Early and late effects of treatments on nociceptive flexor reflex (NFR) and sympathetic skin response (SSR) parameters in patients with migraine treated with calcitonin gene-related peptide (CGRP) antagonist, greater occipital nerve (GON) blockade, botulinum toxin therapy and idiopathic intracranial hypertension (pseudotumor cerebri)

Aim: Great occipital nerve (GON) blockade, botulinum toxin injection and calcitonin gene-related peptide (CGRP) antagonists are frequently preferred in the treatment of migraine. Lumbar puncture (LP) is performed for the diagnosis and treatment of idiopathic intracranial hypertension (IIH), a common secondary headache. Our aim is to investigate electrophysiological findings of the procedures, dynamics and clinical correlation of these findings by examining clinical, demographic, nociceptive flexor reflex (NFR), sympathetic skin response (SSR) data of patients undergoing these invasive procedures. Material and Method: Patients diagnosed with migraine and IIH from the Algology unit of the Department of Neurology, Cerrahpaşa Medical Faculty between 05/2023-11/2023 were included. Demographic, clinical, electrophysiological findings were analyzed before, 2 and 8 weeks after the procedures. Results: 32 patients (23 migraine, 9 IIH) were analyzed. Significant correlations were found between sensory threshold and pain frequency, intensity; in GON group between pain threshold and pain frequency; maximal stimulation intensity and pain intensity; between TA RIII mean area, amplitude, maximal amplitude and pain intensity; in LP group between RIII area, duration and pain frequency. Correlations were found between BF RIII amplitude and pain intensity; among SSR parameters between mean, maximal amplitude and treatment efficacy; and mean latency, maximal amplitude and pain intensity. Conclusion: In study, early and late effects of invasive procedures on electrophysiologic parameters of migraine and IIH patients investigated and many findings of predictive importance were found. Findings reflect the dynamics of the effect of invasive procedures on pain modulation and they are also important for clinical practice.