Fanciullacci M, Pietrini U, Boccuni M, Gatto G, Cangi F
Cephalalgia. 1983 Aug;3 Suppl 1:85-7. doi: 10.1177/03331024830030S110.
Pupil size was measured using a pupillograph, and an asymmetric responsiveness to tyramine, instilled bilaterally, was observed in asymptomatic cluster headache patients. Relatives of cluster headache patients showed an anisocoric mydriasis to tyramine, too. This asymmetry was caused by a less marked mydriatic response of one side which, in the cluster headache sufferers, corresponds to the symptomatic side. After three months of treatment with lithium carbonate (900 mg/die), a bilateral decrease of pupil size was noted, possibly due to a reduced sympathergic tone. After six months of continued treatment an unknown mechanism, likely adaptive in nature, attenuated the effect of lithium on pupil size. Lithium also induced a symmetric response to tyramine by increasing tyramine mydriasis on the symptomatic pupil while reducing it on the asymptomatic pupil. It is postulated that lithium improves cluster headache by correcting abnormal bilateral asymmetries in central neuronal systems which regulate autonomic function and pain sensitivity of the structures involved in the cluster attack.
使用瞳孔描记器测量瞳孔大小，在无症状丛集性头痛患者中观察到双侧滴注酪胺后出现不对称反应。丛集性头痛患者的亲属对酪胺也表现出瞳孔不等大性散瞳。这种不对称是由一侧瞳孔散大反应不明显引起的，在丛集性头痛患者中，这一侧对应于症状侧。用碳酸锂（900毫克/天）治疗三个月后，观察到瞳孔大小双侧减小，这可能是由于交感神经张力降低所致。持续治疗六个月后，一种未知机制（可能本质上是适应性的）减弱了锂对瞳孔大小的影响。锂还通过增加症状侧瞳孔对酪胺的散瞳作用，同时减少无症状侧瞳孔对酪胺的散瞳作用，诱导了对酪胺的对称反应。据推测，锂通过纠正调节自主神经功能和丛集性发作所涉及结构的疼痛敏感性的中枢神经系统中异常的双侧不对称性来改善丛集性头痛。
