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Neurological Sciences

, Volume 32, Supplement 1, pp 61–66 | Cite as

Pain as an evolutionary necessity

  • V. Bonavita
  • R. De Simone
Invited Lecture

Abstract

The proposed title “Pain as an evolutionary necessity” could lead to a broad debate with implications covering many chapters of the medicine and particularly of clinical neurology. In the present perspective, the discussion will focus on migraine and cluster headache chosen as elective examples of biological and not only clinical conditions, that unveil the bond between pain and necessity. Migraine, cluster headache, and perhaps other primary headaches begin to be depicted in terms of recurrent activation of innate bio-behavioral specific patterns, with a crucial and highly conserved evolutionarily adaptive significance. The pan-mammalian sickness behavior and the fight or flight response, selectively activated by different kinds of pain, are here proposed as paradigmatic of migraine and cluster headache attacks associated behaviors, allowing to reformulate these forms as the inappropriate recurrent presentation of coordinated allostatic processes, modeled along million of years of natural evolution. In this light, all the multifaceted characteristics of migraine and cluster headache attacks can be reinterpreted as complex and integrated allostatic defensive reactions to an inescapable or to an escapable pain, respectively aimed to the restoration of biologic homeostasis through a temporary disengagement from active interaction with environment (migraine associated sickness behavior) or, on the contrary, to promote the coordinated biological changes preparatory to emergency and defensive behaviors (cluster headache-related fight or flight response).

Keywords

Pain Evolution Migraine Cluster headache Sickness behavior Fight or flight response 

Notes

Conflict of interest

The authors declare that there is no actual or potential conflict of interest in relation to this article.

