偏头痛发作间期经颅多普勒超声观察及其意义

目的 观察发作间期偏头痛颅内血流动力学及脑血管反应能力。方法 对34例偏头痛发作间期患进行常规经颅多普勒超声（TCD）检查和Muller呼吸抑制实验，以同期30例健康志愿的检查结果作为对照。结果 （1）患组双侧大脑中动脉（MCA）平均血流速度呈轻度增高，血管阻力指数明显下降（P＜0．05）；（2）约1／3患椎基底动脉（VB、BA）有类似改变；（3）患组MCA呼吸抑制指数（BHI）明显增高（P＜0．05）。结论 偏头痛患发作间期颅内血液动力学处于广泛、轻度的异常状态，脑血管的二氧化碳反应性存在缺陷，对其适当干预有可能预防偏头痛发作。     

普通型偏头痛患者的脑血流状态研究

目的：研究普通型偏头痛的脑血管功能状态。方法：对25例普通型偏头痛患者分别在头痛发作期、发作间期进行TCD检查，记录各动脉平均血流速度(MFV)进行统计分析。结果：在偏头痛患者发作间期的颈内动脉系统中，颅内段的平均血流速度明显增高，而颅外段无明显变化；椎-基底动脉系统无明显变化；发作间期双侧半球指数均较发作期明显增高。结论：偏头痛发作间期颅内段颈内动脉系统血管持续性收缩而发作期处于相对扩张状态。     

普通型偏头痛发作期及发作间期TCD对照研究

目的　减少个体差异对脑血流速度的影响,更准确判断偏头痛各期脑血管功能状态。方法　对18例普通型偏头痛患者分别在头痛发作期、发作间期进行TCD检查。结果　发作间期颅内颈内动脉系统平均血流速度(MFV)明显增高;椎-基底动脉系统无明显变化;颅外段颈内动脉不受累及。发作间期双侧半球指数较发作期明显增高。结论　偏头痛发作间期颅内颈内动脉系统血管持续性收缩而发作期处于相对扩张状态。     

偏头痛患者发作间期颅内动脉血流速度变化分析

目的:通过经颅多普勒超声(TCD)检测探究偏头痛患者发作间期颅内动脉血流速度的变化。方法:偏头痛患者20例纳入研究,对所有患者发作间期的大脑前动脉(ACA)、大脑中动脉(MCA)和大脑后动脉(PCA)的平均血流速度(Vm)进行检测。将检测结果与《中国成人TCD正常范围的统计学研究》中的数据和标准进行比较分析。结果:本组偏头痛患者发作间期双侧PCA的Vm低于正常人群(P0.05);双侧MCA、ACA的Vm与正常人群差异无统计学意义(P0.05)。偏头痛患者头痛侧与非头痛侧MCA、ACA和PCA的Vm差异均无统计学意义(均P0.05)。结论:偏头痛患者发作间期PCA的Vm较正常人减低,而ACA及MCA平均血流速度与正常人无明显差异。     

体位改变对重度OSAHS患者颅内血管血流分布的影响及相关分析

目的 研究重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者颅内血管血流分布与睡眠体位的相关分析。方法 选择明确诊断的30例重度OSAHS患者作为实验组,另选择同期排除OSAHS无异常者30例为对照组,比较体位改变对OSAHS患者颅内血管血流分布的影响。结果 与仰卧位相比,OSAHS组侧卧位时大脑中动脉(MCA)和大脑前动脉(ACA)的动脉搏动指数(PI)明显降低,其差异有统计学意义(t=3.95、5.32,P<0.05),且MCA动脉平均血流速度(MFV)明显增高,其差异有统计学意义(P<0.05)。仰卧位呼吸暂停指数(S-AHI)、侧卧位呼吸暂停指数(L-AHI)与对照组MCA的屏气指数(BHI)无统计学意义(P>0.05),S-AHI与重度OSAHS组MCA的BHI值有统计学意义(r=-0.424,P<0.05)。结论 重度OSAHS患者不同体位的颅内MCA和ACA血流灌注存在差异,S-AHI与大脑中动脉的屏气指数(BHI)显著负相关。     

