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HeadWay Issue #213 - Getting More Sensitive to Pain?
June 21, 2022

In this issue:

Sensitization and Chronification

Say what?! Hyperalgesia

Sensitization and Chronification

Yes, every once in a while we need to grab on to some big words and wrestle them to the ground. And maybe it's not as hard as you think.

You can guess, I'm sure, that "sensitization" has to do with getting sensitive. More "aware". When we talk about chronic pain, and especially migraine, we often talk about sensitization as increased pain or discomfort.

First, there's "peripheral sensitization". You may have noticed that when you get an injury, such as a cut or a burn, the tissue around the actual injury may become especially sensitive. That's your body's way of helping to protect that part of your body from further injury.

Peripheral sensitization may increase your pain around nerves. You might notice that you have a headache, and the pain gets worse when you cough, or your face is sore.

There's also "central sensitization". Think of this as a more general sensitivity. Why in the world do some people all of a sudden have a super sense of smell when they have a headache? Their brain is making their senses even more sensitive - in general.

When something designed to protect us goes crazy, it may start causing pain and discomfort that is just making things worse. A vicious cycle may start, pain for the sake of pain.

Allodynia is a common example. Your skin hurts or at least feels very uncomfortable simply because you're combing your hair, or wearing a shirt. This type of allodynia typically accompanies migraine (not necessarily even during a "migraine attack" or headache phase).

Speaking of vicious cycles, many headache specialists are concerned about the way that this sensitization may lead to chronification. That is - migraine attacks move from something occasional to something "chronic". After a while, you're experiencing pain more days than not.

At this year's Migraine World Summit, Dr. Jessica Ailani, Director at the Headache Center at Medstar Georgetown University Hospital, emphasized that they warn their patients of this very thing:

So, there's this constant ongoing noise. And then the nerve starts to get really mad saying, 'Hey, the brain's angry, so I'm gonna be angry.' Now they're pinging off of each other. You have what's called 'central sensitization' and 'peripheral sensitization.' The longer these two go, the harder it gets to treat a migraine attack. And we have evidence that suggests that sometimes, the more often these attacks will occur, the more often they occur and the more likely you are to get into chronic migraine. ... a lot of times we tell our patients, 'If you're having a migraine and they're infrequent, don't ignore the migraine.' Treat it early because we want to avoid it becoming this process where you get central sensitization, peripheral sensitization. And now you're having more frequent migraines that are harder to treat and everything is on fire. And we don't have the right tools to really shut this process down.

Sensitization is another reminder that even a once-in-a-while migraine attack needs to be treated, treated early, if possible by a specialist. Your specialist will want to keep your attacks from getting worse.

Typical advice you'll hear from migraine specialists may include:
  • Focus on sleep. Check for sleep disorders. Avoid sleeping pills. Find natural ways to get proper sleep, including keeping screens out of the bedroom.
  • Watch your weight.
  • Talk to your doctor about painkillers. Preventative medication, migraine-targetting medication, may be a better option.
  • Diet and exercise. Yes, you'll find that these still activate the world's best pharmacy - your own body.
If your headache attacks are not getting better, see a specialist today.

For more details about these two types of sensitization, check out Understanding Peripheral and Central Sensitization

Say what?! Hyperalgesia

Sensitization may result in pain and discomfort that shouldn't be there in the first place. But it may also lead to hyperalgesia. Hyperalgesia is when you have what may be "appropriate" pain, but it's "hyper" - it's worse than it should be. Super-sized.

Thanks for reading!  Remember, if you have feedback or ideas for future issues, visit the HeadWay MailRoom.  Your password is nomoache.
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