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From the Departments of Neurology (M.E.B., S.A., D.B., R.B.L.) and Epidemiology and Population Health (R.B.L.), Albert Einstein College of Medicine, Bronx; The Montefiore Headache Center (M.E.B., R.B.L.), Bronx, NY; The New England Center for Headache (M.E.B.), Stamford, CT; Harvard Medical School (R.B.), Cambridge, MA; Vedanta Research (M.L.R., D.S.), Chapel Hill, NC; and Merck Research Laboratories (M.E.B.), Whitehouse Station, NJ.
Address correspondence and reprint requests to Dr. Marcelo E. Bigal, Global Director, Scientific Affairs, Neuroscience, One Merck Drive, P.O. Box 100, Whitehouse Station, NJ 08889-0100 Marcelo_Bigal{at}merck.com
Objective: The authors estimated the prevalence and severity of cutaneous allodynia (CA) in individuals with primary headaches from the general population.
Methods: We mailed questionnaires to a random sample of 24,000 headache sufferers previously identified from the population. The questionnaire included the validated Allodynia Symptom Checklist (ASC) as well as measures of headache features, disability, and comorbidities. We modeled allodynia as an outcome using headache diagnosis, frequency and severity of headaches, and disability as predictor variables in logistic regression. Covariates included demographic variables, comorbidities, use of preventive medication, and use of opioids.
Results: Complete surveys were returned by 16,573 individuals. The prevalence of CA of any severity (ASC score 
3) varied with headache type. Prevalence was significantly higher in transformed migraine (TM, 68.3%) than in episodic migraine (63.2%, p < 0.01) and significantly elevated in both of these groups compared with probable migraine (42.6%), other chronic daily headaches (36.8%), and severe episodic tension-type headache (36.7%). The prevalence of severe CA (ASC score 9) was also highest in TM (28.5%) followed by migraine (20.4%), probable migraine (12.3%), other chronic daily headaches (6.2%), and severe episodic tension-type headache (5.1%). In the migraine and TM groups, prevalence of CA was higher in women and increased with disability score. Among migraineurs, CA increased with headache frequency and body mass index. In all groups, ASC scores were higher in individuals with major depression.
Conclusions: Cutaneous allodynia (CA) is more common and more severe in transformed migraine and migraine than in other primary headaches. Among migraineurs, CA is associated with female sex, headache frequency, increased body mass index, disability, and depression.
Abbreviations: AMPP = American Migraine Prevalence and Prevention; ASC = Allodynia Symptom Checklist; CA = cutaneous allodynia; CDH = chronic daily headaches; MIDAS = Migraine Disability Assessment; O-CDH = other chronic daily headaches; PM = probable migraine; PR = prevalence ratio; QST = quantitative sensory testing; S-ETTH = severe episodic tension-type headache; TM = transformed migraine.
*Members of the AMPP Advisory Group are listed in the appendix.
Disclosure: This study was sponsored by the National Headache Foundation (NHF) through a grant from Ortho-McNeil Neurologics, Inc. (OMP). Dr. Bigal and Dr. Lipton received grant support from OMP for research projects other than this study. Dr. Bigal and Dr. Lipton are on the advisory board and give lectures supported by OMP. Dr. Bigal is currently an employee of Merck Research Laboratories.
Received July 3, 2007. Accepted in final form October 29, 2007.
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