大面积脑梗死的脑血流动力学动态变化与卒中预后的观察

目的探讨大面积脑梗死后颅内血管血流动力学动态变化特点及其与临床预后的关系。方法 64例大面积脑梗死患者根据影像学供血模型分为完全大脑中动脉(MCA)型和MCA皮质型,急性期大面积脑梗死患者,利用床旁经颅彩色多普勒(TCD)于入院当天和1周内隔日1次及第14天动态检测颅内血流情况,通过测定脑底动脉血流速度、搏动指数及血流速度比值(RVACA和RVPCA),观察颅内血管血流动力学变化。应用美国国立卫生研究院卒中量表(NIHSS)及3个月后存活者日常生活活动能力量表(Barthel指数)评分评价脑血流动力学和神经功能变化与临床预后的关系。选取我院健康体检者64例作为对照组。对照组为同期健康体检人群。性别与年龄选取与病例组具有可比性。结果大面积脑梗死病灶侧MCA平均血流速度(Vm)、颈内动脉(ICA)平均血流速度均明显低于对照组(P<0.05),完全MCA型组较MCA皮质型组MCA血流速度明显减慢(P<0.01);完全MCA型与MCA皮质型梗死后动态观察除部分再通外,MCA血流动态变化不明显(P>0.05),NIHSS评分及脉动指数(PI)在第3,5,7天较第1天明显增高(P<0.05),在第3,5,7天比较差异无统计学意义(P>0.05)。结论大面积脑梗死患者可通过床旁TCD动态检测,可评价大面积脑梗死患者的闭塞血管部位,及时发现侧支循环代偿及血管再通情况,评价颅内压动态变化,观察脱水降颅压治疗效果;在完全MCA型患者中,治疗过程中如果存在RVACA和RVPCA增高,且NIHSS评分稳定,往往对脱水剂治疗敏感,预后较好,可以考虑内科保守治疗。     

经颅多普勒检测在门诊偏头痛诊治中的应用

目的探讨偏头痛发作期发作间期的经颅多普勒(TCD)所测颅内血液动力学变化。方法对178例偏头痛患者发作期进行TCD检查。结果偏头痛患者发作期大脑中动脉平均血流速度明显加大,与对照组相比差异有显著性,大脑后动脉血流加速,与对照组相比差异有显著性。提示偏头痛发作期大脑中动脉和大脑后动脉血管痉挛,血流增快。结论偏头痛患者发作期存在广泛的颅内血流动力学异常。     

偏头痛患者TCD和甲襞微循环的改变

目的：探讨偏头痛患者发作间期颅内血管血流动力学与甲襞微循环改变的关系。方法：对５０例偏头痛患者采用经颅多普勒（ＴＣＤ）检测颅内血管血流动力学与甲襞微循环仪检测患者左手无名批甲襞微循环指标。并与健康体检者进行对照分析。结果：偏头痛组患者ＴＣＤ示颅内动脉血流速度增快,并明显高于对照组（Ｐ〈０．０５）。头痛组甲襞微循环也呈相应的微血管狭窄,张力增加,加权积分值也明显高于对照组（Ｐ〈０．０５～０．００１）。结论：偏头痛患者发作间期颅内血管血流动力学异常与甲襞微循环的异常有密切关系。临床上可采用简便、无创的甲襞微循环检测方法。获得人体微循环信息,间接反映颅内血流动力状态,动态地监测患者病情。     

经颅彩色多普勒超声对儿童偏头痛血流动力学的研究

目的 采用经颅多普勒超声(TCD)探讨儿童偏头痛发作期及间歇期颅内动脉的功能状态.方法 对86例发作期偏头痛患者(观察组)和40例健康儿童(对照组)行TCD检查,并进行对照分析.结果 观察组脑动脉血流速度明显高于健康对照组.结论 颅内动脉管壁紧张度增高是偏头痛发作的原因之一.     

彩色多普勒超声及能量图对年龄致脑血管影响的研究

目的应用彩色多普勒超声(CDUS)及能量图(CDE)技术,检测健康成人脑动脉结构及血流动力学参数,研究年龄改变对其影响。方法122例被检者按年龄分三组,分别观察脑动脉颅外段(颈总动脉CCA、颈内动脉ICA、椎动脉VA)和颅内动脉(大脑前动脉ACA、中动脉MCA、后动脉PCA、椎动脉VA、基底动脉BA),并测量CCA的内中膜厚度(IMT)、所有脑动脉的内径和血流动力学参数。结果(一)脑动脉颅外段:①各年龄组成功显示率均100%。②CCA、ICA、VA内径随年龄增长而增宽其IMT随之增厚(p<0.05)。③各血管血流速度随年龄增长而降低(P<0.05),而搏动指数(PI)、阻力指数(RI)随之增高(p<0.05)。(二)颅内动脉:①成功显示率随年龄增长而下降(p<0.05)。②各血管内径、流速随之变小(p<0.05),而搏动指数(PI)、阻力指数(RI)增高(p<0.05)。结论CDUS和CDE技术能实时检测年龄因素导致的脑血管结构和血流动力学的改变,成为脑血管检查的有效方法。     

