Lippi Giuseppe, Mattiuzzi Camilla
Service of Clinical Governance, General Hospital of Trento, Trento, Italy.
Agri. 2017 Jul;29(3):95-99. doi: 10.5505/agri.2017.25348.
Migraine is a highly prevalent and disabling disorder. Because stress appears to be a prominent trigger of this condition and cortisol is a well-established stress hormone, we performed a search on Medline, Scopus, and Web of Science to identify clinical studies that assessed cortisol levels in migraineurs. Four cross-section studies, one observational study, and three both cross-sectional and observational studies were finally included in our analysis. The heterogeneity was modest for the sample size (49.8%) but was remarkably high for a sample matrix (66.0%), thus precluding the possibility to meta-analyze the data. In six of the seven cross-sectional studies, cortisol levels did not differ between the cases and controls. With regard to the four observational trials, both nitroglycerine and human corticotropin-releasing hormone but not m-chlorophenylpiperazine were effective in generating a more prominent cortisol release in migraineurs than in controls. In a fourth observation trial, salivary cortisol did not differ during the migraine attack and during the migraine free-period. In conclusion, even if altered corticotrope responsiveness exists in migraineurs, it appears to be irrelevant in the pathogenesis of migraine.
偏头痛是一种高度流行且使人致残的疾病。由于压力似乎是这种疾病的一个主要触发因素，而皮质醇是一种公认的应激激素，我们在医学文献数据库（Medline）、Scopus数据库和科学网（Web of Science）上进行了检索，以确定评估偏头痛患者皮质醇水平的临床研究。最终，我们的分析纳入了四项横断面研究、一项观察性研究以及三项兼具横断面和观察性的研究。样本量的异质性适中（49.8%），但样本基质的异质性非常高（66.0%），因此排除了对数据进行荟萃分析的可能性。在七项横断面研究中的六项里，病例组和对照组的皮质醇水平没有差异。关于四项观察性试验，硝酸甘油和促肾上腺皮质激素释放激素能使偏头痛患者比对照组产生更显著的皮质醇释放，而间氯苯哌嗪则无此作用。在第四项观察性试验中，偏头痛发作期间和无偏头痛期间的唾液皮质醇水平没有差异。总之，即使偏头痛患者存在促肾上腺皮质激素反应性改变，这在偏头痛的发病机制中似乎也无关紧要。
