Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215.
Harvard Medical School, Boston, MA 02115.
Proc Natl Acad Sci U S A. 2017 Jul 11;114(28):E5683-E5692. doi: 10.1073/pnas.1708361114. Epub 2017 Jun 26.
Migraineurs avoid light because it intensifies their headache. However, this is not the only reason for their aversion to light. Studying migraineurs and control subjects, we found that lights triggered more changes in autonomic functions and negative emotions during, rather than in the absence of, migraine or in control subjects, and that the association between light and positive emotions was stronger in control subjects than migraineurs. Seeking to define a neuroanatomical substrate for these findings, we showed that, in rats, axons of retinal ganglion cells converge on hypothalamic neurons that project directly to nuclei in the brainstem and spinal cord that regulate parasympathetic and sympathetic functions and contain dopamine, histamine, orexin, melanin-concentrating hormone, oxytocin, and vasopressin. Although the rat studies define frameworks for conceptualizing how light triggers the symptoms described by patients, the human studies suggest that the aversive nature of light is more complex than its association with headache intensification.
偏头痛患者回避光线，因为这会加剧他们的头痛。然而，这并不是他们对光产生厌恶的唯一原因。通过对偏头痛患者和对照组进行研究，我们发现，在偏头痛发作期间而非发作间期，光线会引发更多的自主功能和负面情绪变化，而在对照组中，光线与正面情绪的关联比偏头痛患者更强。为了确定这些发现的神经解剖学基础，我们表明，在大鼠中，视网膜神经节细胞的轴突汇聚在投射到调节副交感神经和交感神经功能并含有多巴胺、组胺、食欲素、黑素浓缩激素、催产素和加压素的下丘脑神经元上。尽管大鼠研究为理解光线如何引发患者所描述的症状提供了概念框架，但人体研究表明，光的令人厌恶的性质比其与头痛加剧的关联更为复杂。
