Department of Neurological Sciences, University of Bologna Medical School, Bologna, Italy.
Headache. 2010 Feb;50(2):273-89. doi: 10.1111/j.1526-4610.2009.01584.x. Epub 2009 Dec 21.
The objective of this study is to present a view of the primary headaches as genetically determined behavioral responses consistent with sickness behavior and defense reaction, respectively.
A review of the literature bearing on the behavioral, humoral, and functional imaging aspects of the primary headaches shows that migraine and cluster headache (CH) are pain conditions characterized by different behaviors during the attacks. Here it is postulated that the behavioral responses to migraine and CH are evolutionary conserved reactions consistent with sickness behavior and defense reaction.
The sickness behavior observed during migraine attacks is a pan-mammalian adaptive response to internal and external stressors, characterized by withdrawal and motor quiescence, sympatho-inhibition and lethargy, in which visceral pain signals a homeostatic imbalance of the body and/or brain. In contrast, the defense reaction in CH consists of a fight-or-flight reaction, with motor restlessness and agitation, in which pain is exteroceptive in kind.
These different behavioral responses are thus specific to different kinds of pain, distinguished by the behavioral significance of the pain (visceral pain in migraine vs exteroceptive pain in CH), and imply brain matrices involving different networks in the brainstem, hypothalamus, and forebrain regions that engender evolutionarily conserved adaptive genetic responses. Cytokines play an important role in their development. Predictions and limitations of the hypothesis are discussed together with implications for genetic studies on headaches.
本研究旨在提出原发性头痛是由基因决定的行为反应的观点，分别与疾病行为和防御反应一致。
对与原发性头痛的行为、体液和功能成像方面相关的文献进行综述，表明偏头痛和丛集性头痛（CH）是具有不同攻击期间行为特征的疼痛状况。这里假设偏头痛和 CH 的行为反应是与疾病行为和防御反应一致的进化保守反应。
偏头痛发作期间观察到的疾病行为是一种哺乳动物普遍存在的对内部和外部应激源的适应性反应，其特征是退缩和运动静止、交感神经抑制和嗜睡，其中内脏疼痛信号表明身体和/或大脑的稳态失衡。相比之下，CH 中的防御反应包括战斗或逃跑反应，伴有运动不安和激动，其中疼痛在性质上是外感受性的。
因此，这些不同的行为反应是特定于不同类型的疼痛的，其区别在于疼痛的行为意义（偏头痛中的内脏疼痛与 CH 中的外感受性疼痛），并暗示涉及脑干、下丘脑和前脑区域不同网络的大脑基质会产生进化保守的适应性遗传反应。细胞因子在其发展中起着重要作用。讨论了该假设的预测和局限性以及对头痛遗传研究的影响。
