偏头痛非头痛症状的发病机制及药物干预

偏头痛是一种临床常见的慢性神经血管性疾患,其发生机制尚不明确,其中与其非头痛症状发生有关的有皮质扩散性抑制、视网膜感光通路调节及下丘脑调节等.偏头痛常伴发心脑血管疾病、精神疾病及癫痫发作等.同时,偏头痛药物可同时干预偏头痛的先兆、头痛及非头痛症状,包括Ca2+通道阻断剂、麦角碱类、β-受体阻断剂、曲坦类、止吐剂、抗抑郁药及抗癫痫药等.     

睡眠相关性头痛

睡眠相关性头痛是指在睡眠期间发生的头痛。头痛常突然出现，持续时间短，疼痛消失后，患继续入睡，并且可能于数小时后被后续的头痛再次惊醒。睡眠相关性头痛类型包括经典性偏头痛、有先兆的偏头痛、普通型偏头痛、无先兆的偏头痛、丛集性偏头痛、慢性阵发性偏头痛（chronic paroxysmal hemicrania，CPH）、非特异性偏头痛、夜间发作性偏头痛（夜发性头痛）、血管性头痛以及晨间头痛；紧张型头痛不包括在睡眠相关性头痛之列。睡眠相关性丛集性偏头痛、慢性阵发性偏头痛以及睡眠相关性偏头痛均为严重的、主要表现为单侧性的头痛，其发生常始于睡眠中。     

丛集性头痛患者内分泌功能的检测

目的 通过检测丛集性头痛（CH）患者的内分泌功能探讨CH的发病机制。方法 采用放射免疫分析法检测了26例CH患者（CH组）在丛集期和缓解期血清睾酮（T）、雌二醇（E2）、催乳激素（PRL）以及生长激素（GH）水平,并与25例正常对照者（NC组）及18例偏头痛患者（MC组）进行比较。结果 （1）CH患者在丛集期血清T、GH、E2、PRL水平较NC组和MC组明显降低。其中男性患者血清T、E2、PRL水平与NC组和MC组比较具有高度显著性差异（P＜0．01）;女性患者血清T、E2、PRL水平及所有患者血清GH水平与NC组和MC比较有显著差异（＜0．05）。（2）CH患者缓解期血清T、GH、E2、PRL水平与NC组和MC组比较,差异不明显（P＞0．05）。（3）CH患者丛集期与缓解期血清T、GH、E2、PRL水平比较,差异不明显（P＞0．05）。结论 CH丛集期内分泌功能明显降低,结合临床特点,提示下丘脑功能改变作为起步机制在丛集性头痛发作中起重要作用。     

偏头痛和其他头痛综合征的分类

介绍ICD-NA的头痛分类,以及部分头痛的诊断标准.     

儿童偏头痛51例临床分析

偏头痛是小儿科最常见的慢性复发性头痛。当今社会竞争日趋激烈,繁重的学业压力、快速的生活节奏和严重的睡眠不足,使小儿偏头痛的病例不断增加。偏头痛多为学龄儿童,平均发病年龄6岁左右,10岁以前发病率男略多于女,青春期(12岁以后)女性发病率高于男性。2008-03~2010-05我科接诊偏头痛患者51例,现对这组病例的发病特点及治疗总结和分析如下。     

偏头痛伴发的皮肤痛觉超敏

皮肤痛觉超敏( cutaneous allodynia,CA)是指非伤害性刺激(如冷、热、机械刺激)作用于正常皮肤引起的疼痛[1].高达53.5％ ～ 73.0％的成年偏头痛患者可在头痛发作过程中或头痛后24 h ～ 48 h内出现CA[2-5],在18岁以下儿童和青少年偏头痛患者中发生率为14.5％～ 37.3％[6-7].CA与偏头痛发作有着密切关系,其发生机制不明,可能涉及中枢致敏[1,8].本文对CA的临床特点及相关的发病机制做一综述.     

