Neurology I, Headache Center, Department of Neuroscience, University of Torino, Via Cherasco 15, Turin, 10126, Italy.
Curr Pain Headache Rep. 2018 Apr 4;22(5):36. doi: 10.1007/s11916-018-0691-7.
The goals of this review are to evaluate recent studies regarding comorbidity between migraine and different metabolic and endocrine disorders and to discuss the role of insulin resistance as a common pathogenetic mechanism of these diseases.
Recently, several studies showed that migraine is associated with insulin resistance, a condition in which a normal amount of insulin induces a suboptimal physiological response. All the clinical studies that used the oral glucose tolerance test to examine insulin sensitivity found that, after glucose load, there is in migraine patients a significant increase of both plasmatic insulin and glucose concentrations in comparison with controls. On the contrary, no association was found between migraine and type 2 diabetes, while type 1 diabetes seems to have a protective effect in the disease. Obesity and hypertension were shown to be risk factors for both episodic and chronic migraine. Metabolic syndrome has been recently associated mainly with migraine with aura and is now considered a risk factor also for medication overuse headache. Finally, a bidirectional association between migraine and hypothyroidism has been recently demonstrated, suggesting that common genetic or autoimmune mechanisms underlie both diseases. Recent studies showed that insulin receptor signaling and the related physiological responses are altered in migraine and may have a relevant pathogenic role in the disease. Further studies are warranted in order to better elucidate mechanisms underlying insulin resistance in migraine in order to develop new therapeutic strategies for this debilitating disease.
本次综述旨在评估有关偏头痛与不同代谢和内分泌疾病之间共病的最新研究，并讨论胰岛素抵抗作为这些疾病共同发病机制的作用。
最近，一些研究表明偏头痛与胰岛素抵抗有关，胰岛素抵抗是指正常量的胰岛素引起的生理反应不佳的情况。所有使用口服葡萄糖耐量试验来检查胰岛素敏感性的临床研究发现，与对照组相比，偏头痛患者在葡萄糖负荷后，血浆胰岛素和葡萄糖浓度均显著升高。相反，偏头痛与 2 型糖尿病之间没有关联，而 1 型糖尿病似乎对偏头痛具有保护作用。肥胖症和高血压被认为是偏头痛发作和慢性偏头痛的危险因素。代谢综合征最近主要与有先兆偏头痛相关，现在也被认为是药物过度使用性头痛的危险因素。最后，最近证明偏头痛与甲状腺功能减退之间存在双向关联，这表明这两种疾病的发病机制可能存在共同的遗传或自身免疫机制。最近的研究表明，偏头痛患者的胰岛素受体信号转导和相关生理反应发生改变，这可能在疾病中具有重要的发病作用。需要进一步研究以更好地阐明偏头痛中胰岛素抵抗的机制，从而为这种使人衰弱的疾病开发新的治疗策略。
