Goadsby P J, Lance J W
Department of Neurology, Prince Henry Hospital, Little Bay, Australia.
Rev Prat. 1990 Feb 11;40(5):389-93.
In those subjects genetically susceptible to migraine, biological rhythms or excessive afferent stimulation trigger an episodic neurovascular reaction with focal neurological symptoms, headache and nausea as its most common manifestations. Mood changes and a craving for sweet foods point to a preliminary hypothalamic disturbance. The referral of ice-cream headache and ice-pick pains to the habitual site of migraine headache (even in the intervals between attacks) indicate defective control of trigeminal pathways. Laboratory experiments have demonstrated that projections from the brainstem, releasing monoamines and peptides as transmitter agents, can mimic the vascular changes of migraine. Serotonin released from platelets may sensitize vessels to respond to distension by generating pain-producing afferent discharges. Central depletion of monoamines can accentuate the perception of pain by reducing the efficacy of the endogenous pain control system. The intravenous injection of serotonin relieves migraine headache but produces side-effects. A new drug, sumatriptan, acting on a subtype of serotonin receptors, the 5HT1-like receptor, is undergoing clinical trial for the relief of acute attacks of migraine. Antagonist of the 5HT2 receptor are beneficial in interval therapy for the prevention of migraine. Increased knowledge of physiological mechanisms and neurotransmitters that can mediate the various components of the migraine attack opens the way for improvements in pharmacotherapy.
在那些对偏头痛具有遗传易感性的受试者中，生物节律或过度的传入刺激引发一种发作性神经血管反应，其最常见的表现为局灶性神经症状、头痛和恶心。情绪变化以及对甜食的渴望表明下丘脑存在初步紊乱。冰淇淋头痛和刺痛感出现在偏头痛的惯常部位（即使在发作间期），这表明三叉神经通路的控制存在缺陷。实验室实验表明，脑干发出的释放单胺和肽作为递质的投射可以模拟偏头痛的血管变化。血小板释放的血清素可能会使血管对扩张敏感，通过产生引起疼痛的传入放电来做出反应。单胺的中枢耗竭会通过降低内源性疼痛控制系统的功效来加剧疼痛感知。静脉注射血清素可缓解偏头痛，但会产生副作用。一种作用于血清素受体亚型5HT1样受体的新药舒马曲坦正在进行缓解偏头痛急性发作的临床试验。5HT2受体拮抗剂在预防偏头痛的间歇期治疗中有益。对可介导偏头痛发作各个组成部分的生理机制和神经递质的了解不断增加，为药物治疗的改进开辟了道路。