Interictal and postictal cognitive changes in migraine

The question whether symptom-free migraine patients show cognitive impairments compared to matched control subjects is addressed, and also whether migraine patients show transient cognitive impairments induced by an attack. The Neuropsychological Evaluation System (NES2) was administered once in an interictal period and twice within 30 h after different migraine attacks. Since cognitive impairments could be related to attack duration or severity, cognitive performance was compared during a postictal period after sumatriptan use and during a postictal period after habitual nonvasoactive medication use. Twenty migraineurs without aura, 10 migraineurs with aura, and 30 matched headache-free controls participated in the study. During a headache-free period, migraineurs without aura responded as quickly as controls, while migraineurs with aura were slower than controls during all tasks specifically requiring selective attention. These effects were not aggravated by a preceding migraine attack, irrespective of medication use and attack duration.     

Is Balance Normal in Migraineurs Without History of Vertigo?

Objective.— To investigate by static posturography the occurrence of balance disorder in migraineurs without a history of vertigo during the interictal period.
Background.— The link between migraine and balance disorders has long been known but postural balance in migraineurs without manifest vestibulopathy has been rarely studied.
Methods.— We studied 25 migraineurs and age- and gender-matched controls. With static posturography we measured: (1) postural sway with eyes open or closed on a platform or on foam with 4 different head positions; (2) limits of stability as patients change their center of gravity to reach to 8 different points; (3) tandem walking.
Results.— With eyes open, sway velocity was significantly greater in migraineurs than in controls while standing on a firm surface with head backwards or on a foam surface in all head positions. With eyes closed, sway velocity was significantly greater in migraineurs than in controls only while standing on a foam surface with head backwards or turned sideways.
Migraineurs also had an offset center of gravity alignment in all conditions and their average reaction time and maximal excursions were significantly greater in the limits of stability test. In tandem walking, step width was significantly wider and walk speed was significantly slower in migraineurs.
Conclusion.— Our findings support the notion that there is a slight but significant postural instability in migraineurs and it is of central vestibular origin.     

Effects of medication use on health state in postictal migraineurs

We investigated whether headache-free patients with migraine report a lower health state compared with healthy controls, and whether health state is differently affected during the postattack period after using sumatriptan versus habitual nonvasoactive medication. Mood, health state, and personality questionnaires were administered once during an interictal period and twice within 30 hours after different migraine attacks treated with sumatriptan or habitual nonvasoactive medication. Twenty migraineurs without aura, 10 migraineurs with aura, and 30 matched and headache-free controls participated in this study. During an interictal period, patients with migraine reported more problems regarding social activities and pain compared with healthy controls. During the postictal period, mood (fatigue and emotional state) was negatively affected by an attack that was treated with habitual medication, whereas health state (physical pain, social activities, current pain) was similar to the migraine-free period. Sumatriptan treatment had beneficial effects on aspects of health state and mood during the postictal period.     

No effect of prophylactic treatment with metoprolol on cerebrovascular CO2 reactivity in migraineurs

The prophylactic effect of metoprolol in the treatment of migraine is well known, but its mode of action is still unclear. In the past, increased CO₂ reactivity has been reported as one pathognomic finding in interictal migraineurs. Using transcranial Doppler we assessed CO₂ reactivity in 20 migraineurs before and 3 h after the first intake of 50 mg metoprolol, and subsequently twice after 1 and 8 weeks of continuous therapy with 150 mg metoprolol/d. Before initiation of therapy migraineurs as a group had increased CO₂ reactivity ( p =0.07) compared to 20 age- and sex-matched volunteers. While treatment with metoprolol has been reported to affect amplitudes of increased contingent negative variation or visual evoked potentials in interictal migraineurs, it had no influence on enhanced CO₂ reactivity in the present study. Moreover, the pretreatment value of CO₂ reactivity did not correlate with the clinical efficacy of metoprolol after a 2-month treatment period.     

