Migraine in children and adolescents: the clinical impact of allodynia

Introduction The pathophysiology of migraine is strongly associated with central sensitization, the presence of which is related to cutaneous allodynia and cervical musculoskeletal dysfunction. However, these aspects remain understudied in children and adolescents. Thus, this study aimed to evaluate differences in clinical variables, sensitization, and musculoskeletal alterations between children (CR) and adolescents (AD) with migraine, considering the presence or absence of cutaneous allodynia. Methods One hundred and one participants aged 6 to 16 years with a clinical diagnosis of migraine were evaluated. Outcomes included cervical range of motion (ROM), pressure pain threshold (PPT) of cranio-cervical muscles, and presence of cutaneous allodynia. Results Significant differences were observed between CR and AD for age (p<0.001) and PPTs of the sternocleidomastoid (p=0.002), levator scapulae (p=0.006), suboccipital (p=0.006), trapezius (p<0.001), and anterior scalene (p<0.001) muscles. The subgroups CR and AD with and without allodynia showed significant differences in the PPTs of the sternocleidomastoid (p=0.020), levator scapulae (p=0.016), suboccipital (p=0.038), trapezius (p<0.001), anterior scalene (p<0.001) muscles, and in cervical ROM in the sagittal plane (p=0.016). The main differences were observed between adolescents and children with and without allodynia. No differences were found within the children and adolescents’ subgroups. Conclusion The presence of cutaneous allodynia is associated with increased muscle sensitivity and reduced cervical sagittal mobility. These findings highlight the importance of early assessment of allodynia and musculoskeletal sensitivity in children and adolescents with migraine.