Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 955 Main Street, Buffalo, NY, 14203, USA.
Dysautonomia Clinic, 300 International Drive, Suite 100, Williamsville, NY, 14221, USA.
Curr Neurol Neurosci Rep. 2023 Nov;23(11):769-776. doi: 10.1007/s11910-023-01307-w. Epub 2023 Oct 17.
Dysautonomia refers to the dysfunction of the autonomic nervous system and encompasses a wide variety of autonomic symptoms and disorders. The most common autonomic disorders are postural orthostatic tachycardia syndrome (POTS), neurocardiogenic syncope (NCS), and orthostatic hypotension (OH), which may be encountered in clinical practice as part of a triad of dysautonomia, hypermobility spectrum disorders (HSD), and mast cell activation syndrome (MCAS). Migraine is one of the most common comorbidities of POTS, HSD, and MCAS; conversely, these conditions are also prevalent in patients with migraine, especially in those with multiple systemic symptoms, such as chronic dizziness, lightheadedness, orthostatic intolerance, joint pain, and allergic symptoms. Diagnostic criteria, pathophysiologic mechanisms, and therapeutic considerations in patients with migraine and comorbid dysautonomia, HSD, and MCAS are reviewed.
Numerous studies indicate a significant overlap and shared pathophysiology in migraine, dysautonomia, HSD, and MCAS. In clinical setting, dysautonomia, HSD, and MCAS may present a diagnostic and therapeutic challenge in patients with migraine and require a high index of suspicion on the part of the neurologist. Diagnosis and treatment of these complex disorders in patients with migraine is essential to comprehensive patient-centric care, reduced symptom burden, and improved functional impairment secondary to both migraine and comorbidities.
自主神经功能障碍是指自主神经系统的功能障碍，包括广泛的自主症状和障碍。最常见的自主障碍是体位性心动过速综合征（POTS）、神经心源性晕厥（NCS）和直立性低血压（OH），这些障碍在临床实践中可能作为自主神经功能障碍三联征、过度活动谱障碍（HSD）和肥大细胞激活综合征（MCAS）的一部分出现。偏头痛是 POTS、HSD 和 MCAS 最常见的合并症之一；相反，这些病症在偏头痛患者中也很常见，尤其是在那些有多种全身症状的患者中，如慢性头晕、头晕、直立不耐受、关节痛和过敏症状。本文综述了偏头痛患者合并自主神经功能障碍、HSD 和 MCAS 的诊断标准、病理生理机制和治疗考虑。
许多研究表明偏头痛、自主神经功能障碍、HSD 和 MCAS 之间存在显著的重叠和共同的病理生理学。在临床环境中，自主神经功能障碍、HSD 和 MCAS 在偏头痛患者中可能会带来诊断和治疗上的挑战，这需要神经科医生有高度的怀疑意识。在偏头痛患者中诊断和治疗这些复杂的疾病对于以患者为中心的全面护理、减轻症状负担以及改善因偏头痛和合并症引起的功能障碍至关重要。
