Noseda Rodrigo
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Harvard Medical School, Boston, MA, United States.
Front Pain Res (Lausanne). 2022 Jul 13;3:940923. doi: 10.3389/fpain.2022.940923. eCollection 2022.
The cerebellum is associated with the biology of migraine in a variety of ways. Clinically, symptoms such as fatigue, motor weakness, vertigo, dizziness, difficulty concentrating and finding words, nausea, and visual disturbances are common in different types of migraine. The neural basis of these symptoms is complex, not completely known, and likely involve activation of both specific and shared circuits throughout the brain. Posterior circulation stroke, or neurosurgical removal of posterior fossa tumors, as well as anatomical tract tracing in animals, provided the first insights to theorize about cerebellar functions. Nowadays, with the addition of functional imaging, much progress has been done on cerebellar structure and function in health and disease, and, as a consequence, the theories refined. Accordingly, the cerebellum may be useful but not necessary for the execution of motor, sensory or cognitive tasks, but, rather, would participate as an efficiency facilitator of neurologic functions by improving speed and skill in performance of tasks produced by the cerebral area to which it is reciprocally connected. At the subcortical level, critical regions in these processes are the basal ganglia and thalamic nuclei. Altogether, a modulatory role of the cerebellum over multiple brain regions appears compelling, mainly by considering the complexity of its reciprocal connections to common neural networks involved in motor, vestibular, cognitive, affective, sensory, and autonomic processing-all functions affected at different phases and degrees across the migraine spectrum. Despite the many associations between cerebellum and migraine, it is not known whether this structure contributes to migraine initiation, symptoms generation or headache. Specific cerebellar dysfunction genetically driven excitatory/inhibitory imbalances, oligemia and/or increased risk to white matter lesions has been proposed as a critical contributor to migraine pathogenesis. Therefore, given that neural projections and functions of many brainstem, midbrain and forebrain areas are shared between the cerebellum and migraine trigeminovascular pathways, this review will provide a synopsis on cerebellar structure and function, its role in trigeminal pain, and an updated overview of relevant clinical and preclinical literature on the potential role of cerebellar networks in migraine pathophysiology.
小脑与偏头痛的生物学机制存在多种关联。临床上，疲劳、运动无力、眩晕、头晕、注意力不集中、找词困难、恶心和视觉障碍等症状在不同类型的偏头痛中很常见。这些症状的神经基础复杂，尚未完全明确，可能涉及全脑特定和共享回路的激活。后循环卒中、后颅窝肿瘤的神经外科切除以及动物解剖学纤维束追踪，为小脑功能的理论推测提供了最初的见解。如今，随着功能成像技术的加入，在健康和疾病状态下小脑结构和功能方面已经取得了很大进展，相应地，理论也得到了完善。因此，小脑对于运动、感觉或认知任务的执行可能有用但并非必需，而是通过提高与其相互连接的脑区执行任务的速度和技能，作为神经功能的效率促进者发挥作用。在皮层下水平，这些过程中的关键区域是基底神经节和丘脑核团。总体而言，小脑对多个脑区的调节作用似乎很明显，主要是考虑到其与参与运动、前庭、认知、情感、感觉和自主神经处理的常见神经网络相互连接的复杂性——所有这些功能在偏头痛发作过程的不同阶段和程度上都会受到影响。尽管小脑与偏头痛之间存在诸多关联，但尚不清楚该结构是否导致偏头痛的发作、症状产生或头痛。特定的小脑功能障碍，如基因驱动的兴奋/抑制失衡、低灌注和/或白质病变风险增加，已被认为是偏头痛发病机制的关键因素。因此，鉴于小脑与偏头痛三叉神经血管通路之间共享许多脑干、中脑和前脑区域的神经投射和功能，本综述将概述小脑的结构和功能、其在三叉神经痛中的作用，并更新有关小脑网络在偏头痛病理生理学中潜在作用的相关临床和临床前文献综述。
