Drummond P D
Psychology Section, Murdoch University, Western Australia.
Headache. 1991 Nov;31(10):669-72. doi: 10.1111/j.1526-4610.1991.hed3110669.x.
Pupil diameter was measured during the headache-free interval in 38 migraine sufferers selected from the general community. In each case, at least 70 percent of attacks recurred on the same side. Anisocoria was greater than in 40 control subjects, but miosis was not consistently greater on the usual side of headache. Average pupil diameter was similar in migraine sufferers and controls. In patients with pupillary dilation lag on the usual side of headache, miosis persisted after 4% cocaine eyedrops. These findings suggest that cervical sympathetic outflow was lower on the usual side of headache in a subgroup of migraine sufferers. Pupillary dilatation to tyramine eyedrops was greater in control subjects than in migraine sufferers, consistent with decreased function of post-ganglionic cervical sympathetic fibres. Pupillary dilatation to 1% phenylephrine eyedrops did not differ consistently between the headache and headache-free sides, and was similar in migraine sufferers and controls. Thus, adrenergic supersensitivity of the pupils was not evident in this community sample of migraine sufferers. Vasodilatation or swelling of the arterial wall in the carotid canal could cause minor cervical sympathetic deficit in patients with frequent or severe attacks of migraine. Loss of sympathetic vascular tone could increase vasodilatation and pain during attacks.
在从普通人群中挑选出的38名偏头痛患者的无头痛间歇期测量瞳孔直径。在每种情况下，至少70%的发作在同一侧复发。与40名对照受试者相比，瞳孔不等大更明显，但在通常的头痛侧瞳孔缩小并不总是更明显。偏头痛患者和对照者的平均瞳孔直径相似。在头痛通常一侧存在瞳孔扩张延迟的患者中，4%可卡因滴眼液滴眼后瞳孔缩小持续存在。这些发现表明，在一部分偏头痛患者中，头痛通常一侧的颈交感神经传出功能较低。与节后颈交感神经纤维功能降低一致，对照受试者对酪胺滴眼液的瞳孔扩张反应大于偏头痛患者。偏头痛患者头痛侧和无头痛侧对1%去氧肾上腺素滴眼液的瞳孔扩张反应没有持续差异，且与对照者相似。因此，在这个偏头痛患者的社区样本中，未发现瞳孔的肾上腺素能超敏反应。颈动脉管内动脉壁的血管扩张或肿胀可能导致频繁或严重偏头痛发作患者出现轻微的颈交感神经功能缺陷。发作期间交感神经血管张力丧失可能会加重血管扩张和疼痛。
