Alstadhaug K B
Department of Neurology, Nordlandssykehuset Bodø, Norway.
Cephalalgia. 2009 Aug;29(8):809-17. doi: 10.1111/j.1468-2982.2008.01814.x.
Migraine is a complex brain disorder where several neuronal pathways and neurotransmitters are involved in the pathophysiology. To search for a specific anatomical or physiological defect in migraine may be futile, but the hypothalamus, with its widespread connections with other parts of the central nervous system and its paramount control of the hypophysis and the autonomic nervous system, is a suspected locus in quo. Several lines of evidence support involvement of this small brain structure in migraine. However, whether it plays a major or minor role is unclear. The most convincing support for a pivotal role so far is the activation of the hypothalamus shown by positron emission tomography (PET) scanning during spontaneous migraine attacks. A well-known theory is that the joint effect of several triggers may cause temporary hypothalamic dysfunction, resulting in a migraine attack. If PET scanning had consistently confirmed hypothalamic activation prior to migraine headache, this hypothesis would have been supported. However, such evidence has not been provided, and the role of the hypothalamus in migraine remains puzzling. This review summarizes and discusses some of the clues.
偏头痛是一种复杂的脑部疾病，其病理生理学涉及多种神经通路和神经递质。寻找偏头痛中特定的解剖学或生理学缺陷可能是徒劳的，但下丘脑与中枢神经系统其他部分广泛相连，对垂体和自主神经系统具有至关重要的控制作用，是一个可疑的发病部位。有几条证据支持这个小脑部结构参与偏头痛。然而，它是起主要作用还是次要作用尚不清楚。迄今为止，对其关键作用最有说服力的支持是正电子发射断层扫描（PET）显示在自发性偏头痛发作期间下丘脑被激活。一个著名的理论是，几种触发因素的共同作用可能导致下丘脑暂时功能障碍，从而引发偏头痛发作。如果PET扫描一直能在偏头痛头痛发作前证实下丘脑被激活，那么这个假设就会得到支持。然而，尚未有这样的证据，下丘脑在偏头痛中的作用仍然令人困惑。本综述总结并讨论了一些线索。
