Mueller Bridget R, Robinson-Papp Jessica
Department of Neurology, Icahn School of Medicine at Mount Sinai, Center for Headache and Facial Pain, New York, New York, USA.
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Headache. 2022 Jul;62(7):792-800. doi: 10.1111/head.14365. Epub 2022 Jul 19.
In this narrative review, we summarize experimental and clinical evidence demonstrating mechanistic connections between POTS and migraine.
Migraine is the most common comorbidity in patients with POTS, a heterogenous disorder of the autonomic nervous system characterized by orthostatic intolerance and positional tachycardia. POTS is a debilitating illness with few effective treatments. We aim for this narrative review to increase awareness of the mechanistic connections between POTS and migraine providing foundational information that optimizes clinical care and advances the development of pathophysiologic-based treatments.
We used the PubMed and Medline databases in November 2021 to perform a literature review and searched for the following keywords: "postural orthostatic tachycardia syndrome," "POTS," "autonomic nervous system," AND "migraine," "headache."
The high prevalence of migraine in patients with POTS may be explained by common pathologic mechanisms. There is evidence that dysregulation of the sympathetic nervous system, alterations in central and peripheral hemodynamics, and central sensitization increase vulnerability to both POTS and migraine. Non-pharmacologic and pharmacologic treatments that target these shared mechanisms may provide significant benefit for the patient with POTS and migraine.
Identification of common affected pathways may provide important insight that advances our understanding and treatment of both migraine and POTS.
在本叙述性综述中，我们总结了实验和临床证据，以证明体位性心动过速综合征（POTS）与偏头痛之间的机制联系。
偏头痛是POTS患者中最常见的合并症，POTS是一种自主神经系统的异质性疾病，其特征为体位性不耐受和体位性心动过速。POTS是一种使人衰弱的疾病，有效治疗方法很少。我们进行本叙述性综述的目的是提高对POTS与偏头痛之间机制联系的认识，提供有助于优化临床护理并推动基于病理生理学的治疗方法发展的基础信息。
我们于2021年11月使用PubMed和Medline数据库进行文献综述，并搜索了以下关键词：“体位性直立性心动过速综合征”、“POTS”、“自主神经系统”以及“偏头痛”、“头痛”。
POTS患者中偏头痛的高患病率可能由共同的病理机制来解释。有证据表明，交感神经系统失调、中枢和外周血流动力学改变以及中枢敏化会增加患POTS和偏头痛的易感性。针对这些共同机制的非药物和药物治疗可能会给POTS和偏头痛患者带来显著益处。
识别共同的受累途径可能会提供重要的见解，从而推动我们对偏头痛和POTS的理解及治疗。
