Olesen J, Friberg L, Olsen T S, Iversen H K, Lassen N A, Andersen A R, Karle A
Department of Neurology, Gentofte Hospital, Copenhagen, Denmark.
Ann Neurol. 1990 Dec;28(6):791-8. doi: 10.1002/ana.410280610.
Ten years of study has resulted in considerable but fragmented knowledge about regional cerebral blood flow in migraine with aura (classic migraine). In the present study, the number of repeatedly studied patients (n = 63) was large enough to determine statistically significant sequences of events and statistically significant spatial relations. The first observable event was a decrease of regional cerebral blood flow posteriorly in one cerebral hemisphere. Further development of this pathological process was accompanied by the aura symptoms. Thereafter headache occurred while regional cerebral blood flow remained decreased. During the headache phase, regional cerebral blood flow gradually changed from abnormally low to abnormally high without apparent change in headache. In some patients headache disappeared while regional cerebral blood flow remained increased. Although regional cerebral blood flow reduction and aura symptoms in the great majority of patients were unilateral, one-third had bilateral headache. Unilateral headache usually localized to the side on which regional cerebral blood flow was reduced and from which the aura symptoms originated (i.e., aura symptoms were perceived to occur contralaterally but presumably originated in the hypoperfused hemisphere). Our results suggest a simple model for migraine attacks: A pathological disturbance in one cerebral hemisphere causes the aura symptoms and after a time delay, it also causes the headache by stimulating local vascular nociceptors. Bilateral headache caused by a unilateral cerebral disturbance may be explained by recent neuroanatomical and neurophysiological findings.
十年的研究已积累了大量但零散的关于伴先兆偏头痛（典型偏头痛）局部脑血流的知识。在本研究中，反复研究的患者数量（n = 63）足够多，足以确定具有统计学意义的事件序列和统计学意义的空间关系。第一个可观察到的事件是一个脑半球后部的局部脑血流减少。这一病理过程的进一步发展伴随着先兆症状。此后，在局部脑血流仍减少的情况下出现头痛。在头痛阶段，局部脑血流逐渐从异常低水平变为异常高水平，而头痛无明显变化。在一些患者中，头痛消失而局部脑血流仍增加。虽然绝大多数患者的局部脑血流减少和先兆症状是单侧的，但三分之一的患者有双侧头痛。单侧头痛通常定位于局部脑血流减少且先兆症状起源的一侧（即，先兆症状被认为发生在对侧，但可能起源于灌注不足的半球）。我们的结果提示了一个偏头痛发作的简单模型：一个脑半球的病理紊乱导致先兆症状，经过一段时间延迟后，它还通过刺激局部血管伤害感受器引起头痛。由单侧脑紊乱引起的双侧头痛可以用最近的神经解剖学和神经生理学发现来解释。