偏头痛发病机制的研究进展

偏头痛是一种临床常见的慢性神经血管性疾患,年患病率女性为3．3％～32．6％,男性为0．7％～16．1％。世界卫生组织发布的2001年世界卫生报告将常见疾病按健康寿命损失年进行排列,偏头痛位列前20位。本病反复发作迁延难愈,其发病机制至今尚未完全阐明。     

头痛严重程度对偏头痛患者生活质量的影响

目的 探讨头痛严重程度对偏头痛患者生活质量的影响.方法 根据头痛严重程度将84例偏头痛患者分为轻、中、重度3组,采用生活质量综合评定问卷-74(GQOLI-74)对患者进行测试.结果 轻、中、重度3组偏头痛患者在躯体不适感、进食功能、工作与学习、婚姻与家庭方面评分的平均值差异均有统计学意义(均P＜0.05),其余牛活质...     

Relationship between non-headache symptoms and right to left shunt in episodic migraine. A single-center cross-sectional study

The relationship between right to left shunt (RLS) and non-headache symptoms (NHS) in episodic migraine is unknown. This study aimed to investigate the incidence and classification of RLS in episodic migraineurs, calculate the occurrence rate of NHS, and analyze the associations between RLS and NHS. We consecutively recruited 204 episodic migraine patients. Contrast-enhanced transcranial doppler was adopted to screen RLS. Structured questionnaire via face-to-face survey was conducted to collect clinical data. A total of 172 episodic migraineurs were included in the final analysis, of which 20 cases were migraine with aura. The positive rate of RLS was 47.1%, of which 50 cases (29.0%) had small shunt (Grade 1) and 31 cases (18.1%) had mid-large shunt (Grade 2–4). The most common NHS was nausea (115 (66.9%)), followed by headache aggravation with physical activity (96 (55.8%)), dizziness (93 (54.1%)), vomiting (77 (44.8%)) and phonophobia (74 (43.0%)). Yawning was more common in Grade 2–4 group than Grade 0 group (p = 0.012), while no statistical differences among other groups. Grade 2–4 group had a higher rate of headache aggravation with physical activity than grade 0 group (p = 0.008). Binary logistic regression analysis showed that yawning at premonitory phase, headache aggravation with physical activity and cranial autonomic symptoms during attack are independent predictors of RLS. In conclusion, yawning and headache aggravation with physical activity are more common in migraine patients with RLS. Besides aura, particular NHS may also serve as indicators for screening RLS in episodic migraineurs.     

偏头痛前驱症状的生物学内涵

近年来,偏头痛前驱期因其可能的头痛预测作用及早期头痛干预机会为人所重视.打呵欠、疲乏、颈强直、感知觉超敏症状(畏光、畏声、畏嗅)均是常见的偏头痛前驱症状.然而,关于偏头痛前驱症状的预测效能及其可能机制,目前结论尚未统一.偏头痛前驱症状可分为感知觉超敏症状、睡眠及认知相关症状、自主神经症状和其他症状.前驱症状与触发因素及偏头痛伴随症状的准确区分,目前仍未达成统一.疲乏、情绪变化、颈强直是青少年期患者常见的前驱症状.目前对偏头痛前驱症状的病理生理机制研究仍处于初步阶段.打呵欠是偏头痛具有预测意义的前驱症状之一,通常认为与多巴胺能神经元改变密切相关,在偏头痛病理生理中,可由多巴胺能D1、D2、D3受体介导.颈强直是偏头痛常见前驱症状,与多巴胺、5-羟色胺能神经元激活有关.下丘脑在偏头痛前驱期激活,可能是导致前驱期颈强直的重要原因.恶心作为偏头痛患者常见前驱症状,其病理生理学起源仍存在争议.目前的研究表明,前驱期恶心与5-羟色胺代谢改变有关.感知觉超敏症状包括皮肤异常性疼痛和畏光、畏声、畏嗅,在前驱期中丘脑激活已被证实与皮肤异常性疼痛和畏光相关.     

