Masters-Israilov Alina, Robbins Matthew S
Saul R Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Montefiore Headache Center, Bronx, USA.
Curr Pain Headache Rep. 2017 Apr;21(4):20. doi: 10.1007/s11916-017-0620-1.
Neuromyelitis optica (NMO) classically features a clinical presentation that includes longitudinally extensive transverse myelitis and optic neuritis. However, many other pathognomonic phenomena have more recently been described in patients diagnosed with NMO, including intractable hiccups, vomiting, and painful tonic spasms, but less has been reported regarding the relationship between NMO and headache. Though headache is well established as both a symptom and comorbidity of multiple sclerosis (MS), it has been much less described thus far in the NMO literature and warrants more careful evaluation. Many questions remain unanswered about the relationship between NMO and headache, including headache prevalence in certain groups, distribution of primary and symptomatic headache disorders that are seen most frequently and the specific neuroimaging findings that are associated with an increased risk of headache.
Various types of headache, such as cervicogenic headache and trigeminal autonomic cephalalgia-like headache, have been reported as the initial clinical presentation of NMO. Other publications have emphasized the association of NMO and other etiologies of headache, such as trigeminal neuralgia, PRES, and preeclampsia. Certain MR imaging findings such as medullary lesions in patients with NMO have also been associated with headache. The link between headache and NMO is evident not only in limited case reports and clinical studies but also with both MR imaging and even with some potential common underlying biomarkers such as pentraxin-3 and interleukin-6. Developing a further understanding in the association between these two diseases may lead to better management of headache in patients with NMO and potentially lead to earlier diagnosis of NMO in whom headache may serve as an initial presenting symptom and may even herald a disease exacerbation.
视神经脊髓炎（NMO）的典型临床表现包括纵向广泛横贯性脊髓炎和视神经炎。然而，最近在被诊断为NMO的患者中还描述了许多其他特征性现象，包括顽固性呃逆、呕吐和疼痛性强直性痉挛，但关于NMO与头痛之间的关系报道较少。尽管头痛已被确认为多发性硬化症（MS）的症状和合并症，但到目前为止，NMO文献中对此描述较少，值得更仔细地评估。关于NMO与头痛之间的关系仍有许多问题未得到解答，包括特定人群中的头痛患病率、最常见的原发性和症状性头痛疾病的分布以及与头痛风险增加相关的特定神经影像学表现。
已报道各种类型的头痛，如颈源性头痛和三叉自主神经性头痛样头痛，可作为NMO的初始临床表现。其他出版物强调了NMO与其他头痛病因的关联，如三叉神经痛、可逆性后部白质脑病综合征（PRES）和先兆子痫。NMO患者的某些磁共振成像（MR）表现，如延髓病变，也与头痛有关。头痛与NMO之间的联系不仅在有限的病例报告和临床研究中明显，而且在MR成像中甚至在一些潜在的共同潜在生物标志物如五聚素-3和白细胞介素-6中也很明显。进一步了解这两种疾病之间的关联可能会更好地管理NMO患者的头痛，并可能导致更早诊断NMO，在这些患者中头痛可能是初始症状，甚至可能预示疾病加重。