Gastric stasis in migraine: more than just a paroxysmal abnormality during a migraine attack

OBJECTIVE: The aim of this article is to evaluate gastric motility and emptying in the ictal and interictal period in migraine. BACKGROUND: Nausea is a predominant symptom of migraine and the basis of it is thought to be gastric stasis. Objective methods to establish this are however lacking. We utilized gastric scintigraphy studies to determine gastric motility in the ictal and interictal period of migraine. METHODS: Ten migraine subjects were compared to equal number of age and sex matched controls. Gastric scintigraphy using a standard meal was performed in all control subjects once and in all 10 migraine subjects in the interictal period and nine studies were performed in the ictal period migraine. RESULTS: The time to half emptying was delayed in migraine ictally (78%) and interictal period (80%) using normative data at this institution. Gastric stasis was less pronounced ictally (149.9 minutes) compared to interictal period (188.8 minutes). There was a significant delay compared to nonmigrainous controls (migraine 188.8 minutes vs normal controls 111.8 minutes; P < .05). These data were replicated in percentage of radioactive material remaining in the stomach at 2 hours. CONCLUSIONS: Contrary to previous belief, this study has demonstrated that migraineurs suffer from gastric stasis both during and outside an acute migraine attack. This may suggest that migraineurs may have an abnormal autonomic function compared to nonmigrainous controls. The potential role of this in pathophysiology of migraine is discussed and avenues for further investigations are explored.     

Interictal quantitative EEG in migraine: a blinded controlled study

Abnormal electroencephalography (EEG) in migraineurs has been reported in several studies. However, few have evaluated EEG findings in migraineurs during a time period when neither the last attack nor the next attack may interact with the results. We, therefore, compared interictal EEG in migraineurs and headache-free subjects with a design controlled for interference by pre-ictal changes. Pre-ictal EEG findings in the painful cranial side during the next attack after registration were also investigated. Correlations between clinical variables and EEG are reported as well. Interictal EEGs from 33 migraineurs (6 with and 27 without aura) and 31 controls were compared. Absolute power, asymmetry and relative power were studied for delta, theta and alpha frequency bands in parieto-occipital, temporal and fronto-central areas. EEG variables were correlated to attack frequency, headache duration, attack duration, pain intensity, photo- and phonophobia. Compared with controls, migraineurs had increased relative theta power in all cortical regions and increased delta activity in the painful fronto-central region. Absolute power and asymmetry were similar among groups. In age-adjusted analyses, headache intensity correlated with increased delta activity. In this blinded controlled study, we found globally increased relative theta activity in migraineurs. A slight interictal brain dysfunction is probably present between attacks.     

Ictal and interictal phonophobia in migraine—a quantitative controlled study

The aim of the study was to evaluate quantitatively ictal and interictal phonophobia in episodic migraine (EM). We included subjects with EM and age- and gender-matched controls. Sound stimuli were pure tones at frequencies of 1000, 4000 and 8000 Hz. Sound aversion thresholds (SATs) were determined as the minimal sound intensity perceived as unpleasant or painful. Migraineurs were examined both between and during attacks. We compared interictal SATs in migraineurs with those in controls. We also compared ictal and interictal SATs in migraineurs. Sixty migraineurs and 52 controls were included. Interictal mean SAT of migraineurs, averaged for the three frequencies, was significantly lower than that of controls [90.4 (0.8) dB vs. 105.9 (1.1) dB, respectively, P  < 0.0001]. In migraineurs, mean ictal SAT, averaged for the three frequencies, was significantly lower than interictal SAT [76.0 (0.9) dB vs. 91.0 (0.8) dB, respectively, P  < 0.0001]. Patients with EM exhibit increased sound aversion between attacks that is further augmented during an acute attack.     

