Department of Neurology, Assiut University Hospital, Egypt.
J Stroke Cerebrovasc Dis. 2010 Mar;19(2):92-103. doi: 10.1016/j.jstrokecerebrovasdis.2009.04.007.
Recent studies indicated that migraine is associated with specific vascular risk profile. However, the functional and structural vascular abnormalities in migraine are rarely addressed. We evaluated the vascular risk factors, endothelial function, and carotid artery (CA)-intima-media thickness (IMT), segregators of preclinical atherosclerosis, in migraineurs. This preliminary study included 63 adults with headache (migraine with aura [n=14], migraine without aura [n=24], transformed migraine [n=6], and tension headache [n=19]) and 35 matched healthy subjects. The following vascular risks were assessed: body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressures (DBP), serum levels of C-reactive protein, fasting glucose, fasting insulin, total cholesterol, and triglycerides. Plasma endothelin (ET)-1, a vasoactive peptide produced by vascular smooth muscle cells and marker for endothelial injury and atherosclerosis, was measured. Endothelial-dependent vasoreactivity was assessed using brachial artery flow-mediated dilatation (FMD) in response to hyperemia. CA-IMT, structural marker of early atherosclerosis, was measured. Compared with control subjects, SBP, DBP, glucose, insulin, ET-1, and CA-IMT were elevated with migraine. FMD% was inversely correlated with SBP (P < .001), DBP (P < .01), glucose (P < .001), and insulin levels (P < .01). CA-IMT was correlated with BMI (P < .05), SBP (P < .01), total cholesterol (P < .01), triglycerides (P < .001), glucose (P < .001), insulin (P < .01), and FMD% (P < .05). In multivariate analysis, ET-1 was correlated with duration of illness, SBP, DBP, glucose, insulin, IMT, and FMD%. We conclude that endothelial injury, impaired endothelial vasoreactivity, and increased CA-IMT occur with migraine and are associated with vascular risk factors that strongly suggest that migraine could be a risk for atherosclerosis.
最近的研究表明，偏头痛与特定的血管风险特征有关。然而，偏头痛患者的血管功能和结构异常很少被关注。我们评估了偏头痛患者的血管危险因素、内皮功能和颈动脉（CA）内膜-中层厚度（IMT），这些都是动脉粥样硬化前期的标志物。这项初步研究包括 63 名头痛患者（有先兆偏头痛[n=14]、无先兆偏头痛[n=24]、转化性偏头痛[n=6]和紧张性头痛[n=19]）和 35 名匹配的健康对照者。评估了以下血管风险因素：体重指数（BMI）、收缩压（SBP）和舒张压（DBP）、C 反应蛋白、空腹血糖、空腹胰岛素、总胆固醇和甘油三酯的血清水平。测量了血管活性肽内皮素（ET）-1 的水平，它是血管平滑肌细胞产生的一种标志物，也是内皮损伤和动脉粥样硬化的标志物。通过肱动脉血流介导的扩张（FMD）来评估内皮依赖性血管反应性，这是一种对充血的反应。CA-IMT 是早期动脉粥样硬化的结构标志物。与对照组相比，偏头痛患者的 SBP、DBP、血糖、胰岛素、ET-1 和 CA-IMT 水平升高。FMD%与 SBP（P<0.001）、DBP（P<0.01）、血糖（P<0.001）和胰岛素水平（P<0.01）呈负相关。CA-IMT 与 BMI（P<0.05）、SBP（P<0.01）、总胆固醇（P<0.01）、甘油三酯（P<0.001）、血糖（P<0.001）、胰岛素（P<0.01）和 FMD%（P<0.05）相关。多元分析显示，ET-1 与病程、SBP、DBP、血糖、胰岛素、IMT 和 FMD%相关。我们的结论是，偏头痛患者存在内皮损伤、内皮血管反应性受损和 CA-IMT 增加，这些与强烈提示偏头痛可能是动脉粥样硬化风险因素的血管危险因素相关。
