Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, NY 10010, USA.
Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, NY 10010, USA.
Pharmacol Ther. 2017 Apr;172:151-170. doi: 10.1016/j.pharmthera.2016.12.005. Epub 2016 Dec 2.
Migraine headache and its associated symptoms have plagued humans for two millennia. It is manifest throughout the world, and affects more than 1/6 of the global population. It is the most common brain disorder, and is characterized by moderate to severe unilateral headache that is accompanied by vomiting, nausea, photophobia, phonophobia, and other hypersensitive symptoms of the senses. While there is still a clear lack of understanding of its neurophysiology, it is beginning to be understood, and it seems to suggest migraine is a disorder of brain sensory processing, characterized by a generalized neuronal hyperexcitability. The complex symptomatology of migraine indicates that multiple neuronal systems are involved, including brainstem and diencephalic systems, which function abnormally, resulting in premonitory symptoms, ultimately evolving to affect the dural trigeminovascular system, and the pain phase of migraine. The migraineur also seems to be particularly sensitive to fluctuations in homeostasis, such as sleep, feeding and stress, reflecting the abnormality of functioning in these brainstem and diencephalic systems. Implications for therapeutic development have grown out of our understanding of migraine neurophysiology, leading to major drug classes, such as triptans, calcitonin gene-related peptide receptor antagonists, and 5-HT receptor agonists, as well as neuromodulatory approaches, with the promise of more to come. The present review will discuss the current understanding of the neurophysiology of migraine, particularly migraine headache, and novel insights into the complex neural networks responsible for associated neurological symptoms, and how interaction of these networks with migraine pain pathways has implications for the development of novel therapeutics.
偏头痛及其相关症状困扰人类已有两千多年。它在世界各地都有表现，影响了全球超过六分之一的人口。它是最常见的脑部疾病，其特征是中度至重度单侧头痛，并伴有呕吐、恶心、畏光、畏声和其他感官过敏症状。尽管对其神经生理学仍缺乏明确的认识，但现在已经开始有所了解，似乎表明偏头痛是一种大脑感觉处理障碍，其特征是神经元普遍过度兴奋。偏头痛的复杂症状表明涉及多个神经元系统，包括脑干和间脑系统，这些系统功能异常，导致前驱症状，最终影响到硬脑膜三叉血管系统和偏头痛的疼痛阶段。偏头痛患者似乎对睡眠、进食和压力等内稳态的波动也特别敏感，这反映了这些脑干和间脑系统功能的异常。对偏头痛神经生理学的理解促进了治疗方法的发展，产生了重大的药物类别，如曲坦类、降钙素基因相关肽受体拮抗剂和 5-HT 受体激动剂，以及神经调节方法，有望出现更多的治疗方法。本综述将讨论偏头痛神经生理学，特别是偏头痛头痛的当前理解，以及对负责相关神经症状的复杂神经网络的新见解，以及这些网络与偏头痛疼痛途径的相互作用如何对新型治疗药物的开发产生影响。
