Sensitization, glutamate, and the link between migraine and fibromyalgia

27/11/2007

Curr Pain Headache Rep. 2007 Oct

Sarchielli P, Di Filippo M, Nardi K, Calabresi P.

Neurologic Clinic, Department of Medical and Surgical Specialties and Public Health, University of Perugia, Ospedale Santa Maria della Misericordia, Via Santa Andrea delle Fratte, San Sisto, 06158 Perugia, Italy. 

PMID: 17894924

Recent advances have shed insight on the pathophysiologic mechanisms of fibromyalgia and migraine, especially in the chronic form.

A growing body of evidence supports the involvement of peripheral and central sensitizationdisturbances of pain-related processes underlying both disorders. They involve increased glutamate transmission through interaction with its ionotropic and metabotropic 
receptors.

Few studies supporting the implication of this excitatory amino acid in chronic migraine and primary fibromyalgia demonstrated increased levels of glutamate in the cerebrospinal fluid of affected patients. These findings have implications for future therapies directed 
against glutamate receptors (in particular, N-methyl-D-aspartate receptors).

Limited clinical experience in this regard, although promising, does not exclude additional mechanisms contributing to the maintenance of pain, which can be the target of therapeutic approaches in both disorders.