The impact of migraine on the need for local anaesthetics

Summary

Background: In experimental settings, migraine patients show a reduced pain threshold in the trigeminal region. However, only little is known about the relevance of this phenomenon for other pain conditions. We evaluated pain perception of migraine patients during dental treatment by counting the amount of local anaesthetics. Methods: We enrolled 30 migraine patients and 133 control patients without migraine who underwent a major surgical dental procedure. We evaluated the amount of local anaesthetics (in ml of lidocaine equivalents) as demanded by the patients during this procedure. Further, patients received a diary to record their pain and the amount of analgesics during the following seven days. Results: The need for local anaesthetics was significantly higher in the group of control patients than in the migraine patients. The amount of totally applied local anaesthetics in ml was significantly lower in migraine patients. Migraine patients showed significantly higher pain levels in the seven days after the procedure. Discussion: We could show that the differences in trigeminal pain perception between migraine and non-migraine patients which have been shown in different experimental settings can also be shown in routine clinical situations. These differences are even relevant e.g. for the amount of anaesthetics and for the level of pain induced by such routine procedures.

Zusammenfassung

Hintergrund: Unter experimentellen Bedingungen zeigen Migräne-Patienten eine reduzierte Schmerzschwelle im Versorgungsgebiet des N. trigeminus. Allerdings ist nur wenig über dieses Phänomen bei anderen Schmerzzuständen bekannt. Wir haben die Schmerzwahrnehmung von Migräne-Patienten während eines Zahneingriffs untersucht, indem wir den Bedarf an Lokalanästhetika ermittelt haben. Methodik: 30 Migräne-Patienten und 133 Kontroll-Patienten ohne Migräne, die sich einem größeren zahnärztlichen Eingriff unterziehen mussten, wurden eingeschlossen. Wir ermittelten die Menge von Lokalanästhetika (in ml Lidocain-Äquivalent), die von den Patienten während des Eingriffs angefordert wurden. Außerdem führten die Patienten ein Schmerztagebuch über die folgenden sieben Tage nach dem Eingriff, um die Schmerzstärke und die Menge der verbrauchten Analgetika zu dokumentieren. Ergebnisse: Der Gebrauch von Lokalanästhetika war in der Gruppe der Kontroll-Patienten signifikant höher als bei den Migräne-Patienten. Migräne- Patienten wiesen signifikant höhere Schmerzstärken in den sieben Tagen nach dem Eingriff auf. Diskussion: Wir konnten zeigen, dass die Unterschiede in der trigeminalen Schmerzverarbeitung zwischen Menschen mit und ohne Migräne, die in experimentellen Studien gezeigt werden konnten, auch bei klinischen Routineeingriffen nachweisbar sind. Diese Unterschiede sind relevant z. B. für die Menge von Lokalanästhetika und für die Schmerzstärke, die durch solche Eingriffe hervorgerufen werden.

Keywords

Migraine - local anaesthetics - dental procedure - pain perception

Schlüsselwörter

Migräne - Lokalanästhetika - Zahneingriff - Schmerzwahrnehmung

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