day. They stay up to date on the latest protocols and diagnostic tools etc, and are very well versed in medications and how to properly administer them. They understand Migraines and headaches better than anyone else – especially if you’re lucky enough to get a doctor that gets Migraines him/herself!

  • Ellen Schnakenberg author
    7 years ago

    Linda N, I’m so glad this has been helpful. I know it is still difficult for my hubs to understand, but once I knew what was happening to me, it wasn’t so distressing. I hope the same is true for you 🙂

  • Linda N
    7 years ago

    In reading this article I have learned that I have suffered with Allodynia and Central Sensitization along with my migraines for years. My initial pain was on my chest from my neck down to the bra line. My skin was so sensitive that any touch, even from clothes, was very painful. At the end of a migraine the crown of my head would be so painful, a bruised feeling like someone hit me with a baseball bat. As the years have passed the pain on the crown of my head has spread to spots all over my head in addition to the crown being so sore. I cry when I have to wash my hair. I have found that keeping my hair short is best. I massage my head in the shower and try to rub the pain out. I just go ahead and cry, knowing that it will help a little. Time is the only real healer, but knowing that it will return with the next headache. I do believe that migraines are a progressive disease also, along with Fibromyaliga. A headache specialist that I went to told me that he believed that my headaches are probably caused by Fibromyalgia. I told him that I have a headache everyday and he did believe me. He stated that they were either a classic migraine, tension migraine or a tension headache. It felt so good to be validated after 25 years of hearing that the pain was all in my head. Being told that I was depressed and that was causing the headaches. I told all of those Dr’s, that yes I am depressed because I have had a headache for 6 weeks straight and yes it is all in my head!
    I have never met another person with migraines that has this same issue, so I am so glad to know that I am not alone. That is the best thing about this blog. I am not alone in this suffering anymore and I have an outlet to vent a little.
    Thank you for the great information and most of all the understanding from everyone.

  • tonya
    7 years ago

    I suffer from migraines everyday,some days are worst then others..It seems to me its getting worse i have been to doctor after doctor and taking pill after pill, you name it i have taking it! Its getting scary now because i get dizzy and light headed with them now, i just don’t know what to do…its effecting my life alot, do you have any sugguestions for me?

  • Ellen Schnakenberg author
    5 years ago

    Headache Connoisseur

    It sounds like you need to be seeing a Migraine and Headache Specialist. Trigeminal Neuralgia type is best determined by doctors who deal in this, just as diagnosing a headache type is best done by a doctor who sees a lot of headache types every day, like a specialist. There are neurosurgeons who specialize in cranial neuralgias and neuropathies, and these are the doctors I would suggest you consider if you think you have trigeminal neuralgia.

    Migraine symptoms can cross-over, making diagnosis and treatment very difficult, hence the need for a specialist, probably from the list I gave you above.

    Hang in there, there is always hope!

    ~Ellen

  • The Headache Connosiour
    5 years ago

    On completing the Questionaire, the result was “Trigmenial neuralgia type 1”. however, the neurologist I saw informed me that it was neither this or migraine. I have been told different things by various medical professionals but none of them has been able to help. I am at my wits end.

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