Mamontov Oleg V, Babayan Laura, Amelin Alexander V, Giniatullin Rashid, Kamshilin Alexei A
Almazov Federal Heart, Blood and Endocrinology Centre, St. Petersburg, Russia.
Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia.
J Headache Pain. 2016;17:52. doi: 10.1186/s10194-016-0645-6. Epub 2016 May 11.
The autonomous cardiovascular control can contribute to progression of migraine. However, current data on cardiovascular reactivity in migraine, especially severe forms, are essentially contradictory. The main aim of this study was to compare the autonomous regulation of circulation in patients with episodic and chronic migraine and healthy subjects.
Seventy three migraine patients (mean age 35 ± 10) including episodic migraine (51 patients, 4-14 headache days/months) and chronic migraine (22 patients, ≥15 headache days/month) along with age-match control (71 healthy voluntaries) were examined. The autonomic regulation of circulation was examined with the tilt-table test, a deep breathing and Valsalva Maneuver, handgrip test, cold-stress vasoconstriction, arterial baroreflex and blood pressure variability.
The changes in heart rate induced by deep breathing, Valsalva Maneuver, and blood pressure in tilt-table test in patients with migraine did not differ from the control group. In contrast, the values of cold-stress-vasoconstriction forearm blood-flow reactivity (p <0.001), the increase in diastolic blood pressure in handgrip test (p <0.001), mean blood pressure in the late stage of the second phase of Valsalva Maneuver (p <0.001) and blood pressure variability (p <0.005) were all higher in patients with migraine than in the control group.
Thus, both episodic and chronic migraine are associated with significant disturbances in autonomous control resulting in enhanced vascular reactivity whereas the cardiac regulation remains largely unchanged.
自主心血管控制可能促使偏头痛病情进展。然而，目前关于偏头痛尤其是严重形式偏头痛的心血管反应性的数据基本相互矛盾。本研究的主要目的是比较发作性和慢性偏头痛患者与健康受试者的自主循环调节情况。
对73例偏头痛患者（平均年龄35±10岁）进行了检查，其中包括发作性偏头痛患者（51例，每月头痛4 - 14天）和慢性偏头痛患者（22例，每月头痛≥15天），同时纳入了年龄匹配的对照组（71名健康志愿者）。通过倾斜试验、深呼吸和瓦尔萨尔瓦动作、握力试验、冷应激血管收缩、动脉压力反射和血压变异性来检测循环的自主调节情况。
偏头痛患者在深呼吸、瓦尔萨尔瓦动作时心率的变化以及倾斜试验中的血压变化与对照组无差异。相比之下，偏头痛患者的冷应激血管收缩前臂血流反应性值（p <0.001）、握力试验中舒张压的升高（p <0.001）、瓦尔萨尔瓦动作第二阶段后期的平均血压（p <0.001）和血压变异性（p <0.005）均高于对照组。
因此，发作性和慢性偏头痛均与自主控制的显著紊乱有关，导致血管反应性增强，而心脏调节基本保持不变。
