Skip to main content

Advertisement

Log in

Pain as an evolutionary necessity

  • Invited Lecture
  • Published:
Neurological Sciences Aims and scope Submit manuscript

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).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Craig AD (2003) A new view of pain as a homeostatic emotion. Trends Neurosci 26(6):303–307

    Article  PubMed  CAS  Google Scholar 

  2. Nagasako EM, Oaklander AL, Dworkin RH (2003) Congenital insensitivity to pain: an update. Pain 101(3):213–219

    Article  PubMed  Google Scholar 

  3. Craig AD (2002) How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci 3(8):655–666

    PubMed  CAS  Google Scholar 

  4. Craig AD (2003) Pain mechanisms: labeled lines versus convergence in central processing. Annu Rev Neurosci 26:1–30

    Article  PubMed  CAS  Google Scholar 

  5. Cannon WB (1939) The wisdom of the body. Norton, New York

    Google Scholar 

  6. Cortelli P, Pierangeli G, Montagna P (2010) Is migraine a disease? Neurol Sci 31(Suppl 1):S29–S31

    Article  PubMed  Google Scholar 

  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):1076–1085

    Article  PubMed  CAS  Google Scholar 

  8. Keay KA, Bandler R (2002) Distinct central representations of inescapable and escapable pain: observations and speculation. Exp Physiol 87(2):275–279

    Article  PubMed  Google Scholar 

  9. Lumb BM (2002) Inescapable and escapable pain is represented in distinct hypothalamic-midbrain circuits: specific roles for Ad- and C-nociceptors. Exp Physiol 87:281–286

    Article  PubMed  Google Scholar 

  10. Lumb BM (2004) Hypothalamic and midbrain circuitry that distinguishes between escapable and inescapable pain. News Physiol Sci 19:22–26

    PubMed  Google Scholar 

  11. Craig AD (2003) Interoception: the sense of the physiological condition of the body. Curr Opin Neurobiol 13:500–505

    Article  PubMed  CAS  Google Scholar 

  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):1333–1343

    Article  PubMed  Google Scholar 

  13. Moisset X, Bouhassira D (2007) Brain imaging of neuropathic pain. Neuroimage 37(Suppl 1):S80–S88

    Article  PubMed  Google Scholar 

  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 31:271–285

    Article  PubMed  Google Scholar 

  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):934–937

    Article  PubMed  CAS  Google Scholar 

  16. Hart BL (1988) Biological basis of the behavior of sick animals. Neurosci Biobehav Rev 12(2):123–137

    Article  PubMed  CAS  Google Scholar 

  17. Tizard I (2008) Sickness behavior, its mechanisms and significance. Anim Health Res Rev 9(1):87–99

    Article  PubMed  Google Scholar 

  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 5:627–634

    Article  Google Scholar 

  19. Montagna P, Pierangeli G, Cortelli P (2010) The primary headaches as a reflection of genetic darwinian adaptive behavioral responses. Headache 50:273–289

    Article  PubMed  Google Scholar 

  20. Blau JN (1992) Migraine: theories of pathogenesis. Lancet 339:1202–1209

    Article  PubMed  CAS  Google Scholar 

  21. Kelman L (2006) The postdrome of the acute migraine attack. Cephalalgia 26:214–220

    Article  PubMed  CAS  Google Scholar 

  22. Quintela E, Castillo J, Muñoz P, Pascual J (2006) Premonitory and resolution symptoms in migraine: a prospective study in 100 unselected patients. Cephalalgia 26:1051–1060

    Article  PubMed  CAS  Google Scholar 

  23. Watkins LR, Maier SF (2000) The pain of being sick: implications of immune-to-brain communication for understanding pain. Annu Rev Psychol 51:29–57

    Article  PubMed  CAS  Google Scholar 

  24. Ekbom K (1970) A clinical comparison of cluster headache and migraine. Acta Neurol Scand 46(Suppl 41):1–48

    Google Scholar 

  25. Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorders. Cephalalgia 24:1–160

    Google Scholar 

  26. Blau JN (1993) Behavior during a cluster headache. Lancet 342:723–725

    Article  PubMed  CAS  Google Scholar 

  27. Torelli P, Manzoni GC (2005) Behavior during cluster headache. Curr Pain Headache Rep 9:113–119

    Article  PubMed  Google Scholar 

  28. Cortelli P, Montagna P (2009) Migraine as a visceral pain. Neurol Sci 30(Suppl 1):S19–S22

    Article  PubMed  Google Scholar 

  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]

  30. Aurora SK, Wilkinson F (2007) The brain is hyperexcitable in migraine. Cephalalgia 27(12):1442–1453

    Article  PubMed  CAS  Google Scholar 

  31. Sillanpää M, Anttila P (1996) Increasing prevalence of headache in 7-year-old schoolchildren. Headache 36(8):466–470

    Article  PubMed  Google Scholar 

  32. Rozen TD, Swanson JW, Stang PE, McDonnell SK, Rocca WA (2000) Increasing incidence of medically recognized migraine headache in a US population. Headache 40:224–230

    Article  Google Scholar 

  33. Honkasalo ML, Kaprio J, Winter T, Heikkila K, Sillanpaa M, Koskenvuo M (1995) Migraine and concomitant symptoms among 8167 adult twin pairs. Headache 35:70–78

    Article  PubMed  CAS  Google Scholar 

  34. Loder E (2002) What is the evolutionary advantage of migraine? Cephalalgia 22:624–632

    Article  PubMed  CAS  Google Scholar 

  35. Nesse RM, Williams GC (1998) Evolution and the origins of disease. Sci Am 279(5):86–93

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

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

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. De Simone.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bonavita, V., De Simone, R. Pain as an evolutionary necessity. Neurol Sci 32 (Suppl 1), 61–66 (2011). https://doi.org/10.1007/s10072-011-0539-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10072-011-0539-y

Keywords

Navigation