Meyer J S, Terayama Y, Konno S, Margishvili G M, Akiyama H, Rauch R A, Mortel K F, Wills P M
Cerebral Blood Flow Laboratory and Radiology Service, Baylor College of Medicine, Houston, TX, USA.
Cephalalgia. 1998 May;18(4):202-8; discussion 171. doi: 10.1046/j.1468-2982.1998.1804202.x.
Migraine headaches usually decrease in frequency and severity and often cease during advancing age. Occasionally, migraineurs report late-life migrainous accompaniments, i.e., auras without headache, particularly when typical migraine attacks terminate or diminish following major or minor strokes, at which time the auras may become atypical. Clinical observations such as these suggest that degenerative cerebrovascular changes accompanying aging may modify the course of migraine headaches particularly those with aura. To test this hypothesis, we quantitated age-related changes in cerebral vasodilator capacitance by measuring local cerebral blood flow utilizing xenon contrast computed tomography (CT) scanning before and after oral administration of the pharmacological cerebral vasodilator, acetazolamide (Diamox). Measurements were compared among 27 normal volunteers without headache (aged 24-94 years; mean age 61.1 +/- 17.6) and 37 carefully categorized groups of migraine patients (aged 27-83 years; mean age 59.4 +/- 12.4). The normals comprised Group A. Migraineurs were divided into two subgroups: Group B consisted of 27 migraineurs with and without aura who continued to suffer from incapacitating and frequent headaches and Group C consisted of 10 migraineurs who no longer suffered from severe and frequent headaches, two of whom still complained of atypical auras of the "late-life migrainous accompaniments" type. Cerebral vasodilator capacitance significantly declined with advancing age among normals and the two groups of migraineurs, confirming the development of age-related cerebrovascular diseases. Global CBF increases after Diamox in Group B (with persistent and severe migraine), were significantly greater compared with normals without headache, and with Group C consisting of migraineurs whose headaches had decreased, subsided, or become replaced by late-life migrainous accompaniments (Group C). Results establish that cerebrovasodilator capacitance declines with advancing age, probably due to progressive cerebral atherosclerosis, since these declines were accentuated by risk factors for stroke, particularly TIAs or documented lacunar infarcts by CT. Progressive impairments of cerebral vasodilator capacitance among migraineurs were associated with: (i) reductions in frequency and severity of migrainous cephalalgia and (ii) appearance of late-life migrainous accompaniments.
偏头痛的发作频率和严重程度通常会随着年龄增长而降低，且常常在老年期停止发作。偶尔，偏头痛患者会报告出现老年期偏头痛伴随症状，即无头痛的先兆，尤其是在典型偏头痛发作在大或小中风后终止或减轻时，此时先兆可能会变得不典型。诸如此类的临床观察表明，伴随衰老出现的退行性脑血管变化可能会改变偏头痛的病程，尤其是有先兆的偏头痛。为了验证这一假设，我们通过在口服药理学脑血管扩张剂乙酰唑胺（醋氮酰胺）前后利用氙增强计算机断层扫描（CT）测量局部脑血流量，来量化与年龄相关的脑血管扩张能力变化。对27名无头痛的正常志愿者（年龄24 - 94岁；平均年龄61.1±17.6）和37组经过仔细分类的偏头痛患者（年龄27 - 83岁；平均年龄59.4±12.4）进行了测量比较。正常志愿者为A组。偏头痛患者分为两个亚组：B组由27名有或无先兆且仍遭受致残性频繁头痛的偏头痛患者组成，C组由10名不再遭受严重频繁头痛的偏头痛患者组成，其中两名仍诉说有“老年期偏头痛伴随症状”类型的不典型先兆。正常人和两组偏头痛患者的脑血管扩张能力均随着年龄增长而显著下降，证实了与年龄相关的脑血管疾病的发展。B组（患有持续性严重偏头痛）在服用醋氮酰胺后全脑血流量的增加，与无头痛的正常人以及由头痛已减轻、缓解或被老年期偏头痛伴随症状取代的偏头痛患者组成的C组相比，显著更大。结果表明，脑血管扩张能力随着年龄增长而下降，可能是由于进行性脑动脉粥样硬化，因为这些下降在中风危险因素尤其是短暂性脑缺血发作或CT证实的腔隙性梗死的影响下更为明显。偏头痛患者脑血管扩张能力的逐渐受损与以下情况相关：（i）偏头痛性头痛的频率和严重程度降低，以及（ii）老年期偏头痛伴随症状的出现。
