Peroutka Stephen J
Headache. 2004 Jan;44(1):53-64. doi: 10.1111/j.1526-4610.2004.04011.x.
To determine the degree of diagnostic and clinical similarity between chronic sympathetic nervous system disorders and migraine.
Migraine is an episodic syndrome consisting of a variety of clinical features that result from dysfunction of the sympathetic nervous system. During headache-free periods, migraineurs have a reduction in sympathetic function compared to nonmigraineurs. Sympathetic nervous system dysfunction is also the major feature of rare neurological disorders such as pure autonomic failure and multiple system atrophy. There are no known reports in the medical literature, however, comparing sympathetic nervous system function in individuals with migraine, pure autonomic failure, and multiple system atrophy.
A detailed review of the literature was performed to compare the results of a wide variety of diagnostic tests and clinical signs that have been described in these 3 heretofore unrelated disorders.
The data indicate that migraine shares significant diagnostic and clinical features with both pure autonomic failure and multiple system atrophy, yet represents a distinct subtype of chronic sympathetic dysfunction. Migraine is most similar to pure autonomic failure in terms of reduced supine plasma norepinephrine levels, peripheral adrenergic receptor supersensitivity, and clinical symptomatology directly related to sympathetic nervous system dysfunction. The peripheral sympathetic nervous system dysfunction is much more severe in pure autonomic failure than in migraine. Migraine differs from both pure autonomic failure and multiple system atrophy in that migraineurs retain the ability, although suboptimal, to increase plasma norepinephrine levels following physiological stressors.
The major finding of the present study is that migraine is a disorder of chronic sympathetic dysfunction, sharing many diagnostic and clinical characteristics with pure autonomic failure and multiple system atrophy. However, the sympathetic nervous system dysfunction in migraine differs from pure autonomic failure and multiple system atrophy in that occurs in an anatomically intact system. It is proposed that the sympathetic dysfunction in migraine relates to an imbalance of sympathetic co-transmitters. Specifically, it is suggested that a migraine attack is characterized by a relative depletion of sympathetic norepinephrine stores in conjunction with an increase in the release of other sympathetic cotransmitters such as dopamine, prostaglandins, adenosine triphosphate, and adenosine. An enhanced understanding of the sympathetic dysfunction in migraine may help to more effectively diagnose, prevent, and/or treat migraine and other types of headache.
确定慢性交感神经系统疾病与偏头痛之间的诊断及临床相似程度。
偏头痛是一种发作性综合征，由交感神经系统功能障碍导致的多种临床特征组成。在无头痛发作期间，偏头痛患者相较于非偏头痛患者交感神经功能有所下降。交感神经系统功能障碍也是诸如单纯自主神经功能衰竭和多系统萎缩等罕见神经系统疾病的主要特征。然而，医学文献中尚无关于比较偏头痛患者、单纯自主神经功能衰竭患者和多系统萎缩患者交感神经系统功能的报道。
对文献进行详细回顾，以比较在这三种此前互不相关的疾病中所描述的各种诊断测试结果及临床体征。
数据表明，偏头痛与单纯自主神经功能衰竭和多系统萎缩均具有显著的诊断及临床特征，但代表了慢性交感神经功能障碍的一种独特亚型。在仰卧位血浆去甲肾上腺素水平降低、外周肾上腺素能受体超敏以及与交感神经系统功能障碍直接相关的临床症状方面，偏头痛与单纯自主神经功能衰竭最为相似。单纯自主神经功能衰竭中外周交感神经系统功能障碍比偏头痛严重得多。偏头痛与单纯自主神经功能衰竭和多系统萎缩的不同之处在于，偏头痛患者尽管效果欠佳，但在生理应激源作用后仍保留增加血浆去甲肾上腺素水平 的能力。
本研究的主要发现是，偏头痛是一种慢性交感神经功能障碍性疾病，与单纯自主神经功能衰竭和多系统萎缩有许多诊断及临床特征相同。然而，偏头痛中的交感神经系统功能障碍与单纯自主神经功能衰竭和多系统萎缩不同，它发生在解剖结构完整的系统中。有人提出，偏头痛中的交感神经功能障碍与交感神经共递质失衡有关。具体而言，有人认为偏头痛发作的特征是交感去甲肾上腺素储备相对耗竭，同时其他交感共递质如多巴胺、前列腺素、三磷酸腺苷和腺苷的释放增加。对偏头痛中交感神经功能障碍的深入了解可能有助于更有效地诊断、预防和/或治疗偏头痛及其他类型的头痛。
