Shinoura Nobusada, Yamada Ryozi
Departments of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-Komagome, Bunkyo-ku, Tokyo 113-8677, Japan.
Clin Neurophysiol. 2005 Jun;116(6):1280-5. doi: 10.1016/j.clinph.2005.01.016. Epub 2005 Mar 28.
Several studies have reported changes in cerebrovascular reactivity during the interictal period of migraine. To characterize mechanisms of migraine, we compared changes in total haemoglobin (THbl) and regional oxygen saturation (rSO(2)) of the right and left frontal lobes in response to intracranial pressure changes during the interictal period of migraine.
Twelve right-handed migraineurs without aura and twelve age- and sex-matched healthy volunteers were asked to perform a head-down maneuver to increase intracranial venous pressure. Initial THbl was designated as 1.0, and all subsequent THbl measurements, which was proportional to the change in cerebral blood flow, were expressed as a value relative to this baseline.
The head-down maneuver resulted in a significantly smaller increase in right-sided THbl in migraineurs when compared to volunteers (migraineurs, -0.1+/-0.04; volunteers, 30+/-13; P=0.027), but there was no significant difference in left-sided THbl when comparing migraineurs and volunteers. Further, the head-down maneuver produced a significantly smaller increase in right-sided THbl than in left-sided THbl in migraineurs (right side, -0.1+/-0.04; left side, 0.35+/-0.08; P<0.0001), but produced a significantly greater increase in right-sided THbl than in left-sided THbl in volunteers (right side, 30+/-13; left side, 0.44+/-0.13; P=0.030). The head-down maneuver resulted in a smaller decrease in right-sided rSO(2) in migraineurs when compared to volunteers (migraineurs, -4.1+/-2.2%; volunteers, -16+/-9.1%), but produced a significantly greater decrease in left-sided rSO(2) in migraineurs when compared to volunteers (migraineurs, -1.3+/-1.1%; volunteers, 2.8+/-0.63%; P=0.0037).
These data indicate that pressure-related vasoreactivity is suppressed in the right hemisphere of migraineurs during the interictal period.
The suppression of vasoreactivity in the right hemisphere might be related to the pathogenesis of migraine.
多项研究报道了偏头痛发作间期脑血管反应性的变化。为了阐明偏头痛的机制，我们比较了偏头痛发作间期偏头痛患者和年龄、性别匹配的健康志愿者在颅内压变化时左右额叶总血红蛋白（THbl）和局部氧饱和度（rSO₂）的变化。
12名无先兆的右利手偏头痛患者和12名年龄、性别匹配的健康志愿者被要求进行头低位动作以增加颅内静脉压。初始THbl设定为1.0，所有随后与脑血流量变化成比例的THbl测量值均表示为相对于该基线的数值。
与志愿者相比，偏头痛患者头低位动作时右侧THbl的增加显著较小（偏头痛患者，-0.1±0.04；志愿者，30±13；P=0.027），但比较偏头痛患者和志愿者时左侧THbl无显著差异。此外，偏头痛患者头低位动作时右侧THbl的增加显著小于左侧THbl（右侧，-0.1±0.04；左侧，0.35±0.08；P<0.0001），但志愿者头低位动作时右侧THbl的增加显著大于左侧THbl（右侧，30±13；左侧，0.44±0.13；P=0.030）。与志愿者相比，偏头痛患者头低位动作时右侧rSO₂的降低较小（偏头痛患者，-4.1±2.2%；志愿者，-16±9.1%），但偏头痛患者头低位动作时左侧rSO₂的降低显著大于志愿者（偏头痛患者，-1.3±1.1%；志愿者，2.8±0.63%；P=0.0037）。
这些数据表明，偏头痛发作间期偏头痛患者右半球与压力相关的血管反应性受到抑制。
右半球血管反应性的抑制可能与偏头痛的发病机制有关。
