Silvestrini Mauro, Baruffaldi Roberto, Bartolini Marco, Vernieri Fabrizio, Lanciotti Chiara, Matteis Maria, Troisi Elio, Provinciali Leandro
Neurological Clinic, University of Ancona, Torrette di Ancona, Italy.
Headache. 2004 Jan;44(1):29-34. doi: 10.1111/j.1526-4610.2004.04006.x.
Migraine has been reported as a possible risk factor for ischemic stroke. The mechanisms underlying this association are unknown.
To evaluate cerebrovascular reactivity to hypercapnia in the anterior and posterior circulation of patients with migraine, as reduced cerebrovascular reactivity is associated with a predisposition to stroke in various clinical conditions.
Using transcranial Doppler ultrasonography, changes in flow velocity during apnea were measured in both middle cerebral arteries and in the basilar artery of 15 control subjects and 30 patients with migraine (15 with aura and 15 without aura) during an attack-free period. Cerebrovascular reactivity was evaluated using the breath-holding index, which is calculated by dividing the percent increase in mean flow velocity recorded during a breath-holding episode by its duration (in seconds) after a normal inspiration.
Vascular reactivity in the middle cerebral arteries was similar in patients and controls and significantly lower in the basilar artery of patients with migraine with aura compared with the other 2 groups (P <.0001).
These findings show that in patients with migraine with aura, there is an impairment in the adaptive cerebral hemodynamic mechanisms in the posterior circulation. This fact could have pathogenetic implications since the association between migraine and stroke frequently regards patients with migraine with aura, and cerebral infarcts occur more commonly in the vertebrobasilar district.
偏头痛已被报道为缺血性卒中的一个可能危险因素。这种关联背后的机制尚不清楚。
评估偏头痛患者前循环和后循环对高碳酸血症的脑血管反应性，因为在各种临床情况下，脑血管反应性降低与卒中易感性相关。
在15名对照受试者和30名偏头痛患者（15名有先兆和15名无先兆）的发作间期，使用经颅多普勒超声测量在屏气期间大脑中动脉和基底动脉的血流速度变化。使用屏气指数评估脑血管反应性，该指数通过将屏气期间记录的平均血流速度增加百分比除以正常吸气后其持续时间（以秒为单位）来计算。
患者和对照者大脑中动脉的血管反应性相似，与其他两组相比，有先兆偏头痛患者的基底动脉血管反应性显著降低（P <.0001）。
这些发现表明，有先兆偏头痛患者后循环中的适应性脑血流动力学机制存在损害。这一事实可能具有发病学意义，因为偏头痛与卒中之间的关联通常涉及有先兆偏头痛患者，并且脑梗死在椎基底动脉区更常见。
