Drummond P D
Department of Neurology, Prince Henry Hospital, Australia.
Brain. 1988 Oct;111 ( Pt 5):1199-209. doi: 10.1093/brain/111.5.1199.
Ocular sympathetic function, facial flushing and the presence or absence of lachrymation and rhinorrhoea were examined in 30 patients during spontaneous or nitroglycerin-induced cluster headache. In 27 cases measurements were also obtained during the headache-free interval. Ocular sympathetic function was impaired on the symptomatic side between cluster attacks and function was reduced further during cluster headache. Greater heat loss from the orbital region on the symptomatic side was associated with ocular sympathetic dysfunction both during and between attacks, and with lachrymation during attacks. Heat loss from the cheek and side of the nose was greater on the symptomatic side in patients whose attack was accompanied by lachrymation, but heat loss from these areas was unrelated to the extent of ocular sympathetic deficit. These findings suggest that parasympathetic overactivity in the greater superficial petrosal nerve provokes facial flushing and lachrymation. Parasympathetic overactivity could also cause dilatation of the internal carotid artery and compression of the periarterial plexus of sympathetic fibres, producing a sympathetic deficit with release of vasoconstrictor tone in the eye. Thus autonomic disturbances in cluster headache may be explained by the unitary hypothesis of parasympathetic hyperactivity being responsible for ocular sympathetic deficit.
在30例患者的自发性或硝酸甘油诱发的丛集性头痛发作期间，对其眼部交感神经功能、面部潮红以及是否存在流泪和流涕情况进行了检查。在27例患者中，还在无头痛间歇期进行了测量。在丛集性发作期间，患侧的眼部交感神经功能受损，而在丛集性头痛发作时功能进一步降低。在发作期间及发作间歇期，患侧眶区更大的热量散失与眼部交感神经功能障碍有关，且与发作时的流泪有关。在伴有流泪的患者中，患侧脸颊和鼻侧的热量散失更大，但这些区域的热量散失与眼部交感神经功能缺损程度无关。这些发现提示，岩大浅神经副交感神经活动过度可引发面部潮红和流泪。副交感神经活动过度还可能导致颈内动脉扩张以及交感神经纤维动脉周围丛受压，从而产生交感神经功能缺损，并使眼部血管收缩张力释放。因此，丛集性头痛中的自主神经紊乱可能可用副交感神经活动亢进导致眼部交感神经功能缺损的单一假说进行解释。
