Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Australia.
Headache. 2010 May;50(5):895-908. doi: 10.1111/j.1526-4610.2010.01669.x.
This article reviews the baffling problem of the pathophysiology behind a peripheral genesis of migraine pain--or more particularly the baffling problem of its absence. I examine a number of pathophysiological states and the effector mechanisms for these states and find most of them very plausible and that they are all supported by abundant evidence. However, this evidence is mostly indirect; to date the occurrence of any of the presumed pathological states has not been convincingly demonstrated. Furthermore, there is little evidence of increased trigeminal sensory traffic into the central nervous system during a migraine attack. The article also examines a number of observations and experimental programs used to bolster a theory of peripheral pathology and suggests reasons why they may in fact not bolster it. I suggest that a pathology, if one exists, may be in the brain and even that it may not be a pathology at all. Migraine headache might just happen because of random noise in an exquisitely sensitive and complex network. The article suggests an experimental program to resolve these issues.
这篇文章回顾了偏头痛疼痛外周起源背后令人费解的病理生理学问题——或者更确切地说，是其缺失的令人费解的问题。我检查了许多病理生理状态及其效应机制，并发现大多数状态都非常合理，并且都有大量证据支持。然而，这些证据大多是间接的；迄今为止，任何假定的病理状态的发生都没有得到令人信服的证明。此外，在偏头痛发作期间，三叉神经感觉传入到中枢神经系统的增加很少有证据。本文还检查了一些用于支持外周病理学理论的观察和实验方案，并提出了为什么它们实际上可能不会支持该理论的原因。我认为，如果存在一种病理学，它可能存在于大脑中，甚至可能根本不是一种病理学。偏头痛头痛可能只是由于极其敏感和复杂的网络中的随机噪声而发生。本文提出了一个实验方案来解决这些问题。
