Boes Christopher J, Black David F, Dodick David W
Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Semin Neurol. 2006 Apr;26(2):232-41. doi: 10.1055/s-2006-939924.
There is considerable overlap in the mechanisms mediating migraine headache pain and sustained opioid-induced paradoxical pain. Both involve upregulation of calcitonin gene-related peptide and increased excitability of dorsal horn neurons. Descending facilitation from the rostral ventromedial medulla may contribute to this increased excitability. Using special magnetic resonance imaging techniques, high iron levels were found in the periaqueductal gray of patients with chronic daily headache with medication overuse. The periaqueductal gray is the center of a powerful descending antinociceptive neuronal network and projects to the rostral ventromedial medulla and subsequently to the dorsal horn. The periaqueductal gray is also involved in the behavioral response to opiate withdrawal. Dysfunction in the periaqueductal gray may explain why frequent analgesic use can result in medication overuse headache in migraineurs. Management of transformed migraine with medication overuse involves patient education, biobehavioral therapy, withdrawal of overused acute medications, bridge therapy for withdrawal headache, initiation of preventive medication, and close follow-up.
介导偏头痛性头痛疼痛和阿片类药物持续诱导的反常性疼痛的机制存在相当大的重叠。两者都涉及降钙素基因相关肽的上调和背角神经元兴奋性的增加。来自延髓头端腹内侧的下行易化可能促成了这种兴奋性增加。使用特殊的磁共振成像技术，在药物过度使用性慢性每日头痛患者的导水管周围灰质中发现了高铁水平。导水管周围灰质是一个强大的下行抗伤害感受神经元网络的中心，并投射到延髓头端腹内侧，随后投射到背角。导水管周围灰质也参与对阿片类药物戒断的行为反应。导水管周围灰质功能障碍可能解释了为什么频繁使用镇痛药会导致偏头痛患者出现药物过度使用性头痛。药物过度使用性转化型偏头痛的管理包括患者教育、生物行为疗法、停用过度使用的急性药物、针对戒断性头痛的过渡治疗、开始预防性用药以及密切随访。
