Ornello Raffaele, Frattale Ilaria, Caponnetto Valeria, Pistoia Francesca, Sacco Simona
Neurology Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy.
Neurology Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy.
J Neurol Sci. 2020 Jul 15;414:116887. doi: 10.1016/j.jns.2020.116887. Epub 2020 May 6.
Migraine, and especially migraine with aura, is associated with an increased risk of stroke and vascular events; however, the reasons for this association are unclear. Several studies evaluated cerebral autoregulation and vasomotor reactivity in patients with migraine compared with non-migraineurs, with conflicting results. Our narrative review aimed at summarizing their results to find the most reliable evidence in the field. Studies which used visual stimuli to evoke vascular responses consistently showed an increased vascular reactivity in migraineurs compared with non-migraineurs, while studies which used systemic stimuli such as hyper- or hypocapnia showed inconsistent results. Therefore, central neural mechanisms might be more important than peripheral vascular mechanisms in determining the cerebral vascular responses of patients with migraine. However, a large body of evidence supports the existence of peripheral vascular dysfunction in patients with migraine. Further studies are needed to explain the complex interactions between central neural and peripheral vascular mechanisms in determining migraine and its vascular risk. Migraine preventive treatments, and especially the most recent ones with a peripheral action, might provide important insights in this field.
偏头痛，尤其是伴有先兆的偏头痛，与中风及血管事件风险增加相关；然而，这种关联的原因尚不清楚。与非偏头痛患者相比，多项研究评估了偏头痛患者的脑自动调节和血管运动反应，结果相互矛盾。我们的叙述性综述旨在总结这些研究结果，以找出该领域最可靠的证据。使用视觉刺激诱发血管反应的研究一致表明，与非偏头痛患者相比，偏头痛患者的血管反应性增加，而使用高碳酸血症或低碳酸血症等全身刺激的研究结果则不一致。因此，在决定偏头痛患者的脑血管反应方面，中枢神经机制可能比外周血管机制更为重要。然而，大量证据支持偏头痛患者存在外周血管功能障碍。需要进一步研究来解释中枢神经和外周血管机制在决定偏头痛及其血管风险方面的复杂相互作用。偏头痛预防性治疗，尤其是最近具有外周作用的治疗方法，可能会为该领域提供重要见解。
