目前对偏头痛头痛中脑膜和脑血管功能的理解。
Current understanding of meningeal and cerebral vascular function underlying migraine headache.
机构信息
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
出版信息
Cephalalgia. 2019 Nov;39(13):1606-1622. doi: 10.1177/0333102418771350. Epub 2018 Jun 21.
BACKGROUND
The exact mechanisms underlying the onset of a migraine attack are not completely understood. It is, however, now well accepted that the onset of the excruciating throbbing headache of migraine is mediated by the activation and increased mechanosensitivity (i.e. sensitization) of trigeminal nociceptive afferents that innervate the cranial meninges and their related large blood vessels.
OBJECTIVES
To provide a critical summary of current understanding of the role that the cranial meninges, their associated vasculature, and immune cells play in meningeal nociception and the ensuing migraine headache.
METHODS
We discuss the anatomy of the cranial meninges, their associated vasculature, innervation and immune cell population. We then debate the meningeal neurogenic inflammation hypothesis of migraine and its putative contribution to migraine pain. Finally, we provide insights into potential sources of meningeal inflammation and nociception beyond neurogenic inflammation, and their potential contribution to migraine headache.
背景
偏头痛发作的确切机制尚未完全阐明。然而，现在人们普遍认为，偏头痛剧烈搏动性头痛的发作是由支配颅脑膜及其相关大血管的三叉神经伤害性传入纤维的激活和机械敏感性（即敏化）增加介导的。
目的
批判性总结当前对颅脑膜、相关血管和免疫细胞在脑膜伤害感受和随后的偏头痛头痛中的作用的理解。
方法
我们讨论了颅脑膜的解剖结构、相关血管、神经支配和免疫细胞群。然后，我们辩论了偏头痛的脑膜神经原性炎症假说及其对偏头痛疼痛的可能贡献。最后，我们深入探讨了神经原性炎症以外的脑膜炎症和伤害感受的潜在来源及其对偏头痛头痛的潜在贡献。
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