Jakubowski Moshe, McAllister Peter J, Bajwa Zahid H, Ward Thomas N, Smith Patty, Burstein Rami
Departments of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA Program in Neuroscience, Harvard Medical School, Boston, MA 02115, USA Associate Neurologists of Southern Connecticut, Fairfield, CT, USA Dartmouth-Hitchcock Medical Center, Hanover, NH, USA.
Pain. 2006 Dec 5;125(3):286-295. doi: 10.1016/j.pain.2006.09.012. Epub 2006 Oct 25.
Migraine headache is routinely managed using medications that abort attacks as they occur. An alternative approach to migraine management is based on prophylactic medications that reduce attack frequency. One approach has been based on local intramuscular injections of Botulinum Toxin Type A (BTX-A). Here, we explored for neurological markers that might distinguish migraine patients who benefit from BTX-A treatment (100 units divided into 21 injections sites across pericranial and neck muscles). Responders and non-responders to BTX-A treatment were compared prospectively (n=27) and retrospectively (n=36) for a host of neurological symptoms associated with their migraine. Data pooled from all 63 patients are summarized below. The number of migraine days per month dropped from 16.0+/-1.7 before BTX-A to 0.8+/-0.3 after BTX-A (down 95.3+/-1.0%) in 39 responders, and remained unchanged (11.3+/-1.9 vs. 11.7+/-1.8) in 24 non-responders. The prevalence of aura, photophobia, phonophobia, osmophobia, nausea, and throbbing was similar between responders and non-responders. However, the two groups offered different accounts of their pain. Among non-responders, 92% described a buildup of pressure inside their head (exploding headache). Among responders, 74% perceived their head to be crushed, clamped or stubbed by external forces (imploding headache), and 13% attested to an eye-popping pain (ocular headache). The finding that exploding headache was impervious to extracranial BTX-A injections is consistent with the prevailing view that migraine pain is mediated by intracranial innervation. The amenability of imploding and ocular headaches to BTX-A treatment suggests that these types of migraine pain involve extracranial innervation as well.
偏头痛通常采用在发作时终止发作的药物进行治疗。偏头痛管理的另一种方法是基于预防性药物，这些药物可降低发作频率。一种方法是基于局部肌肉注射A型肉毒杆菌毒素（BTX-A）。在此，我们探索了可能区分从BTX-A治疗中获益的偏头痛患者的神经学标志物（100单位分为21个注射部位，分布于颅周和颈部肌肉）。对BTX-A治疗的反应者和无反应者进行前瞻性（n=27）和回顾性（n=36）比较，观察一系列与其偏头痛相关的神经症状。汇总来自所有63名患者的数据如下。39名反应者每月偏头痛天数从BTX-A治疗前的16.0±1.7降至治疗后的0.8±0.3（下降95.3±1.0%），而24名无反应者则保持不变（11.3±1.9对11.7±1.8）。反应者和无反应者之间先兆、畏光、畏声、畏嗅、恶心和搏动性疼痛的发生率相似。然而，两组对疼痛的描述不同。在无反应者中，92%描述为头部内部压力积聚（爆炸样头痛）。在反应者中，74%感觉头部被外力挤压、夹紧或刺痛（内爆样头痛），13%证实有眼球突出样疼痛（眼性头痛）。爆炸样头痛对颅外BTX-A注射无反应这一发现与偏头痛疼痛由颅内神经支配介导的主流观点一致。内爆样头痛和眼性头痛对BTX-A治疗的敏感性表明，这些类型的偏头痛疼痛也涉及颅外神经支配。
