Olesen Jes, Burstein Rami, Ashina Messoud, Tfelt-Hansen Peer
Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, DK-2600 Glostrup, Copenhagen, Denmark.
Lancet Neurol. 2009 Jul;8(7):679-90. doi: 10.1016/S1474-4422(09)70090-0.
Migraine is the most common neurological disorder, and much has been learned about its mechanisms in recent years. However, the origin of painful impulses in the trigeminal nerve is still uncertain. Despite the attention paid recently to the role of central sensitisation in migraine pathophysiology, in our view, neuronal hyperexcitability depends on activation of peripheral nociceptors. Although the onset of a migraine attack might take place in deep-brain structures, some evidence indicates that the headache phase depends on nociceptive input from perivascular sensory nerve terminals. The input from arteries is probably more important than the input from veins. Several studies provide evidence for input from extracranial, dural, and pial arteries but, likewise, there is also evidence against all three of these locations. On balance, afferents are most probably excited in all three territories or the importance of individual territories varies from patient to patient. We suggest that migraine can be explained to patients as a disorder of the brain, and that the headache originates in the sensory fibres that convey pain signals from intracranial and extracranial blood vessels.
偏头痛是最常见的神经系统疾病，近年来人们对其发病机制已有诸多了解。然而，三叉神经中痛觉冲动的起源仍不明确。尽管近期中枢敏化在偏头痛病理生理学中的作用受到了关注，但在我们看来，神经元的过度兴奋依赖于外周伤害感受器的激活。虽然偏头痛发作可能始于脑深部结构，但一些证据表明头痛阶段取决于来自血管周围感觉神经末梢的伤害性输入。来自动脉的输入可能比来自静脉的输入更重要。多项研究为来自颅外、硬脑膜和软脑膜动脉的输入提供了证据，但同样也有证据反对这三个部位。总体而言，传入神经很可能在所有这三个区域都被激活，或者各个区域的重要性因患者而异。我们建议可以向患者解释偏头痛是一种脑部疾病，且头痛源于从颅内和颅外血管传递疼痛信号的感觉纤维。
