Neurology Unit, Headache Center, SG Moscati, Avellino, Italy.
Neurol Sci. 2012 May;33 Suppl 1:S55-9. doi: 10.1007/s10072-012-1042-9.
A large series of clinical and experimental observations on the interactions between migraine and the extrapyramidal system are available. Some previous studies reported high frequency of migraine in some basal ganglia (BG) disorders, such as essential tremor (ET), Tourette's syndrome (TS), Sydenham's chorea and more recently restless legs syndrome (RLS). For example, the frequency of migraine headache in a clinic sample of TS patients was found nearly fourfold more than that reported in the general population. To the best of our knowledge, no controlled studies have been conducted to determine a real association. ET and migraine headache have been considered comorbid diseases on the basis of uncontrolled studies for many years. In a recent Italian study, this comorbid association has been excluded, reporting no significant differences in the frequency of lifetime and current migraine between patients with ET and controls. Among mostly common movement disorders, RLS has been recently considered as possibly comorbid with migraine. Studies in selected patient groups strongly suggest that RLS is more common in migraine patients than in control populations, although no population-based study of the coincidence of migraine and RLS has yet been identified. The exact mechanisms and contributing factors for a positive association between migraine and RLS remain unclear. A number of possible explanations have been offered for the association of RLS and primary headache, but the three most attractive ones are a hypothetical dopaminergic dysfunction and dysfunctional brain iron metabolism, a possible genetic linkage and a sleep disturbance. More recently, the role of BG in pain processing has been confirmed by functional imaging data in the caudate, putamen and pallidum in migraine patients. A critical appraisal of all these clinical and experimental data suggests that the extrapyramidal system is somehow related to migraine. Although the primary involvement of extrapyramidal system in the pathophysiology of migraine cannot as yet be proven, a more general role in the processing of nociceptive information and/or maybe part of the complex behavioral adaptive response that characterizes migraine may be suggested.
大量的临床和实验观察表明偏头痛与锥体外系之间存在相互作用。一些先前的研究报告称，某些基底节（BG）疾病如特发性震颤（ET）、妥瑞氏综合征（TS）、风湿性舞蹈病以及最近的不宁腿综合征（RLS）中偏头痛的发病率较高。例如，在 TS 患者的临床样本中，偏头痛头痛的频率发现比一般人群报告的频率高近四倍。据我们所知，尚未进行对照研究以确定真正的关联。多年来，基于非对照研究，ET 和偏头痛头痛被认为是共病。在最近的一项意大利研究中，这种共病关联已被排除，报告称 ET 患者和对照组之间终生和当前偏头痛的频率无显着差异。在大多数常见的运动障碍中，RLS 最近被认为可能与偏头痛共病。在选定的患者群体中进行的研究强烈表明，RLS 在偏头痛患者中比在对照人群中更为常见，尽管尚未确定偏头痛和 RLS 同时发生的基于人群的研究。偏头痛和 RLS 之间呈阳性关联的确切机制和促成因素尚不清楚。对于 RLS 和原发性头痛的关联，已经提出了许多可能的解释，但其中三个最有吸引力的解释是假设的多巴胺能功能障碍和脑铁代谢功能障碍、可能的遗传联系和睡眠障碍。最近，功能成像数据在偏头痛患者的尾状核、壳核和苍白球中证实了 BG 在疼痛处理中的作用。对所有这些临床和实验数据的批判性评估表明，锥体外系与偏头痛有某种联系。尽管尚不能证明锥体外系在偏头痛的病理生理学中的主要参与，但它可能在伤害性信息处理和/或偏头痛特征性的复杂行为适应反应中发挥更普遍的作用。
