Finsterer Josef, Zarrouk-Mahjoub Sinda
Krankenanstalt Rudolfstiftung, Vienna, Austria.
University of Tunis El Manar and Genomics Platform, Pasteur Institute of Tunis, Tunisia.
Clin Neurol Neurosurg. 2018 Mar;166:44-49. doi: 10.1016/j.clineuro.2018.01.020.
Headache is a prominent feature in mitochondrial disorders (MIDs) but no comprehensive overview is currently available. This review aims at summarising and discussing findings concerning type, frequency, pathogenesis, and treatment of headache in MIDs. The most frequent headache types in MIDs are migraine and migraine-like headache (MLH). MLH is classified as secondary headache. More rarely, tension-type headache, trigemino-autonomic headache, or different secondary headaches can be found. Migraine or MLH may manifest with or without aura. MLH is frequently associated with an ongoing or previous stroke-like episode (SLE) or a seizure but may also occur independently of other neurological features. MLH may be associated with prolonged aura or visual phenomena after headache. Except for MLH, treatment of headache in MIDs is not at variance from other causes of headache. Beyond the broadly accepted subtype-related headache treatment, diet, cofactors, vitamins, and antioxidants may provide a supplementary benefit. Midazolam, l-arginine, or l-citrulline may be beneficial for MLH. The pathogenesis of headache in MIDs largely remains unsolved. However, since migraine and MLH respond both to triptanes, a shared pathomechanism is likely. In conclusion, migraine and MLH are the prominent headache types in MIDs. MLH may or may not be associated with current or previous SLEs. MLH is pathophysiologically different from migraine and requires treatment at variance from that of migraine with aura.
头痛是线粒体疾病（MIDs）的一个突出特征，但目前尚无全面的概述。本综述旨在总结和讨论有关MIDs中头痛的类型、频率、发病机制及治疗的研究结果。MIDs中最常见的头痛类型是偏头痛和偏头痛样头痛（MLH）。MLH被归类为继发性头痛。较少见的有紧张型头痛、三叉自主神经性头痛或其他不同的继发性头痛。偏头痛或MLH可伴有或不伴有先兆。MLH常与正在发生的或既往的类卒中发作（SLE）或癫痫发作相关，但也可能独立于其他神经学特征而出现。MLH可能与头痛后先兆延长或视觉现象有关。除MLH外，MIDs中头痛的治疗与其他头痛原因并无差异。除了广泛接受的与亚型相关的头痛治疗方法外，饮食、辅助因子、维生素和抗氧化剂可能会带来额外益处。咪达唑仑、L-精氨酸或L-瓜氨酸可能对MLH有益。MIDs中头痛的发病机制在很大程度上仍未解决。然而，由于偏头痛和MLH对曲坦类药物均有反应，因此可能存在共同的病理机制。总之，偏头痛和MLH是MIDs中突出的头痛类型。MLH可能与当前或既往的SLE有关，也可能无关。MLH在病理生理上与偏头痛不同，需要与伴有先兆的偏头痛采用不同的治疗方法。
