De Simone Roberto, Sansone Mattia, Bonavita Vincenzo
Department of Neuroscience, Reproductive Sciences and Odontostomatology, Headache Centre, University Federico II of Naples, Via Pansini, 5, 80131, Naples, Italy.
Istituto di Diagnosi e Cura Hermitage Capodimonte, Naples, Italy.
Neurol Sci. 2020 Dec;41(Suppl 2):417-421. doi: 10.1007/s10072-020-04641-w.
Headache is the most frequent and often the most severe symptom of idiopathic intracranial hypertension (IIH) clinical presentation, although pain characteristics are very variable among sufferers and the pain may even lack in some cases. Whatever the headache features, refractoriness to treatments, pain worsening in the recumbent position, and frequent awakenings with severe headache late in the night are the specific complains of such patients. However, a migraine or probable migraine headache, mostly with a chronic headache pattern, can be diagnosed in about 2/3 of the cases. In IIH cases without papilledema (IIHWOP), this leads to a high rate of misdiagnosis with primary chronic migraine (CM). Mechanisms responsible for the shared migrainous presentation of CM and IIH/IIHWOP may rely on a pathologic CGRP release from the rich trigemino-vascular innervated dural sinuses, congested in the course of raised intracranial pressure. The possible role of IIHWOP as a powerful and modifiable risk factor for migraine progression is discussed. Further studies investigating the possible efficacy of anti CGRP/receptor antibodies in IIH/IIHWOP headache treatment are needed.
头痛是特发性颅内高压（IIH）临床表现中最常见且往往最严重的症状，尽管患者的疼痛特征差异很大，甚至在某些情况下可能没有疼痛症状。无论头痛特征如何，治疗难治性、卧位时疼痛加剧以及深夜频繁因严重头痛醒来都是此类患者的特殊主诉。然而，约2/3的病例可诊断为偏头痛或可能的偏头痛性头痛，大多为慢性头痛模式。在无视乳头水肿的IIH病例（IIHWOP）中，这导致与原发性慢性偏头痛（CM）的误诊率很高。CM与IIH/IIHWOP共同的偏头痛样表现的机制可能依赖于在颅内压升高过程中充血的、富含三叉神经血管支配的硬脑膜窦病理性释放降钙素基因相关肽（CGRP）。讨论了IIHWOP作为偏头痛进展的一个强大且可改变的危险因素的可能作用。需要进一步研究抗CGRP/受体抗体在IIH/IIHWOP头痛治疗中的可能疗效。
