Department of Neurology, University of Munich Hospital-Großhadern, Munich, Germany.
Cephalalgia. 2010 Apr;30(4):413-24. doi: 10.1111/j.1468-2982.2009.01945.x. Epub 2010 Mar 9.
We included 58 patients with meningioma in a prospective study to analyse the prevalence of and risk factors for different types of meningioma-associated headache. Twenty-three patients (40%) had meningioma-associated headache. Of these, the pain was migraine-like in five (22%) and tension-type headache (TTH)-like in 13 (57%). Sixteen of 21 (76%) experienced relief of pain intensity of at least 50% after 18-24 months. Univariate analysis revealed bone-invasive growth pattern (P = 0.007) as a risk factor for headache and intake of antiepileptic drugs (P = 0.04) or large surrounding oedema (P = 0.04) as possible protective parameters. For migraine-like headache, risk factors were a positive history of migraine (P = 0.009) and bone-invasive growth pattern (P = 0.046) and, for TTH-like headache, only bone-invasive growth pattern (P = 0.009). Binary logistic regression analysis added to assess predictability and interaction effects could not identify a single factor predicting the occurrence of headache in the presence of a meningioma (correct prediction in 74% by a model consisting of bone-invasive growth pattern, history of head surgery, intake of antiepileptic drugs, temporal tumour location and moderate and large surrounding oedema). Analysis of 38 tumour specimens could not confirm the hypothesis that the occurrence of headache correlates with the expression magnitude of signal substances known to be present in meningiomas [stroma cell-derived factor 1, interleukin (IL)-1β, IL-6, vascular endothelial growth factor A] or thought to be relevant to headache/pain pathophysiology [prostaglandin-endoperoxide synthase 2, calcitonin-related polypeptide alpha, nitric oxide synthase (NOS) 1, NOS2A, NOS3, transforming growth factor-alpha, tumour necrosis factor, tachykinin, vasoactive intestinal peptide]. The affection of bone integrity and the expression of molecules thought to be relevant to headache pathophysiology might be important for meningioma-associated headache in predisposed individuals.
我们纳入了 58 例脑膜瘤患者进行前瞻性研究，以分析不同类型脑膜瘤相关头痛的患病率和危险因素。23 例（40%）患者存在脑膜瘤相关头痛。其中，5 例（22%）为偏头痛样疼痛，13 例（57%）为紧张型头痛（TTH）样疼痛。21 例中的 16 例（76%）在 18-24 个月后疼痛强度至少缓解 50%。单因素分析显示，骨侵袭性生长模式（P = 0.007）是头痛的危险因素，而服用抗癫痫药物（P = 0.04）或大周围水肿（P = 0.04）是可能的保护参数。对于偏头痛样头痛，危险因素是偏头痛阳性史（P = 0.009）和骨侵袭性生长模式（P = 0.046），对于 TTH 样头痛，只有骨侵袭性生长模式（P = 0.009）。进行二元逻辑回归分析以评估预测能力和交互作用，但未能确定单一因素可预测脑膜瘤存在时头痛的发生（由骨侵袭性生长模式、头部手术史、抗癫痫药物使用、肿瘤部位和中至大周围水肿组成的模型正确预测率为 74%）。对 38 例肿瘤标本的分析无法证实头痛的发生与已知存在于脑膜瘤中的信号物质（基质细胞衍生因子 1、白细胞介素（IL）-1β、IL-6、血管内皮生长因子 A）或被认为与头痛/疼痛病理生理学相关的物质（前列腺素内过氧化物合酶 2、降钙素相关肽 α、一氧化氮合酶（NOS）1、NOS2A、NOS3、转化生长因子-α、肿瘤坏死因子、速激肽、血管活性肠肽）表达量之间存在相关性的假设。骨完整性的影响和与头痛病理生理学相关的分子的表达可能对易感个体的脑膜瘤相关头痛很重要。
