Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, United Kingdom; Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan; University Hospital, Taipa, Macau.
Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; College of Medicine, Taipei Medical University, Taipei, Taiwan.
Prog Brain Res. 2020;255:207-247. doi: 10.1016/bs.pbr.2020.05.018. Epub 2020 Jun 15.
The visual network is crucially implicated in the pathophysiology of migraine. Several lines of evidence indicate that migraine is characterized by an altered visual cortex excitability both during and between attacks. Visual symptoms, the most common clinical manifestation of migraine aura, are likely the result of cortical spreading depression originating from the extrastriate area V3A. Photophobia, a clinical hallmark of migraine, is linked to an abnormal sensory processing of the thalamus which is converged with the non-image forming visual pathway. Finally, visual snow is an increasingly recognized persistent visual phenomenon in migraine, possibly caused by increased perception of subthreshold visual stimuli. Emerging research in non-invasive brain stimulation (NIBS) has vastly developed into a diversity of areas with promising potential. One of its clinical applications is the single-pulse transcranial magnetic stimulation (sTMS) applied over the occipital cortex which has been approved for treating migraine with aura, albeit limited evidence. Studies have also investigated other NIBS techniques, such as repetitive TMS (rTMS) and transcranial direct current stimulation (tDCS), for migraine prophylaxis but with conflicting results. As a dynamic brain disorder with widespread pathophysiology, targeting migraine with NIBS is challenging. Furthermore, unlike the motor cortex, evidence suggests that the visual cortex may be less plastic. Controversy exists as to whether the same fundamental principles of NIBS, based mainly on findings in the motor cortex, can be applied to the visual cortex. This review aims to explore existing literature surrounding NIBS studies on the visual system of migraine. We will first provide an overview highlighting the direct implication of the visual network in migraine. Next, we will focus on the rationale behind using NIBS for migraine treatment, including its effects on the visual cortex, and the shortcomings of currently available evidence. Finally, we propose a broader perspective of how novel approaches, the concept of brain networks and the integration of multimodal imaging with computational modeling, can help refine current NIBS methods, with the ultimate goal of optimizing a more individualized treatment for migraine.
视觉网络在偏头痛的病理生理学中起着至关重要的作用。有几条证据表明，偏头痛在发作期间和发作之间都表现出视觉皮层兴奋性的改变。视觉症状是偏头痛最常见的临床先兆表现，很可能是源于 V3A 区的皮质扩散性抑制。畏光，偏头痛的一个临床特征，与丘脑异常感觉处理有关，而丘脑与非成像视觉通路相融合。最后，视觉雪是偏头痛中越来越被认识到的持续性视觉现象，可能是由于对阈下视觉刺激的感知增加所致。新兴的非侵入性脑刺激 (NIBS) 研究已经在许多领域得到了广泛的发展，具有广阔的应用前景。其临床应用之一是在枕叶皮层上应用单脉冲经颅磁刺激 (sTMS)，尽管证据有限，但已被批准用于治疗有先兆偏头痛。研究还探索了其他 NIBS 技术，如重复经颅磁刺激 (rTMS) 和经颅直流电刺激 (tDCS)，用于偏头痛预防，但结果存在冲突。由于偏头痛是一种具有广泛病理生理学的动态脑障碍，因此使用 NIBS 治疗偏头痛具有挑战性。此外，与运动皮层不同，有证据表明视觉皮层的可塑性可能较低。关于基于运动皮层的主要发现的 NIBS 基本原则是否可以应用于视觉皮层，存在争议。本综述旨在探讨偏头痛视觉系统的 NIBS 研究的现有文献。我们将首先提供一个概述，强调视觉网络在偏头痛中的直接作用。接下来，我们将重点介绍使用 NIBS 治疗偏头痛的原理，包括其对视觉皮层的影响，以及现有证据的局限性。最后，我们提出了一个更广泛的观点，即新方法、脑网络概念以及多模态成像与计算建模的整合如何帮助完善当前的 NIBS 方法，最终目标是优化更个体化的偏头痛治疗方法。
