ABSTRACT
The objective of this study was to determine the relationship between sleepiness and migraine in the intercritical period and to evaluate the time course of critical drowsiness during the attacks. One hundred patients fulfilling IHCD 2nd (2004) criteria for migraine without aura were compared to 100 healthy subjects. Habitual excessive daily sleepiness, evaluated by means of Epworth Sleepiness Scale, was not more frequent in patients with episodic migraine than in controls (12% migraineurs vs. 8% controls, NS). The analysis of critical sleepiness by means of Stanford Sleepiness Scale (SSS) revealed a beginning of sleepiness increase before the attack onset, starting 12 h before, a peak of SSS values at the migraine attack onset and then a gradual decrease to reach baseline values only 12-24 h later. Moreover, patients responding to symptomatic drugs showed a greater and faster decrease of critical sleepiness in comparison with non-responder migraineurs; this finding allows excluding the role of medications in promoting critical somnolence and together with critical drowsiness time-course supports the hypothesis that vigilance impairment could be related to migraine pathogenesis.
Subject(s)
Arousal/physiology , Disorders of Excessive Somnolence/etiology , Migraine Disorders/complications , Sleep Stages/physiology , Adult , Disorders of Excessive Somnolence/physiopathology , Female , Humans , Male , Middle Aged , Migraine Disorders/physiopathology , Young AdultABSTRACT
Laser-evoked potentials (LEPs) are brain responses to laser radiant heat pulses and reflect the activation of Adelta nociceptors. LEPs are to date the reference standard technique for studying nociceptive pathway function in patients with neuropathic pain. To find out whether LEPs also provide a useful neurophysiological tool for assessing antinociceptive drug efficacy, in this double-blind placebo-controlled study we measured changes induced by the analgesic tramadol on LEPs in 12 healthy subjects. We found that tramadol decreased the amplitude of LEPs, whereas placebo left LEPs unchanged. The opioid antagonist naloxone partially reversed the tramadol-induced LEP amplitude decrease. We conclude that LEPs may be reliably used in clinical practice and research for assessing the efficacy of antinociceptive drugs.
Subject(s)
Analgesics/therapeutic use , Evoked Potentials/drug effects , Lasers , Pain Measurement/methods , Pain/diagnosis , Pain/drug therapy , Adult , Analgesics/antagonists & inhibitors , Analgesics, Opioid/antagonists & inhibitors , Analgesics, Opioid/therapeutic use , Cross-Over Studies , Double-Blind Method , Electroencephalography/drug effects , Female , Humans , Male , Naloxone/pharmacology , Narcotic Antagonists/pharmacology , Tramadol/antagonists & inhibitors , Tramadol/therapeutic useABSTRACT
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