200例偏头痛患者急性发作期的经颅多普勒超声（TCD）检测及相关因素分析

目的探讨经颅多普勒超声（TCD）对偏头痛急性发作期的检测意义。方法将200例偏头痛患者按不同年龄段分成5组,在急性发作期进行TCD检测血流速度。结果偏头痛患者不同年龄段急性发作期脑血流速度和正常人血流速度与同名动脉比较,偏头痛患者MCA及PCA、VA血流速度和正常人血流速度比较有显著性差异（P〈0．05）。偏头痛患者TCD检测的总体表现脑血管血流速度增快。有先兆偏头痛与无先兆偏头痛的2组血流速度比较不明显（P〉0．05）。结论TCD能敏感地反映偏头痛患者在急性发作期颅脑血管舒缩功能及其血流动力学变化情况,TCD检测结果可作为偏头痛患者急性发作期的诊断依据。     

糖酵解抑制剂2-DG改善大鼠偏头痛模型的偏头痛样症状

目的 探讨偏头痛实验模型中糖酵解的作用。方法 通过硬脑膜灌输炎性汤建立偏头痛实验模型; 2-脱氧-D-葡萄糖(2-Deoxy-D-glucose,2-DG)用于抑制糖酵解; 治疗效果通过挠头次数和机械痛阈评定; 通过动物行为学、蛋白免疫印迹、免疫荧光等方法检测糖酵解抑制剂2-DG对炎性汤诱导的机械异常性疼痛、降钙素基因相关肽(Calcitonin gene related peptide,CGRP)、即刻早期基因(c-Fos)和促炎因子表达水平的影响。结果 糖酵解抑制剂2-DG可改善偏头痛实验模型中的偏头痛样症状,减少促炎因子的释放,并降低CGRP和c-Fos的表达水平。结论 糖酵解抑制剂对c-Fos,CGRP、炎症因子释放和偏头痛样症状缓解的影响表明增强的糖酵解可能是实验性偏头痛的发病机制; 糖酵解抑制可能是偏头痛治疗的新靶点。     

Accompanying symptoms and psychiatric comorbidity in migraine and tension-type headache patients

OBJECTIVE: Our objective was to assess the prevalence of accompanying symptoms of migraine and tension-type headache in patients with such conditions (both episodic and chronic) and in headache-free controls, and their relationship with depression and anxiety. METHOD: A psychological assessment (Axis I, DSM-IV) was performed, and 21 accompanying symptoms were investigated in 506 patients with episodic migraine (231), chronic migraine (102), episodic tension-type headache (83), and chronic tension-type headache (90) and in 80 controls. The relationship between symptoms, headache type, and psychiatric comorbidity was analyzed. RESULTS: The mean number of symptoms was significantly higher in patients (n=10.3) than in controls (n=3.4). Most symptoms were significantly associated with depression and anxiety, while only some of them were significantly associated with headache, with no relevant difference among groups. CONCLUSION: In headache patients, psychiatric comorbidity (compared with headache type or chronicity) seems to be more strictly associated with an increased burden of accompanying symptoms.     

Visual symptoms in epilepsy and migraine: localization and patterns

PURPOSE: To clarify differences in the localization of visual symptom patterns in epilepsy and migraine, we analyzed patient-generated illustrations of visual symptoms. METHODS: Patients were asked to draw their visual symptoms from memory using marker pens of 12 colors. All patients illustrated their symptoms on a template sheet representing the binocular visual field. We analyzed a total of 67 illustrations from 54 patients aged 6-40 years: 28 with epilepsy, 23 with migraine, and 3 with migraine-epilepsy syndrome. RESULTS: With respect to positive visual manifestations, those of epileptic patients were predominantly centrally localized (20 of 24, 83%), whereas those of migraine patients were predominantly peripherally localized (10 of 13, 77%) (p < 0.0001). With respect to negative visual symptoms, those in epilepsy were commonly diffuse (10 of 14, 71%) compared with those in migraine, which were peripheral (9 of 12, 75%) (p < 0.05). CONCLUSIONS: Results of this study suggest that the localization of visual symptoms differs between epilepsy and migraine.     

