Continuum (Minneap Minn). 2024 Apr 1;30(2):325-343. doi: 10.1212/CON.0000000000001412.
This article provides an overview of the current understanding of migraine pathophysiology through insights gained from the extended symptom spectrum of migraine, neuroanatomy, migraine neurochemistry, and therapeutics.
Recent advances in human migraine research, including human experimental migraine models and functional neuroimaging, have provided novel insights into migraine attack initiation, neurochemistry, neuroanatomy, and therapeutic substrates. It has become clear that migraine is a neural disorder, in which a wide range of brain areas and neurochemical systems are implicated, producing a heterogeneous clinical phenotype. Many of these neural pathways are monoaminergic and peptidergic, such as those involving calcitonin gene-related peptide and pituitary adenylate cyclase-activating polypeptide. We are currently witnessing an exciting era in which specific drugs targeting these pathways have shown promise in treating migraine, including some studies suggesting efficacy before headache has even started.
Migraine is a brain disorder involving both headache and altered sensory, limbic, and homeostatic processing. A complex interplay between neurotransmitter systems, physiologic systems, and pain processing likely occurs. Targeting various therapeutic substrates within these networks provides an exciting avenue for future migraine therapeutics.
本文通过对偏头痛扩展症状谱、神经解剖学、偏头痛神经化学和治疗学的深入了解，概述了目前对偏头痛发病机制的认识。
人类偏头痛研究的最新进展，包括人类实验性偏头痛模型和功能神经影像学，为偏头痛发作的起始、神经化学、神经解剖学和治疗学基质提供了新的见解。很明显，偏头痛是一种神经系统疾病，其中涉及广泛的脑区和神经化学系统，产生了异质的临床表型。这些神经通路中有许多是单胺能和肽能的，如涉及降钙素基因相关肽和垂体腺苷酸环化酶激活肽的通路。我们目前正处于一个令人兴奋的时代，靶向这些通路的特定药物在治疗偏头痛方面显示出了希望，包括一些研究表明在头痛甚至开始之前就有疗效。
偏头痛是一种涉及头痛和感觉、边缘和内稳态处理改变的大脑疾病。神经递质系统、生理系统和疼痛处理之间可能存在复杂的相互作用。针对这些网络中的各种治疗学靶点为未来的偏头痛治疗提供了一个令人兴奋的途径。
