Department of Neurosurgery, CHRU de Tours, U1253, 10, Boulevard Tonnellé, 37032 Tours, France; UMR 1253, ibrain, Université de Tours, Inserm, Tours, France.
Department of Neurosurgery, CHU de Nice, Université Cote d'Azur, Nice, France; Université Cote d'Azur, FHU INOVPAIN, CHU de Nice, Nice, France.
Rev Neurol (Paris). 2021 Sep;177(7):765-772. doi: 10.1016/j.neurol.2021.07.012. Epub 2021 Aug 9.
Understanding intracranial nociceptive innervation is essential to understand the pathophysiology of headaches. Our knowledge about human intracranial nociception comes from sparse observations during neurosurgical procedures performed in awake patients, from human anatomical studies and from experimental studies in animals. In this article we review the anatomical and functional organization underlying nociceptive innervation. Intracranial nociception is mainly mediated by the trigeminal system, except in the posterior cranial fossa that is innervated by the first cervical roots. For decades, the dura mater, its vessels and major cerebral blood vessels were considered as the only intracranial pain-sensitive structures. Recent animal and human studies have suggested that smaller brain arteries and potentially pia mater might also be pain sensitive. Nociceptive neurons innervating intracranial blood vessels project via the ophthalmic division (V1) to the trigeminal ganglion and store several neurotransmitters including glutamate, substance P and calcitonin gene-related peptide (CGRP). The trigeminal ganglion, root and brainstem nuclei have a specific topographic and functional somatotopy. Progressive transition between the trigeminal spinal nucleus and the dorsal horn of the cervical spinal cord, and convergence of nociceptive inputs from the face, intracranial structures and the occipital area on the so-called "trigemino-cervical complex" may explain some headache features, relations between facial and occipital pain, and efficacy of occipital nerve stimulation in headache. The specific anatomic organization of the trigeminal system, from the primary-order neuron in the trigeminal ganglion, to the second-order neuron is the trigeminal nuclei, may explain a part of the various characteristics of headaches.
理解颅内痛觉传入对于理解头痛的病理生理学至关重要。我们对人类颅内痛觉的认识来自于清醒患者接受神经外科手术时的稀疏观察、人体解剖学研究以及动物实验研究。本文综述了痛觉传入的解剖和功能组织。颅内痛觉主要由三叉神经系统介导,除了由第一颈椎根支配的后颅窝。几十年来,硬脑膜、其血管和主要脑动脉被认为是唯一的颅内痛觉敏感结构。最近的动物和人体研究表明,较小的脑动脉和潜在的软脑膜也可能对疼痛敏感。支配颅内血管的伤害性神经元通过眼分支 (V1) 投射到三叉神经节,并储存几种神经递质,包括谷氨酸、P 物质和降钙素基因相关肽 (CGRP)。三叉神经节、神经根和脑干核具有特定的拓扑和功能躯体定位。三叉脊核和颈脊髓背角之间的逐渐过渡,以及来自面部、颅内结构和枕区的伤害性传入在所谓的“三叉-颈复合体”上的汇聚,可能解释了一些头痛特征、面部和枕部疼痛之间的关系,以及枕神经刺激在头痛中的疗效。三叉神经系统的特定解剖组织,从三叉神经节中的初级神经元到第二级神经元——三叉神经核,可能解释了头痛的各种特征的一部分。