Biondi David M
Headache Management Program, Spaulding Rehabilitation Hospital, 125 Nashua Street, Boston, MA 02114, USA.
Curr Pain Headache Rep. 2006 Jun;10(3):167-78. doi: 10.1007/s11916-006-0042-y.
The understanding of migraine pathophysiology has evolved from the belief that migraine is a vascular disorder, to evidence that better defines migraine as a neurogenic disorder associated with secondary changes in brain perfusion. There is evidence to suggest that the early phase of migraine pain results from neurogenic inflammation affecting cranial blood vessels and dura. Allodynia, hyperalgesia, and expansion of nociceptive fields occur during most well-established migraine attacks. These clinical features of migraine are evocative of those traditionally associated with neuropathic pain. A hypothesis that defines migraine pain as a unique neuropathic pain disorder can imply the potential for neural plasticity and may provide insight into the mechanisms that underlie the transformation of episodic to chronic forms of migraine. The neuropathic pain model of migraine pathophysiology not only paves the way for mechanism-based treatment strategies that can improve the acute and preventive management of migraine attacks, but also opens the door for the discovery of novel therapeutic targets. It also lends momentum to an understanding of clinically intriguing topics such as opiate-induced hyperalgesia and medication-overuse headache (rebound headache), opioid resistance in the treatment of chronic headache, and disease modification in defending against the potential for migraine transformation.
对偏头痛病理生理学的理解已从认为偏头痛是一种血管性疾病，发展到有证据表明偏头痛更确切地是一种与脑灌注继发性改变相关的神经源性疾病。有证据表明，偏头痛疼痛的早期阶段是由影响颅脑血管和硬脑膜的神经源性炎症引起的。在大多数典型的偏头痛发作期间会出现痛觉过敏、痛觉超敏和伤害性感受区域扩大。偏头痛的这些临床特征让人联想到那些传统上与神经性疼痛相关的特征。将偏头痛疼痛定义为一种独特的神经性疼痛疾病的假说可能意味着神经可塑性的潜力，并可能为发作性偏头痛转变为慢性偏头痛的潜在机制提供见解。偏头痛病理生理学的神经性疼痛模型不仅为基于机制的治疗策略铺平了道路，这些策略可以改善偏头痛发作的急性和预防性管理，而且还为发现新的治疗靶点打开了大门。它还推动了对临床上有趣话题的理解，如阿片类药物引起的痛觉过敏和药物过度使用性头痛（反弹性头痛）、慢性头痛治疗中的阿片类药物耐药性以及预防偏头痛转变可能性的疾病修饰。
