偏头痛中的颅自主症状与中枢敏化有关：三级头痛中心 164 例偏头痛患者的前瞻性研究。
Cranial autonomic symptoms in migraine are related to central sensitization: a prospective study of 164 migraine patients at a tertiary headache center.
机构信息
Headache Center and Department of Neurology, Tominaga Hospital, 1 - 4 - 48 Minatomachi, Naniwa ward, Osaka, Japan.
Division of Neurology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
出版信息
BMC Neurol. 2022 Mar 14;22(1):89. doi: 10.1186/s12883-022-02610-8.
BACKGROUND
Cranial autonomic symptoms (CASs) during migraine attacks are reported to be quite common regardless of ethnicity. In our previous study investigating 373 migraineurs, we found that 42.4% of them had CASs. The patients with CASs more frequently had cutaneous allodynia than did those without CASs, and we speculated that CASs were associated with central sensitization. The present study searched for substantial evidence on the relationship between CASs and central sensitization in migraine patients.
METHODS
This was a prospective cross-sectional study. We studied a new independent cohort of 164 migraineurs who presented to the Tominaga Hospital Headache Center from July 2018 until December 2019. The clinical features of CASs according to the criteria in ICHD-3 (beta) were investigated. We also evaluated central sensitization based on the 25 health-related symptoms utilizing the validated central sensitization inventory (CSI), and each symptom was rated from 0 to 4 resulting a total score of 0-100.
RESULTS
The mean age was 41.8 (range: 20 to 77) years old. One hundred and thirty-one patients (78.9%) were women. Eighty-six of the 164 (52.4%) patients had at least 1 cranial autonomic symptom. The CSI score of the patients with ≥3 CASs reflected a moderate severity and was significantly higher than in those without CASs (41.9 vs. 30.7, p = 0.0005). The score of the patients with ≥1 conspicuous CAS also reflected a moderate severity and was significantly higher than in those without CASs (40.7 vs. 33.2, p = 0.013). The patients in the CSI ≥40 group had lacrimation, aural fullness, nasal blockage, and rhinorrhea, which are cranial autonomic parasympathetic symptoms, significantly more frequently than those in the CSI < 40 group.
CONCLUSIONS
Migraine patients with CASs showed significantly greater central sensitization than those without such symptoms. In particular, cranial parasympathetic symptoms were more frequent in centrally sensitized patients than in nonsensitized patients, suggesting that cranial parasympathetic activation may contribute to the maintenance of central sensitization.
TRIAL REGISTRATION
This study was retrospectively registered with UMIN-CTR on 29 Aug 2020 ( UMIN000041603 ).
背景
无论种族如何，偏头痛发作时的颅自主症状（CAS）都被报道相当常见。在我们之前研究 373 名偏头痛患者的研究中，发现其中 42.4%有 CAS。有 CAS 的患者比没有 CAS 的患者更常出现皮肤感觉过敏，我们推测 CAS 与中枢敏化有关。本研究旨在寻找偏头痛患者中 CAS 与中枢敏化之间关系的实质性证据。
方法
这是一项前瞻性横断面研究。我们研究了 2018 年 7 月至 2019 年 12 月期间来自富田医院头痛中心的 164 名新的独立偏头痛患者队列。根据 ICHD-3(beta)标准调查 CAS 临床特征。我们还利用经过验证的中枢敏化量表（CSI）基于 25 个与健康相关的症状评估中枢敏化，每个症状评分为 0 至 4，总分为 0-100。
结果
平均年龄为 41.8（范围：20-77）岁。131 名患者（78.9%）为女性。164 名患者中有 86 名（52.4%）至少有 1 种颅自主症状。有≥3 种 CAS 的患者的 CSI 评分反映出中度严重程度，明显高于无 CAS 的患者（41.9 vs. 30.7，p=0.0005）。有≥1 种明显 CAS 的患者的评分也反映出中度严重程度，明显高于无 CAS 的患者（40.7 vs. 33.2，p=0.013）。CSI≥40 组的患者流泪、耳胀、鼻塞和流涕的发生率明显高于 CSI<40 组，这些是颅自主副交感神经症状。
结论
有 CAS 的偏头痛患者表现出明显更大的中枢敏化，明显高于无此类症状的患者。特别是，中枢敏化患者中颅副交感神经症状比非敏化患者更常见，这表明颅副交感神经激活可能有助于中枢敏化的维持。
试验注册
本研究于 2020 年 8 月 29 日在 UMIN-CTR 进行了回顾性注册（UMIN000041603）。
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