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偏头痛疼痛和紧张多种触发因素的单一假说。

Unitary hypothesis for multiple triggers of the pain and strain of migraine.

作者信息

Burstein Rami, Jakubowski Moshe

机构信息

Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115, USA.

出版信息

J Comp Neurol. 2005 Dec 5;493(1):9-14. doi: 10.1002/cne.20688.

Abstract

Migraine headache is triggered by and associated with a variety of hormonal, emotional, nutritional, and physiological changes. The perception of migraine headache is formed when nociceptive signals originating in the meninges are conveyed to the somatosensory cortex through the trigeminal ganglion, medullary dorsal horn, and thalamus. Is there a common descending pathway accounting for the activation of meningeal nociceptors by different migraine triggers? We propose that different migraine triggers activate a wide variety of brain areas that impinge on parasympathetic neurons innervating the meninges. According to this hypothesis, migraine triggers such as perfume, stress, or awakening activate multiple hypothalamic, limbic, and cortical areas, all of which contain neurons that project to the preganglionic parasympathetic neurons in the superior salivatory nucleus (SSN). The SSN, in turn, activates postganglionic parasympathetic neurons in the sphenopalatine ganglion, resulting in vasodilation and local release of inflammatory molecules that activate meningeal nociceptors. Are there ascending pathways through which the trigeminovascular system can induce the wide variety of migraine symptoms? We propose that trigeminovascular projections from the medullary dorsal horn to selective areas in the midbrain, hypothalamus, amygdala, and basal forebrain are functionally positioned to produce migraine symptoms such as irritability, loss of appetite, fatigue, depression, or the quest for solitude. Bidirectional trafficking by which the trigeminovascular system can activate the same brain areas that have triggered its own activity in the first place provides an attractive network of perpetual feedback that drives a migraine attack for many hours and even days.

摘要

偏头痛由多种激素、情绪、营养和生理变化引发并与之相关。当源自脑膜的伤害性信号通过三叉神经节、延髓背角和丘脑传递至躯体感觉皮层时,偏头痛的感觉就形成了。是否存在一条共同的下行通路来解释不同偏头痛触发因素对脑膜伤害感受器的激活作用?我们提出,不同的偏头痛触发因素会激活多种脑区,这些脑区会影响支配脑膜的副交感神经元。根据这一假说,诸如香水、压力或醒来等偏头痛触发因素会激活多个下丘脑、边缘系统和皮层区域,所有这些区域都含有投射到上涎核(SSN)节前副交感神经元的神经元。SSN继而激活蝶腭神经节中的节后副交感神经元,导致血管舒张和炎症分子的局部释放,从而激活脑膜伤害感受器。是否存在上行通路,通过这些通路三叉神经血管系统能够诱发各种各样的偏头痛症状?我们提出,从延髓背角到中脑、下丘脑、杏仁核和基底前脑的选择性区域的三叉神经血管投射在功能上能够产生诸如易怒、食欲不振、疲劳、抑郁或寻求独处等偏头痛症状。三叉神经血管系统的双向传输能够激活最初引发其自身活动的相同脑区,这提供了一个有吸引力的永久反馈网络,可驱动偏头痛发作持续数小时甚至数天。

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