Department of Anaesthesia Neuroscience, Comprehensive Headache Center, Harvard Medical School, Boston, MA, USA.
J Clin Neurol. 2012 Jun;8(2):89-99. doi: 10.3988/jcn.2012.8.2.89. Epub 2012 Jun 29.
Migraine headache is commonly associated with signs of exaggerated intracranial and extracranial mechanical sensitivities. Patients exhibiting signs of intracranial hypersensitivity testify that their headache throbs and that mundane physical activities that increase intracranial pressure (such as bending over or coughing) intensify the pain. Patients exhibiting signs of extracranial hypersensitivity testify that during migraine their facial skin hurts in response to otherwise innocuous activities such as combing, shaving, letting water run over their face in the shower, or wearing glasses or earrings (termed here cephalic cutaneous allodynia). Such patients often testify that during migraine their bodily skin is hypersensitive and that wearing tight cloth, bracelets, rings, necklaces and socks or using a heavy blanket can be uncomfortable and/or painful (termed her extracephalic cutaneous allodynia). This review summarizes the evidence that support the view that activation of the trigeminovascular pathway contribute to the headache phase of a migraine attack, that the development of throbbing in the initial phase of migraine is mediated by sensitization of peripheral trigeminovascular neurons that innervate the meninges, that the development of cephalic allodynia is propelled by sensitization of second-order trigeminovascular neurons in the spinal trigeminal nucleus which receive converging sensory input from the meninges as well as from the scalp and facial skin, and that the development of extracephalic allodynia is mediated by sensitization of third-order trigeminovascular neurons in the posterior thalamic nuclei which receive converging sensory input from the meninges, facial and body skin.
偏头痛常伴有颅内和颅外机械敏感性增强的迹象。表现出颅内高敏迹象的患者表示，他们的头痛搏动，而增加颅内压的日常活动（如弯腰或咳嗽）会加剧疼痛。表现出颅外高敏迹象的患者表示，在偏头痛期间，他们的面部皮肤在受到梳、刮、让水在淋浴中流过面部或戴眼镜或耳环等无害活动的刺激时会感到疼痛（这里称为颅皮感觉过敏）。此类患者常表示，在偏头痛期间，他们的身体皮肤高度敏感，穿紧身衣服、手镯、戒指、项链和袜子，或使用厚重毯子会感到不适和/或疼痛（称为颅外皮肤感觉过敏）。这篇综述总结了支持以下观点的证据：三叉血管通路的激活有助于偏头痛发作的头痛阶段，偏头痛初始阶段搏动的发展是由支配脑膜的外周三叉血管神经元的敏化介导的，颅皮感觉过敏的发展是由脊髓三叉神经核中二级三叉血管神经元的敏化推动的，这些神经元接收来自脑膜以及头皮和面部皮肤的汇聚感觉输入，颅外感觉过敏的发展是由后丘脑核中三级三叉血管神经元的敏化介导的，这些神经元接收来自脑膜、面部和身体皮肤的汇聚感觉输入。
