Datta Soumitra Shankar, Kumar Sudhir
Department of Psychiatry, Royal Cornhill Hospital, Aberdeen, UK.
Neurol India. 2006 Jun;54(2):205-6.
We report a 19-year-old man presenting to the department of Psychiatry for the evaluation of prominent behavioral symptoms associated with episodic headaches, with normal inter-episodic periods. A diagnosis of classic migraine with hypomanic aura was made. Other possible co-morbid or causative illnesses were excluded and preventive therapy with valproate was started due to the prominent affective symptoms as a part of the migranous aura. With this the frequency of headaches gradually decreased over the next four months. He was followed up for 2 years when he was found to be symptom-free. Recent research into the mechanisms of migraine has identified that the cortical hyperexcitability and an imbalance between neuronal inhibition and excitement mediated by gamma-aminobutyric acid and excitatory amino acids respectively may be the underlying mechanism. The high rate of affective disorders in patients with migraine, association of migraine with an aura comprising of mood symptoms and good response to treatment with mood-stabilisers might give newer insights into the pathophysiology of mood disorder as well.
我们报告了一名19岁男性，因发作性头痛伴突出行为症状前来精神科就诊，发作间期正常。诊断为伴有轻躁狂先兆的典型偏头痛。排除了其他可能的共病或致病疾病，由于作为偏头痛先兆一部分的突出情感症状，开始使用丙戊酸盐进行预防性治疗。此后，头痛频率在接下来的四个月逐渐降低。对他进行了2年的随访，发现他无症状。最近对偏头痛机制的研究表明，皮层兴奋性过高以及分别由γ-氨基丁酸和兴奋性氨基酸介导的神经元抑制与兴奋之间的失衡可能是其潜在机制。偏头痛患者情感障碍的高发生率、偏头痛与包含情绪症状的先兆的关联以及对情绪稳定剂治疗的良好反应，可能也会为情绪障碍的病理生理学提供新的见解。
