Kisler LB, et al. - Given the invaluable significance of an individual-specific, efficacy-predicting tool in directing, shortening, and improving individualization of migraine prevention and that the serotonin-norepinephrine reuptake inhibitor duloxetine is a pain modulator, researchers investigated if drug efficacy could be predicted by pronociceptivity, so that the more pronociceptive the patient is, the more efficacious the drug and hence, using psychophysical pain measures, they sought to predict duloxetine efficacy in migraine prevention. Participants were 55 migraineurs: duloxetine was administered to 27 and nonactive placebo was provided to 28. Before treatment, participants were assessed for responses to painful stimuli, conditioned pain modulation, and temporal summation of pain. In line with the patient’s estimation of migraine improvement, higher efficacy of duloxetine vs placebo in migraine prevention was observed (duloxetine: 52.3±30.4%; placebo: 26.0±27.3%). In addition, in the duloxetine group, this measure was prognosticated by higher pretreatment pain ratings for tonic heat pain; greater pain sensitivity at baseline prognosticated greater percent of migraine recovery in duloxetine, but not in placebo. Results thereby suggest the possible way of application of personalized medicine to designing appropriate migraine prevention treatment. Performing psychophysical testing can assist in characterizing pronociceptive migraineurs who may benefit more than non–pronociceptive ones from migraine prevention with serotonin-norepinephrine reuptake inhibitors.