Cortelli P, Pierangeli G
Department of Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, I-41100 Modena, Italy.
Neurol Sci. 2003 May;24 Suppl 2:S68-70. doi: 10.1007/s100720300045.
The nociceptive and the autonomic nervous systems interact at the levels of the periphery, spinal cord, brainstem, and forebrain. Spinal and visceral afferents provide converging information to spinothalamic neurons in the dorsal horn and to neurons of the nucleus tractus solitarius and parabrachial nuclei. These structures project to areas involved in reflex, homeostatic and behavioral control of autonomic outflow and nociception. Clinical and experimental observations on migraine suggest that a general hyperexcitability could develop along nociceptive trigeminal neurons allowing the activation of descending pathways that facilitate pain processing or the suppression of pathways that slow down pain transmission. Slowly progressive dysfunction of central pain systems secondary to the repetition of attacks of the originating headache has been implicated in transforming the process from an episodic to a chronic condition. This concept of an irritable focus in the central nervous system is currently known as "central sensitization" and is a characteristic feature of visceral pain. Considering primary headache as the result of the interactions between the nociceptive and autonomic systems (visceral pain) can help us to understand the complex pathophysiology of these disorders and to explore new treatments.
伤害性神经系统和自主神经系统在外周、脊髓、脑干和前脑水平相互作用。脊髓和内脏传入神经向背角的脊髓丘脑神经元以及孤束核和臂旁核的神经元提供汇聚信息。这些结构投射到参与自主神经输出和伤害感受的反射、稳态和行为控制的区域。对偏头痛的临床和实验观察表明，伤害性三叉神经元可能会出现普遍的过度兴奋，从而激活促进疼痛处理的下行通路，或抑制减缓疼痛传递的通路。由于原发性头痛发作的反复发生而导致的中枢疼痛系统的缓慢进行性功能障碍，被认为与头痛从发作性转变为慢性状态的过程有关。中枢神经系统中这种易激惹焦点的概念目前被称为“中枢敏化”，是内脏痛的一个特征。将原发性头痛视为伤害性系统和自主神经系统（内脏痛）相互作用的结果，有助于我们理解这些疾病的复杂病理生理学，并探索新的治疗方法。
