Zaproudina Nina, Rissanen Antti-Pekka E, Lipponen Jukka A, Vierola Anu, Rissanen Saara M, Karjalainen Pasi A, Soinila Seppo, Närhi Matti
Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.
Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland.
Front Neurol. 2018 Dec 21;9:1112. doi: 10.3389/fneur.2018.01112. eCollection 2018.
Prevalence of masticatory parafunctions, such as tooth clenching and grinding, is higher among migraineurs than non-migraineurs, and masticatory dysfunctions may aggravate migraine. Migraine predisposes to cerebrovascular disturbances, possibly due to impaired autonomic vasoregulation, and sensitization of the trigeminovascular system. The relationships between clenching, migraine, and cerebral circulation are poorly understood. We used Near-Infrared Spectroscopy to investigate bilateral relative oxy- (%Δ[OHb]), deoxy- (%Δ[HHb]), and total (%Δ[tHb]) hemoglobin concentration changes in prefrontal cortex induced by maximal tooth clenching in twelve headache-free migraineurs and fourteen control subjects. From the start of the test, migraineurs showed a greater relative increase in right-side %Δ[HHb] than controls, who showed varying reactions, and right-side increase in %Δ[tHb] was also greater in migraineurs ( < 0.001 and < 0.05, respectively, time-group interactions, Linear mixed models). With multivariate regression model, migraine predicted the magnitude of maximal blood pressure increases, associated in migraineurs with mood scores and an intensity of both headache and painful signs of temporomandibular disorders (pTMD). Although changes in circulatory parameters predicted maximal NIRS responses, the between-group differences in the right-side NIRS findings remained significant after adjusting them for systolic blood pressure and heart rate. A family history of migraine, reported by all migraineurs and four controls, also predicted maximal increases in both %Δ[HHb] and %Δ[tHb]. Presence of pTMD, revealed in clinical oral examination in eight migraineurs and eight controls, was related to maximal %Δ[HHb] increase only in controls. To conclude, the greater prefrontal right-side increases in cerebral %Δ[HHb] and %Δ[tHb] may reflect disturbance of the tooth clenching-related cerebral (de)oxygenation based on impaired reactivity and abnormal microcirculation processes in migraineurs. This finding may have an impact in migraine pathophysiology and help to explain the deleterious effect of masticatory dysfunctions in migraine patients. However, the role of tooth clenching as a migraine trigger calls for further studies.
磨牙症等咀嚼功能异常在偏头痛患者中的发生率高于非偏头痛患者，且咀嚼功能障碍可能会加重偏头痛。偏头痛易引发脑血管紊乱，这可能是由于自主神经血管调节受损以及三叉神经血管系统敏感化所致。目前，对于紧咬牙、偏头痛和脑循环之间的关系了解甚少。我们使用近红外光谱技术，研究了12名无头痛症状的偏头痛患者和14名对照者在最大程度紧咬牙时前额叶皮质中双侧相对氧合血红蛋白（%Δ[OHb]）、脱氧血红蛋白（%Δ[HHb]）和总血红蛋白（%Δ[tHb]）浓度的变化。从测试开始，偏头痛患者右侧%Δ[HHb]的相对增加幅度大于对照者，对照者表现出不同的反应，偏头痛患者右侧%Δ[tHb]的增加幅度也更大（时间-组交互作用，线性混合模型，分别为<0.001和<0.05）。通过多变量回归模型，偏头痛可预测最大血压升高幅度，在偏头痛患者中，这与情绪评分以及头痛和颞下颌关节紊乱症（pTMD）疼痛症状的强度相关（pTMD）。尽管循环参数的变化可预测最大近红外光谱反应，但在根据收缩压和心率进行调整后，右侧近红外光谱结果的组间差异仍然显著。所有偏头痛患者和4名对照者报告的偏头痛家族史，也可预测%Δ[HHb]和%Δ[tHb]的最大增加。在8名偏头痛患者和8名对照者的临床口腔检查中发现的pTMD，仅与对照者中%Δ[HHb]的最大增加有关。总之，偏头痛患者前额叶右侧大脑%Δ[HHb]和%Δ[tHb]的更大增加，可能反映了基于反应性受损和微循环异常过程的与紧咬牙相关的脑（去）氧合障碍。这一发现可能对偏头痛的病理生理学产生影响，并有助于解释咀嚼功能障碍对偏头痛患者的有害影响。然而，紧咬牙作为偏头痛触发因素的作用仍需进一步研究。
