Takeshima T, Mishima T, Tabata M, Burioka N, Nakashima K
Division of Neurology, Tottori University Faculty of Medicine, Yonago, Japan.
Headache. 1997 Oct;37(9):577-82. doi: 10.1046/j.1526-4610.1997.3709577.x.
Ambulatory blood pressure was recorded and analyzed in 13 migraineurs during headache-free periods and in 11 healthy subjects. Systolic blood pressure, mean blood pressure, diastolic blood pressure, pulse pressure, and pulse rate were recorded for 48 hours (three times every hour from 6 AM to mid-night, once an hour at night). Circadian variation of blood pressure was analyzed using single cosinor analysis and group mean cosinor analysis methods. Single cosinor analysis identified significant circadian rhythm of systolic blood pressure in 10 of 11 control subjects (90.9%) and 5 of 13 migraineurs (38.5%, P < 0.02 versus controls, Fisher's exact test). Incidences of significant circadian rhythm of mean blood pressure and diastolic blood pressure were 100% and 100% in controls, 46.2% and 53.8% in the migraineurs (P < 0.01, P < 0.02 versus controls). Incidences of significant rhythm of pulse pressure were 36.3% in controls and 38.5% in the migraine group (difference was not significant). Group mean cosinor analysis identified significant circadian rhythm in both the migraine group and the controls. The MESOR (midline estimating statistic of rhythm) values of systolic, mean, and diastolic blood pressures showed no significant differences between the migraine group and the controls. Acrophase amplitudes of systolic, mean, and diastolic blood pressure were 4.2, 5.2, and 5.9 mm Hg in the migraine group, respectively; and 7.2, 7.3, and 7.5 mm Hg in the controls, respectively. These amplitudes of systolic, mean, and diastolic blood pressures in the migraine group were significantly smaller than those in the controls. These data suggest that some migraineurs lose or alter their circadian blood pressure rhythm. Evaluating migraineurs as a group, significant circadian rhythm of blood pressure can be identified and oscillation amplitudes of blood pressures are decreased. The present results suggest that migraineurs may be subject to dysfunction of the circadian rhythm generator and the autonomic nervous system. Possible involvement of serotonergic projections from the raphe to the suprachiasmatic nuclei of the hypothalamus in migraine is discussed.
在13名偏头痛患者的无头痛期以及11名健康受试者中记录并分析了动态血压。记录48小时的收缩压、平均血压、舒张压、脉压和脉搏率（从上午6点至午夜每小时记录3次，夜间每小时记录1次）。使用单余弦分析和组均值余弦分析方法分析血压的昼夜变化。单余弦分析显示，11名对照受试者中有10名（90.9%）的收缩压存在显著昼夜节律，13名偏头痛患者中有5名（38.5%，与对照组相比P<0.02，Fisher精确检验）。对照组平均血压和舒张压的显著昼夜节律发生率分别为100%和100%，偏头痛患者中分别为46.2%和53.8%（与对照组相比P<0.01，P<0.02）。脉压显著节律的发生率在对照组为36.3%，在偏头痛组为38.5%（差异不显著）。组均值余弦分析显示偏头痛组和对照组均存在显著昼夜节律。偏头痛组和对照组的收缩压、平均血压和舒张压的MESOR（节律中线估计统计量）值无显著差异。偏头痛组收缩压、平均血压和舒张压的峰值相位幅度分别为4.2、5.2和5.9 mmHg；对照组分别为7.2、7.3和7.5 mmHg。偏头痛组的这些收缩压、平均血压和舒张压幅度显著小于对照组。这些数据表明，一些偏头痛患者丧失或改变了其昼夜血压节律。将偏头痛患者作为一个群体进行评估时，可以识别出显著的血压昼夜节律，且血压振荡幅度降低。目前的结果表明，偏头痛患者可能存在昼夜节律发生器和自主神经系统功能障碍。讨论了中缝核向下丘脑视交叉上核的5-羟色胺能投射在偏头痛中可能的参与情况。
