Wilmshurst Peter, Nightingale Simon
Department of Cardiology, Royal Shrewsbury Hospital, UK.
Headache. 2006 Mar;46(3):429-34. doi: 10.1111/j.1526-4610.2006.00374.x.
From observation of recent data linking migraine with right-to-left shunts and by analogy with the etiologies of decompression illness, we postulate that cardiac and pulmonary pathology can have an important effect on the cranial final common pathway that generates attacks of migraine. One possible mechanism is associated with a significant right-to-left shunt, which is usually through a persistent foramen ovale, but is sometime through a pulmonary shunt. This allows a venous agent, possibly 5-hydroxytryptamine, to bypass the lung filter. Migraine can occur when there is no shunt if similar agents are liberated in the left heart beyond the lung filter, possibly by platelet activation. Migraine could also occur if the venous agents are produced in such large amounts that they overwhelm the pulmonary filter or are unaffected by passage through the lungs. In some individuals migraine may be unrelated to blood-borne triggers.
通过观察近期将偏头痛与右向左分流联系起来的数据，并类比减压病的病因，我们推测心脏和肺部病理状况可能对引发偏头痛发作的颅内最后共同通路产生重要影响。一种可能的机制与显著的右向左分流有关，这种分流通常通过持续存在的卵圆孔，但有时也通过肺分流。这使得一种静脉介质（可能是5-羟色胺）能够绕过肺部滤器。如果类似介质在左心超过肺部滤器处释放（可能通过血小板激活），即使没有分流也可能发生偏头痛。如果静脉介质大量产生以至于超过肺部滤器或不受通过肺部的影响，也可能发生偏头痛。在一些个体中，偏头痛可能与血源性触发因素无关。