References

  1. 1.
    Craig AD (2003) A new view of pain as a homeostatic emotion. Trends Neurosci 26(6):303–307PubMedCrossRefGoogle Scholar
  2. 2.
    Nagasako EM, Oaklander AL, Dworkin RH (2003) Congenital insensitivity to pain: an update. Pain 101(3):213–219PubMedCrossRefGoogle Scholar
  3. 3.
    Craig AD (2002) How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci 3(8):655–666PubMedGoogle Scholar
  4. 4.
    Craig AD (2003) Pain mechanisms: labeled lines versus convergence in central processing. Annu Rev Neurosci 26:1–30PubMedCrossRefGoogle Scholar
  5. 5.
    Cannon WB (1939) The wisdom of the body. Norton, New YorkGoogle Scholar
  6. 6.
    Cortelli P, Pierangeli G, Montagna P (2010) Is migraine a disease? Neurol Sci 31(Suppl 1):S29–S31PubMedCrossRefGoogle Scholar
  7. 7.
    Parry DM, Macmillan FM, Koutsikou S, McMullan S, Lumb BM (2008) Separation of A- versus C-nociceptive inputs into spinal-brainstem circuits. Neuroscience 152(4):1076–1085PubMedCrossRefGoogle Scholar
  8. 8.
    Keay KA, Bandler R (2002) Distinct central representations of inescapable and escapable pain: observations and speculation. Exp Physiol 87(2):275–279PubMedCrossRefGoogle Scholar
  9. 9.
    Lumb BM (2002) Inescapable and escapable pain is represented in distinct hypothalamic-midbrain circuits: specific roles for Ad- and C-nociceptors. Exp Physiol 87:281–286PubMedCrossRefGoogle Scholar
  10. 10.
    Lumb BM (2004) Hypothalamic and midbrain circuitry that distinguishes between escapable and inescapable pain. News Physiol Sci 19:22–26PubMedGoogle Scholar
  11. 11.
    Craig AD (2003) Interoception: the sense of the physiological condition of the body. Curr Opin Neurobiol 13:500–505PubMedCrossRefGoogle Scholar
  12. 12.
    Gracely RH, Petzke F, Wolf JM, Clauw DJ (2002) Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum 46(5):1333–1343PubMedCrossRefGoogle Scholar
  13. 13.
    Moisset X, Bouhassira D (2007) Brain imaging of neuropathic pain. Neuroimage 37(Suppl 1):S80–S88PubMedCrossRefGoogle Scholar
  14. 14.
    Saper JR, Dodick DW, Silberstein SD, McCarville S, Sun M, Goadsby PJ (2011) for the ONSTIM Investigators Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study. Cephalalgia 31:271–285PubMedCrossRefGoogle Scholar
  15. 15.
    Leone M, May A, Franzini A et al (2004) Deep brain stimulation for intractable chronic cluster headache: proposals for patient selection. Cephalalgia 24(11):934–937PubMedCrossRefGoogle Scholar
  16. 16.
    Hart BL (1988) Biological basis of the behavior of sick animals. Neurosci Biobehav Rev 12(2):123–137PubMedCrossRefGoogle Scholar
  17. 17.
    Tizard I (2008) Sickness behavior, its mechanisms and significance. Anim Health Res Rev 9(1):87–99PubMedCrossRefGoogle Scholar
  18. 18.
    Keay K, Bandler R (2008) Emotional and behavioral significance of the pain signal and the role of the midbrain periaqueductal gray (PAG). The Senses: A Comp Reference 5:627–634CrossRefGoogle Scholar
  19. 19.
    Montagna P, Pierangeli G, Cortelli P (2010) The primary headaches as a reflection of genetic darwinian adaptive behavioral responses. Headache 50:273–289PubMedCrossRefGoogle Scholar
  20. 20.
    Blau JN (1992) Migraine: theories of pathogenesis. Lancet 339:1202–1209PubMedCrossRefGoogle Scholar
  21. 21.
    Kelman L (2006) The postdrome of the acute migraine attack. Cephalalgia 26:214–220PubMedCrossRefGoogle Scholar
  22. 22.
    Quintela E, Castillo J, Muñoz P, Pascual J (2006) Premonitory and resolution symptoms in migraine: a prospective study in 100 unselected patients. Cephalalgia 26:1051–1060PubMedCrossRefGoogle Scholar
  23. 23.
    Watkins LR, Maier SF (2000) The pain of being sick: implications of immune-to-brain communication for understanding pain. Annu Rev Psychol 51:29–57PubMedCrossRefGoogle Scholar
  24. 24.
    Ekbom K (1970) A clinical comparison of cluster headache and migraine. Acta Neurol Scand 46(Suppl 41):1–48Google Scholar
  25. 25.
    Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorders. Cephalalgia 24:1–160Google Scholar
  26. 26.
    Blau JN (1993) Behavior during a cluster headache. Lancet 342:723–725PubMedCrossRefGoogle Scholar
  27. 27.
    Torelli P, Manzoni GC (2005) Behavior during cluster headache. Curr Pain Headache Rep 9:113–119PubMedCrossRefGoogle Scholar
  28. 28.
    Cortelli P, Montagna P (2009) Migraine as a visceral pain. Neurol Sci 30(Suppl 1):S19–S22PubMedCrossRefGoogle Scholar
  29. 29.
    Reyngoudt H, Paemeleire K, Descamps B, De Deene Y, Achten E (2011) 31P-MRS demonstrates a reduction in high-energy phosphates in the occipital lobe of migraine without aura patients. Cephalalgia [Epub ahead of print]Google Scholar
  30. 30.
    Aurora SK, Wilkinson F (2007) The brain is hyperexcitable in migraine. Cephalalgia 27(12):1442–1453PubMedCrossRefGoogle Scholar
  31. 31.
    Sillanpää M, Anttila P (1996) Increasing prevalence of headache in 7-year-old schoolchildren. Headache 36(8):466–470PubMedCrossRefGoogle Scholar
  32. 32.
    Rozen TD, Swanson JW, Stang PE, McDonnell SK, Rocca WA (2000) Increasing incidence of medically recognized migraine headache in a US population. Headache 40:224–230CrossRefGoogle Scholar
  33. 33.
    Honkasalo ML, Kaprio J, Winter T, Heikkila K, Sillanpaa M, Koskenvuo M (1995) Migraine and concomitant symptoms among 8167 adult twin pairs. Headache 35:70–78PubMedCrossRefGoogle Scholar
  34. 34.
    Loder E (2002) What is the evolutionary advantage of migraine? Cephalalgia 22:624–632PubMedCrossRefGoogle Scholar
  35. 35.
    Nesse RM, Williams GC (1998) Evolution and the origins of disease. Sci Am 279(5):86–93PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Istituto di Diagnosi e Cura Hermitage CapodimonteNaplesItaly
  2. 2.Department of Neurological Sciences, Headache CentreUniversity “Federico II” of NaplesNaplesItaly

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