Dzator Jemima Sa, Howe Peter Rc, Wong Rachel Hx
Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia.
Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.
J Cereb Blood Flow Metab. 2021 May;41(5):919-944. doi: 10.1177/0271678X20964344. Epub 2020 Oct 22.
Previous studies have investigated whether migraine is a circulatory disorder, as migraineurs are at heightened risk of cerebrovascular disease. However, in most cases, systemic vascular function was evaluated, which may not reflect abnormalities in the cerebral circulation. Therefore, we aimed to determine whether cerebrovascular function differs between migraineurs and controls. A systematic literature search was conducted across three electronic databases to search for studies that compared cerebrovascular function in migraineurs to controls. Where applicable, meta-analyses were used to determine standardised mean differences (SMD) between migraineurs and controls. Seventy articles were identified, 40 of which contained quantitative data. Meta-analyses showed pulsatility index (PI) was higher (SMD = 0.23; 95%CI = 0.05 to 0.42, = 0.01) and cerebrovascular responsiveness (CVR) to hypercapnia was lower (SMD=-0.34; 95%CI=-0.67 to -0.01, = 0.04) in the posterior circulation of migraineurs, particularly those without aura. The meta-analyses also indicated that migraineurs have higher resting mean blood flow velocity in both anterior (SMD = 0.14; 95%CI = 0.05 to 0.23, = 0.003) and posterior circulations (SMD = 0.20; 95%CI = 0.05 to 0.34, = 0.007). Compared to healthy controls, migraineurs have altered cerebrovascular function, evidenced by elevated PI (representing arterial stiffness) and impaired CVR to hypercapnia (representing cerebral vasodilator function). Future studies should investigate whether improvement of cerebrovascular function is able to alleviate migraine.
既往研究探讨了偏头痛是否为一种循环系统疾病,因为偏头痛患者患脑血管疾病的风险更高。然而,在大多数情况下,评估的是全身血管功能,这可能无法反映脑循环的异常情况。因此,我们旨在确定偏头痛患者和对照组之间的脑血管功能是否存在差异。我们在三个电子数据库中进行了系统的文献检索,以查找比较偏头痛患者和对照组脑血管功能的研究。在适用的情况下,采用荟萃分析来确定偏头痛患者和对照组之间的标准化平均差异(SMD)。共识别出70篇文章,其中40篇包含定量数据。荟萃分析显示,偏头痛患者,尤其是无先兆偏头痛患者的后循环中,搏动指数(PI)较高(SMD = 0.23;95%CI = 0.05至0.42,P = 0.01),对高碳酸血症的脑血管反应性(CVR)较低(SMD = -0.34;95%CI = -0.67至-0.01,P = 0.04)。荟萃分析还表明,偏头痛患者在前循环(SMD = 0.14;95%CI = 0.05至0.23,P = 0.003)和后循环(SMD = 0.20;95%CI = 0.05至0.34,P = 0.007)中的静息平均血流速度均较高。与健康对照组相比,偏头痛患者的脑血管功能发生了改变,表现为PI升高(代表动脉僵硬度)和对高碳酸血症的CVR受损(代表脑血管舒张功能)。未来的研究应探讨改善脑血管功能是否能够缓解偏头痛。