Department of Neurology and Headache Unit L. Sacco Hospital, Milan, Italy -
Minerva Med. 2013 Dec;104(6):605-11.
Interactions between blood pressure control, sleep and headache have been largely studied, although not well understood. We designed a study trying to simultaneously evaluate all three aspects in the same subjects. We particularly concentrated on the observation of physiological blood pressure circadian rhythm, and the presence of cutaneous allodynia correlated to headache. Objective of the study was to investigate blood pressure during nocturnal sleep in patients that underwent a blood pressure 24 hours monitoring, and at the same time the presence of headache and of sleep behavioural alterations.
Blood pressure 24 hours monitoring was performed by an ambulatory blood pressure (ABP) monitor (Space Labs) with its ad hoc software. Headache diagnosis was made according to ICHD-II criteria. Presence of allodynia and sleep behavior were evaluated through semi-structured ad hoc questionnaires.
A total of 195 subjects were included, of which 122 without headache (mean age 60.4±11.6 years, 78 men and 44 women) and 73 with history of headache, (mean age 54.2±12.5 years, 18 men and 55 women). Fifty-one headache patients had migraine (mean age 52.6±11.7 years, 11 men and 40 women) and 22 tension type headache (TTH - mean age 58.0±13.5 years, 7 men and 15 women). Allodynia was found in 30 out of 73 headache patients: 23 out of 51 in the migraine group and in 7 out of 22 in the tension-type one. The physiological reduction of blood pressure during night (dipping) was more conserved among headache patients (34 dippers out of 73 subjects, 46,6%) with respect to subjects without headache (40 dippers out of 122, 32,8%) and that this border-line difference was more strongly significant comparing allodynic subjects (19 dippers out of 30, 63.3%) with both non-headache (40 dippers out of 122, 32.8%, P<0.001) and non-allodynic (15 out of 43, 34.9%, P<0.05) ones. No significant difference was observed between headache patients and subjects without headache in terms of mean systolic and diastolic pressure, neither between migraine and TTH.
Allodynic headache patients seem to maintain a more physiologic pressure circadian rhythm. While considering the possibility of selection bias, the hypothesis of an allostatic function of headache and allodynia in patients with unbalanced blood pressure could be made.
血压控制、睡眠和头痛之间的相互作用已经得到了广泛的研究，但仍未被很好地理解。我们设计了一项研究，试图在同一组受试者中同时评估这三个方面。我们特别关注观察生理性血压昼夜节律，以及与头痛相关的皮肤感觉过敏。研究的目的是调查接受 24 小时血压监测的患者在夜间睡眠时的血压，并同时观察头痛和睡眠行为改变的情况。
通过动态血压（ABP）监测仪（Space Labs）及其专用软件进行 24 小时血压监测。头痛诊断根据 ICHD-II 标准进行。通过半结构化专用问卷评估感觉过敏和睡眠行为。
共纳入 195 例受试者，其中 122 例无头痛（平均年龄 60.4±11.6 岁，78 名男性和 44 名女性），73 例有头痛史（平均年龄 54.2±12.5 岁，18 名男性和 55 名女性）。51 例头痛患者为偏头痛（平均年龄 52.6±11.7 岁，11 名男性和 40 名女性），22 例紧张型头痛（TTH-平均年龄 58.0±13.5 岁，7 名男性和 15 名女性）。73 例头痛患者中有 30 例存在感觉过敏：51 例偏头痛患者中有 23 例，22 例紧张型头痛患者中有 7 例。与无头痛的患者（40 例中有 46.6%）相比，头痛患者夜间（夜间下降）血压生理性下降更为明显（73 例患者中有 34 例下降）。与无头痛的患者（40 例中有 32.8%）相比，这一临界差异在感觉过敏的患者（30 例中有 63.3%）中更为显著，而在非头痛（40 例中有 32.8%，P<0.001）和非感觉过敏（43 例中有 15 例，34.9%，P<0.05）的患者中差异无统计学意义。头痛患者与无头痛患者之间的收缩压和舒张压平均值之间无显著差异，偏头痛与 TTH 之间也无显著差异。
感觉过敏的头痛患者似乎保持着更生理的血压昼夜节律。虽然考虑到选择偏差的可能性，但可以假设头痛和感觉过敏在血压失衡患者中的适应性功能。
