硝化甘油引发曲坦类药物反应性颅神经病和三叉神经神经元敏化。

Nitroglycerine triggers triptan-responsive cranial allodynia and trigeminal neuronal hypersensitivity.

机构信息

Headache Group-Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.

Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, NY, USA.

出版信息

Brain. 2019 Jan 1;142(1):103-119. doi: 10.1093/brain/awy313.

Abstract

Cranial allodynia associated with spontaneous migraine is reported as either responsive to triptan treatment or to be predictive of lack of triptan efficacy. These conflicting results suggest that a single mechanism mediating the underlying neurophysiology of migraine symptoms is unlikely. The lack of a translational approach to study cranial allodynia reported in migraine patients is a limitation in dissecting potential mechanisms. Our objective was to study triptan-responsive cranial allodynia in migraine patients, and to develop an approach to studying its neural basis in the laboratory. Using nitroglycerine to trigger migraine attacks, we investigated whether cranial allodynia could be triggered experimentally, observing its response to treatment. Preclinically, we examined the cephalic response properties of central trigeminocervical neurons using extracellular recording techniques, determining changes to ongoing firing and somatosensory cranial-evoked sensitivity, in response to nitroglycerine followed by triptan treatment. Cranial allodynia was triggered alongside migraine-like headache in nearly half of subjects. Those who reported cranial allodynia accompanying their spontaneous migraine attacks were significantly more likely to have symptoms triggered than those that did not. Patients responded to treatment with aspirin or sumatriptan. Preclinically, nitroglycerine caused an increase in ongoing firing and hypersensitivity to intracranial-dural and extracranial-cutaneous (noxious and innocuous) somatosensory stimulation, reflecting signatures of central sensitization potentially mediating throbbing headache and cranial allodynia. These responses were aborted by a triptan. These data suggest that nitroglycerine can be used as an effective and reliable method to trigger cranial allodynia in subjects during evoked migraine, and the symptom is responsive to abortive triptan treatments. Preclinically, nitroglycerine activates the underlying neural mechanism of cephalic migraine symptoms, central sensitization, also predicting the clinical outcome to triptans. This supports a biological rationale that several mechanisms can mediate the underlying neurophysiology of migraine symptoms, with nitrergic-induced changes reflecting one that is relevant to spontaneous migraine in many migraineurs, whose symptoms of cranial allodynia are responsive to triptan treatment. This approach translates directly to responses in animals and is therefore a relevant platform to study migraine pathophysiology, and for use in migraine drug discovery.

摘要

与自发性偏头痛相关的颅神经痛被报道为对曲坦类药物治疗有反应或对曲坦类药物疗效缺乏预测。这些相互矛盾的结果表明,介导偏头痛症状潜在神经生理学的单一机制不太可能存在。在偏头痛患者中,缺乏一种用于研究颅神经痛的转化方法是剖析潜在机制的一个限制。我们的目的是研究偏头痛患者中曲坦类药物反应性颅神经痛,并开发一种在实验室研究其神经基础的方法。我们使用硝酸甘油诱发偏头痛发作,研究颅神经痛是否可以通过实验触发,并观察其对治疗的反应。在临床前,我们使用细胞外记录技术检查了中枢三叉颈神经元的头部反应特性,确定了硝酸甘油后曲坦类药物治疗对持续放电和感觉性颅神经诱发敏感性的变化。在近一半的受试者中,颅神经痛与偏头痛样头痛同时发生。那些报告伴随自发性偏头痛发作的颅神经痛的患者比没有报告的患者更有可能出现症状触发。患者对阿司匹林或舒马曲坦的治疗有反应。在临床前,硝酸甘油导致持续放电增加,对颅内硬膜和颅外皮肤(有害和无害)感觉刺激的敏感性增加,反映了潜在介导搏动性头痛和颅神经痛的中枢敏化的特征。这些反应被曲坦类药物阻断。这些数据表明,硝酸甘油可用于在诱发偏头痛期间有效且可靠地触发受试者的颅神经痛,并且该症状对中止性曲坦类药物治疗有反应。在临床前,硝酸甘油激活了头部偏头痛症状的潜在神经机制,即中枢敏化,也预测了曲坦类药物的临床疗效。这支持了一种生物学原理,即几种机制可以介导偏头痛症状的潜在神经生理学,而硝酸甘油诱导的变化反映了许多偏头痛患者自发性偏头痛相关的一种机制,其颅神经痛症状对曲坦类药物治疗有反应。这种方法直接转化为动物的反应,因此是研究偏头痛病理生理学的一个相关平台,也可用于偏头痛药物发现。

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