Knotkova Helena, Pappagallo Marco
Research Division, Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, Manhattan Campus for the Albert Einstein College of Medicine, New York, NY 10003, USA.
Pain Med. 2007 May-Jun;8(4):383-7. doi: 10.1111/j.1526-4637.2006.00197.x.
Despite recent research advances, the origin of nociception in migraine headaches remains unclear and continues to be a topic of intense examination. Experiments using animal models of dural neurogenic plasma extravasation (DNPE) as an index of meningeal inflammation provided the basis for the meningeal inflammation hypothesis of migraine pain.
We explore the possibility that DNPE can be detected in humans during a migraine attack.
DNPE single photon emission computerized tomography (SPECT) with an intravenous injection of technetium-99m (Tc-99m) human serum albumin (HSA) has been used in a 46-year-old migraine symptomatic patient who met the International Headache Society criteria for episodic migraine. The patient was injected with 10 mCi HSA and imaged by SPECT. A second (delayed) SPECT was done 3 hours later. After 3 days, following complete resolution of her migraine headache, the patient returned for the control SPECT.
All SPECT images were compared with the patient's self-recorded pictorial description of her migraine head pain epicenter. Tc-99m HSA extravasation appeared on the same side and approximately in the same region as the epicenter of the patient's head pain.
This observation suggests the occurrence of intracranial plasma extravasation during migraine attacks. Activity on SPECT scans suggests that tracer extravasation and not hyperemia is responsible for the positive finding.
尽管最近研究取得了进展，但偏头痛性头痛中伤害感受的起源仍不清楚，并且仍然是深入研究的主题。使用硬脑膜神经源性血浆外渗（DNPE）动物模型作为脑膜炎症指标的实验为偏头痛疼痛的脑膜炎症假说提供了基础。
我们探讨在偏头痛发作期间人类是否能检测到DNPE。
对一名46岁符合国际头痛协会发作性偏头痛标准的偏头痛症状患者，采用静脉注射锝-99m（Tc-99m）人血清白蛋白（HSA）的DNPE单光子发射计算机断层扫描（SPECT）。给患者注射10毫居里HSA并通过SPECT成像。3小时后进行第二次（延迟）SPECT检查。3天后，在她的偏头痛完全缓解后，患者返回进行对照SPECT检查。
将所有SPECT图像与患者自行记录的偏头痛头痛震中的图像描述进行比较。Tc-99m HSA外渗出现在与患者头痛震中相同的一侧且大致相同的区域。
这一观察结果提示偏头痛发作期间颅内血浆外渗的发生。SPECT扫描的活性表明，示踪剂外渗而非充血是阳性发现的原因。