Clinical relevance of depressed kynurenine pathway in episodic migraine patients: potential prognostic markers in the peripheral plasma during the interictal period

BackgroundAltered glutamatergic neurotransmission and neuropeptide levels play a central role in migraine pathomechanism. Previously, we confirmed that kynurenic acid, an endogenous glutamatergic antagonist, was able to decrease the expression of pituitary adenylate cyclase-activating polypeptide 1–38, a neuropeptide with known migraine-inducing properties. Hence, our aim was to reveal the role of the peripheral kynurenine pathway (KP) in episodic migraineurs. We focused on the complete tryptophan (Trp) catabolism, which comprises the serotonin and melatonin routes in addition to kynurenine metabolites. We investigated the relationship between metabolic alterations and clinical characteristics of migraine patients.MethodsFemale migraine patients aged between 25 and 50 years (n = 50) and healthy control subjects (n = 34) participated in this study. Blood samples were collected from the cubital veins of subjects (during both the interictal/ictal periods in migraineurs, n = 47/12, respectively). 12 metabolites of Trp pathway were determined by neurochemical measurements (UHPLC-MS/MS).ResultsPlasma concentrations of the most Trp metabolites were remarkably decreased in the interictal period of migraineurs compared to healthy control subjects, especially in the migraine without aura (MWoA) subgroup: Trp (p < 0.025), L-kynurenine (p < 0.001), kynurenic acid (p < 0.016), anthranilic acid (p < 0.007), picolinic acid (p < 0.03), 5-hydroxy-indoleaceticacid (p < 0.025) and melatonin (p < 0.023). Several metabolites showed a tendency to elevate during the ictal phase, but this was significant only in the cases of anthranilic acid, 5-hydroxy-indoleaceticacid and melatonin in MWoA patients. In the same subgroup, higher interictal kynurenic acid levels were identified in patients whose headache was severe and not related to their menstruation cycle. Negative linear correlation was detected between the interictal levels of xanthurenic acid/melatonin and attack frequency. Positive associations were found between the ictal 3-hydroxykynurenine levels and the beginning of attacks, just as between ictal picolinic acid levels and last attack before ictal sampling.ConclusionsOur results suggest that there is a widespread metabolic imbalance in migraineurs, which manifests in a completely depressed peripheral Trp catabolism during the interictal period. It might act as trigger for the migraine attack, contributing to glutamate excess induced neurotoxicity and generalised hyperexcitability. This data can draw attention to the clinical relevance of KP in migraine.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-021-01239-1.     

Endothelial function in patients with migraine during the interictal period

OBJECTIVES: The aim of this study is to evaluate endothelial function in migraineurs subjects during the asymptomatic period. BACKGROUND: Migraine has been proposed as a risk factor for cerebrovascular events. The underlying mechanisms that relate these 2 pathologies are unknown. Nitric oxide (NO) has been proposed as the final causative molecule of migraine. Increased NO metabolites concentrations have been reported in migraineurs subjects during acute migraine attacks, but there is no evidence indicating alterations in endothelial NO release during the symptom free period in theses subjects. DESIGN AND METHODS: Fifty migraineurs subjects and 25 healthy subjects matched by gender and age were included. Every subject underwent a complete examination that included medical history, physical examination, resting electrocardiogram, forearm flow-mediated vasodilation (FMD), blood determinations of fasting nitrates and nitrites (NO(2) (-)+ NO(3) (-)), glucose, lipid profile, creatinine, C-reactive protein, and blood cell count. RESULTS: No differences in FMD or NO(2) (-)+ NO(3) (-) were detected among groups. The only difference between migraineurs and control subjects was a higher mean blood pressure 92.1 (8.8) mmHg versus 86.7 (8.2) mmHg P= .01. CONCLUSION: The endothelial function is not altered during the interictal period in migraineurs subjects.     

Transcranial Doppler Sonography in Headache-Free Migraineurs

SYNOPSIS
We used transcranial Doppler ultrasonography to determine whether intracranial blood velocities in 182 headache-free migraineurs (60 with aura, 122 without aura) differed from velocities in 38 nonheadache prone control subjects. During the headache-free period, migraineurs with and without aura had significantly elevated mean velocities in all intracranial arteries except the right internal carotid artery at the level of the siphon. Velocities in migraineurs with aura did not differ significantly from velocities in those without aura.
Markedly increased velocities were noted in a subset of interictal migraineurs. Two explanations are possible: 1) Blood flow velocities may increase in response to a decrease in the cross sectional area of a vessel st or near the point of insonation. 2) Alterations at the level of the cerebral arteriole may affect regional cerebral blood flow, thereby changing blood flow velocities at the point of insonation. Transcranial Doppler sonography alone cannot sort out which process is responsible for the vascular response.
This work may have therapeutic as well as diagnostic implications. When interictal flow velocities are markedly increased, it is possible that therapeutic agents with vasoconstrictor action might cause an excessive response. Further study is needed to clarify the sites of vasoreactivity as well as the magnitude of drug-induced vasoconstrictor response.