Wilcox Sophie L, Veggeberg Rosanna, Lemme Jordan, Hodkinson Duncan J, Scrivani Steven, Burstein Rami, Becerra Lino, Borsook David
Center for Pain and the Brain (PAIN Research Group), Boston Children's Hospital, Harvard Medical School, BostonMA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, BostonMA, USA.
Center for Pain and the Brain (PAIN Research Group), Boston Children's Hospital, Harvard Medical School, BostonMA, USA; Department of Psychiatry, PAIN Research Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, BelmontMA, USA.
Front Hum Neurosci. 2016 Jul 26;10:366. doi: 10.3389/fnhum.2016.00366. eCollection 2016.
Pain is both an unpleasant sensory and emotional experience. This is highly relevant in migraine where cortical hyperexcitability in response to sensory stimuli (including pain, light, and sound) has been extensively reported. However, migraine may feature a more general enhanced response to aversive stimuli rather than being sensory-specific. To this end we used functional magnetic resonance imaging to assess neural activation in migraineurs interictaly in response to emotional visual stimuli from the International Affective Picture System. Migraineurs, compared to healthy controls, demonstrated increased neural activity in response to negative emotional stimuli. Most notably in regions overlapping in their involvement in both nociceptive and emotional processing including the posterior cingulate, caudate, amygdala, and thalamus (cluster corrected, p < 0.01). In contrast, migraineurs and healthy controls displayed no and minimal differences in response to positive and neutral emotional stimuli, respectively. These findings support the notion that migraine may feature more generalized altered cerebral processing of aversive/negative stimuli, rather than exclusively to sensory stimuli. A generalized hypersensitivity to aversive stimuli may be an inherent feature of migraine, or a consequential alteration developed over the duration of the disease. This proposed cortical-limbic hypersensitivity may form an important part of the migraine pathophysiology, including psychological comorbidity, and may represent an innate sensitivity to aversive stimuli that underpins attack triggers, attack persistence and (potentially) gradual headache chronification.
疼痛是一种不愉快的感觉和情绪体验。这在偏头痛中高度相关，因为已有大量报道表明偏头痛患者对感觉刺激（包括疼痛、光线和声音）存在皮质兴奋性过高。然而，偏头痛可能表现出对厌恶刺激的更普遍增强反应，而非仅限于感觉特异性。为此，我们使用功能磁共振成像来评估偏头痛患者发作间期对国际情感图片系统中的情感视觉刺激的神经激活情况。与健康对照组相比，偏头痛患者对负面情绪刺激表现出神经活动增加。最显著的是在参与伤害性感受和情感处理的重叠区域，包括后扣带回、尾状核、杏仁核和丘脑（簇校正，p < 0.01）。相反，偏头痛患者和健康对照组对正面和中性情绪刺激的反应分别没有差异和差异极小。这些发现支持了这样一种观点，即偏头痛可能具有更普遍的对厌恶/负面刺激的大脑处理改变，而非仅仅针对感觉刺激。对厌恶刺激的普遍超敏反应可能是偏头痛的一个固有特征，或者是在疾病过程中产生的一种继发性改变。这种提出的皮质-边缘系统超敏反应可能构成偏头痛病理生理学的重要部分，包括心理共病，并且可能代表对厌恶刺激的一种先天敏感性，这种敏感性是发作触发、发作持续以及（可能）头痛逐渐慢性化的基础。
