Danish Headache Center, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Department of Neurology, University Hospital of Toulouse, Toulouse, France.
J Headache Pain. 2022 Dec 13;23(1):158. doi: 10.1186/s10194-022-01518-5.
To critically appraise the evidence for and against premonitory symptoms in migraine being due to hypothalamic dysfunction.
Some premonitory symptoms (e.g. fatigue, mood changes, yawning, and food craving) are associated with the physiologic effects of neurotransmitters such as orexins, neuropeptide Y, and dopamine; all of which are expressed in hypothalamic neurons. In rodents, electrophysiologic recordings have shown that these neurotransmitters modulate nociceptive transmission at the level of second-order neurons in the trigeminocervical complex (TCC). Additional insights have been gained from neuroimaging studies that report hypothalamic activation during the premonitory phase of migraine. However, the available evidence is limited by methodologic issues, inconsistent reporting, and a lack of adherence to ICHD definitions of premonitory symptoms (or prodromes) in human experimental studies.
The current trend to accept that premonitory symptoms are due to hypothalamic dysfunction might be premature. More rigorously designed studies are needed to ascertain whether the neurobiologic basis of premonitory symptoms is due to hypothalamic dysfunction or rather reflects modulatory input to the trigeminovascular system from several cortical and subcortical areas. On a final note, the available epidemiologic data raises questions as to whether the existence of premonitory symptoms and even more so a distinct premonitory phase is a true migraine phenomenon. Video recording of the debate held at the 1st International Conference on Advances in Migraine Sciences (ICAMS 2022, Copenhagen, Denmark) is available at: https://www.youtube.com/watch?v=d4Y2x0Hr4Q8 .
批判性地评价偏头痛先兆症状是由于下丘脑功能障碍引起的证据。
一些先兆症状（如疲劳、情绪变化、打哈欠和食欲增加）与神经递质（如食欲素、神经肽 Y 和多巴胺）的生理效应有关；所有这些递质都在下丘脑神经元中表达。在啮齿动物中，电生理记录显示这些神经递质在三叉颈复合体（TCC）的二级神经元水平上调节痛觉传递。神经影像学研究的进一步研究表明，在下丘脑激活期间偏头痛的先兆期。然而，现有证据受到方法学问题、报告不一致和缺乏对人类实验研究中先兆症状（或前驱症状）的 ICHD 定义的遵守的限制。
目前接受先兆症状是由于下丘脑功能障碍引起的趋势可能还为时过早。需要更严格设计的研究来确定先兆症状的神经生物学基础是否是由于下丘脑功能障碍，还是反映了来自几个皮质和皮质下区域对三叉血管系统的调制输入。最后，现有的流行病学数据提出了这样一个问题，即先兆症状的存在，甚至更明显的先兆期是否是真正的偏头痛现象。在第 1 届偏头痛科学进展国际会议（ICAMS 2022，丹麦哥本哈根）上举行的辩论的视频记录可在以下网址获得：https://www.youtube.com/watch?v=d4Y2x0Hr4Q8。
