Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Neurol Neurosurg Psychiatry. 2015 Nov;86(11):1253-7. doi: 10.1136/jnnp-2014-309571. Epub 2014 Dec 30.
Although systemic endothelial function is unimpaired in migraine, it is unknown whether cerebral endothelial function impairment exists in migraineurs.
We conducted a prospective study to assess endothelial function in migraineurs (n=45) and healthy volunteers (n=44). Cerebral endothelial function was assessed by Breath Holding Index (BHI) on transcranial Doppler in bilateral middle cerebral artery (MCA at 30-60 mm), posterior cerebral artery (PCA at 60-80 mm) and basilar artery (BA at 80-120 mm) using bilateral monitoring probes fixed on headband. Brachial artery flow-mediated dilation (FMD) was used as measure of systemic endothelial function.
There was no difference in baseline mean velocities of MCA, PCA, BA among migraineurs and controls. Mean BHI was significantly lower in PCA (p<0.001) and BA (p<0.001) in patients with migraine with no difference in MCA (p=0.909, 0.450). Cerebral endothelial dysfunction (BHI<1.15) was present in 62.2% of migraineurs in the right PCA (p<0.001), 57.8% in left PCA (p<0.001) and 77.8% in BA (BHI <0.83, p<0.001). There was no difference in BHI among migraineurs without and with aura (n=15). Cerebral and systemic endothelial function had no correlation in migraineurs. Increasing BMI was identified as a predictor of impaired BHI in the BA in migraineurs (p=0.020). Age, sex, presence of aura, lateralisation of headache, headache frequency, time to last attack and impaired FMD were not associated with impaired PCA and BA BHI in migraineurs.
Migraineurs may have isolated cerebral endothelial dysfunction restricted to the posterior circulation in the absence of systemic endothelial dysfunction.
尽管偏头痛患者的全身内皮功能未受损，但偏头痛患者是否存在脑内皮功能障碍尚不清楚。
我们进行了一项前瞻性研究，以评估偏头痛患者（n=45）和健康志愿者（n=44）的内皮功能。通过经颅多普勒超声在双侧大脑中动脉（MCA 在 30-60mm 处）、大脑后动脉（PCA 在 60-80mm 处）和基底动脉（BA 在 80-120mm 处）上使用双侧监测探头评估脑内皮功能，探头固定在头带。肱动脉血流介导的扩张（FMD）用作全身内皮功能的测量指标。
偏头痛患者和对照组之间的 MCA、PCA 和 BA 的基线平均速度没有差异。偏头痛患者的 PCA（p<0.001）和 BA（p<0.001）的平均 BHI 明显较低，但 MCA 无差异（p=0.909，0.450）。右侧 PCA（p<0.001）、左侧 PCA（p<0.001）和 BA（BHI<0.83，p<0.001）的偏头痛患者中有 62.2%、57.8%和 77.8%存在脑内皮功能障碍（BHI<1.15）。无先兆偏头痛患者（n=15）和有先兆偏头痛患者之间的 BHI 无差异。偏头痛患者的脑内皮功能和全身内皮功能之间没有相关性。BMI 增加被确定为偏头痛患者 BA 中 BHI 受损的预测因素（p=0.020）。年龄、性别、有无先兆、头痛侧化、头痛频率、末次发作时间和 FMD 受损与偏头痛患者 PCA 和 BA 的 BHI 受损无关。
偏头痛患者可能存在孤立的脑内皮功能障碍，局限于后循环，而全身内皮功能正常。