偏头痛患者的rCBF和TCD研究

采用＾１３３氙吸入法测量局部大脑血流量（ｒＣＢＦ）和经颅多普勒超声（ＴＣＤ），对６４例固定一侧偏头痛患者进行了ｒＣＢＦ及脑大动脉的最大平均血流速度（ＭＦＶ）、脉动指数（ＰＩ）联合研究。研究结果倾向该症血流变化为交感－末梢动脉阻力调节紊乱学说，而不支持ＭＣＡ扩张２０％的推理。     

偏头痛患者血浆一氧化氮和降钙素基因相关肽含量测定及发病机制探讨

目的探讨一氧化氮（ＮＯ）和降钙素基因相关肽（ＣＧＲＰ）在偏头痛发病机制中的作用。方法采用分光光度法和放免法,对偏头痛发作期２６例、间歇期２３例,其他头痛患者２７例及正常人２０例颈静脉（ＥＪＶ）和肘静脉（ＣＦ）血中ＮＯ和ＣＧＲＰ进行了测定。结果偏头痛发作组ＥＪＶ和ＣＦ血中ＮＯ含量均较正常人显著升高（Ｐ均＜０．０１）;偏头痛发作组ＥＪＶ血中ＣＧＲＰ含量明显升高（Ｐ＜０．０１）,而ＣＦ血中两组间无显著差异（Ｐ＞０．０５）。结论ＮＯ和ＣＧＲＰ在偏头痛的发病机制中起重要作用。     

Persistent ocular motor disturbances in migraine without aura

Abstract. Activation in the brain stem during attacks of migraine has been detected with the use of functional imaging, suggesting an important role of the brain stem in this disorder. Recent findings showed permanent cerebellar signs in common forms of migraine. Both structures are involved in generating smooth pursuit eye movements. The aim of this study was to investigate migraine patients by electrooculography to identify persisting abnormalities that may provide a clinical sign of continuous dysfunction of these structures. We investigated 25 patients with migraine without aura and 15 controls. Smooth pursuit was pathologically changed, velocity gain was reduced and phase was significantly altered in migraineurs as compared to controls. The data provide clinical evidence of a persistent dysfunction in the brain stem and certain cerebellar structures in migraine patients. This is consistent with previous studies indicating an important role of the brain stem in generating migraine attacks.     

Topiramate in migraine prophylaxis: a randomised double-blind versus placebo study

Abstract The objectives of this paper are to evaluate the efficacy and tolerability of topiramate, given at the dose of 100 mg/day, in the prophylactic treatment of migraine. The hypothesis that migraine is the result of a condition of neuronal hyperexcitability and the quest for drugs that are able to limit the number of crises justifies the attempt to utilise the new antiepileptic drugs in the prophylaxis of this pathology, which is so important due to its high prevalence and due to the high disability it causes. The study was randomised double-blind versus placebo, lasting 16 weeks, and was preceded by a run-in period of 4 weeks. One hundred and fifteen patients were randomly allocated to treatment with topiramate (TPM) or placebo: 35 patients completed the study in the TPM group and 37 patients in the placebo group. At the end of the double-blind phase of study, in the TPM group, we recorded a significant reduction in the frequency of migraine crises (from 5.26 at baseline to 2.60 in the last 4 weeks), a significant reduction in the quantity of symptomatic drugs taken as compared to the placebo control group (from 6.17±1.80 SD to 2.57±0.80) and a significant downward trend in the number of days of disability over the 16-week period of therapy. In the TPM group, side effects were transient and well tolerated. TPM has thus proven its efficacy and tolerability in the prophylaxis of migraine.