Kallela M, Wessman M, Färkkilä M, Palotie A, Koskenvuo M, Honkasalo M L, Kaprio J
Department of Neurology, University of Helsinki, Finland.
Acta Neurol Scand. 1999 Oct;100(4):254-9. doi: 10.1111/j.1600-0404.1999.tb00390.x.
The aim of the study was to search for clinical differences between migraine with and without aura.
From a population-based Finnish Twin Cohort we studied 51 migraine concordant monozygotic twin pairs.
There were 20 pairs concordant for migraine with aura, 6 pairs concordant for migraine without aura and 12 "mixed" pairs. In the remaining 13 pairs the aura of at least 1 twin could not be classified. All 20 migraine with aura pairs were concordant for visual aura and 19 for moderate or severe headache while all 6 pairs with migraine without aura were concordant for headache duration of 4 to 24 h, moderate or severe headache and nausea. The 12 "mixed" pairs had more often unilateral and pulsating headache compared to both the migraine with or without aura pairs. Overall individual migraine with aura twins had more photophobia (P = 0.032) and the migraine without aura twins more nausea (P = 0.025).
The difference between migraine with and without aura is not explained entirely by genetical factors: 12 genetically identical twin pairs were discordant for the aura. The headache phase in migraine with and without aura is very similar, but not identical. Probably there are several and different liability loci for the migraine aura and the migraine headache. The distribution of these several loci along with acquired factors will decide whether the phenotype is migraine with or without aura.
本研究旨在探寻有先兆偏头痛与无先兆偏头痛之间的临床差异。
我们从芬兰基于人群的双胞胎队列中选取了51对偏头痛一致的同卵双胞胎进行研究。
有20对双胞胎均患有有先兆偏头痛，6对双胞胎均患有无先兆偏头痛，12对为“混合”型。在其余13对双胞胎中，至少有1名双胞胎的先兆症状无法分类。所有20对有先兆偏头痛双胞胎的视觉先兆症状均一致，19对双胞胎的头痛程度为中度或重度；而所有6对无先兆偏头痛双胞胎的头痛持续时间为4至24小时、头痛程度为中度或重度以及恶心症状均一致。与有先兆或无先兆偏头痛双胞胎相比，12对“混合”型双胞胎更常出现单侧搏动性头痛。总体而言，有先兆偏头痛双胞胎个体更常出现畏光症状（P = 0.032），无先兆偏头痛双胞胎个体更常出现恶心症状（P = 0.025）。
有先兆偏头痛与无先兆偏头痛之间的差异并非完全由遗传因素所致：12对基因相同的双胞胎在先兆症状方面不一致。有先兆偏头痛和无先兆偏头痛的头痛阶段非常相似，但并不完全相同。偏头痛先兆症状和偏头痛头痛可能存在多个不同的易感基因位点。这些多个基因位点的分布以及后天因素将决定其表型是有先兆偏头痛还是无先兆偏头痛。
