三叉神经-颈反射在无先兆偏头痛和慢性紧张型头痛中的意义  

Clinical application of trigemino-cervicai reflex in migraine without aura and chronic tension-type headache

作　　者：吴美娜[1] 季晓林[1] 

机构地区：[1]福建省级机关医院神经内科,福州350000

出　　处：《中华神经科杂志》2011年第11期742-744,共3页Chinese Journal of Neurology

摘　　要：目的研究三叉神经-颈反射（trigemino—cervical reflex，TCR）在无先兆偏头痛（migraine without aura，MWOA）和慢性紧张型头痛（chronic tension—type headache，CTYH）中的意义。方法选取2009年1月至2010年2月福建省级机关医院门诊25例单侧MWOA患者、25例CTTH患者及36名健康成年对照进行TCR检测。刺激一侧眶下神经（infraorbital nerve，ION），可在同侧胸锁乳突肌（sternocleidomastoid muscle，SCM）上记录到一个短潜伏期正-负波，即TCR。比较各组TCR参数[峰潜伏期（PL）、刺激前后波幅比率的平方根（A值）]的差异。结果MWOA组和CTFH组双侧PLP19[MWOA右侧（19．81±1．79）ms，左侧（19．49±1．95）ms；CTFH右侧（19．16±1．67）ms，左侧（19．56±2．02）ms]、PLN31[MWOA右侧（30．75±2．35）ms，左侧（30．44±3．75）ms；CTTH右侧（30．32±3．47）ms，左侧（30．11±3．34）ms]较对照组缩短（t=2．027～3．654，P〈0．05）；CTTH组和MWOA组双侧PLP19、PLN31及A值差异无统计学意义。结论MWOA组和CTYH组的双侧PLp19、PLN31潜伏期较对照组缩短，提示三叉神经、脑干系统参与MWOA、CTTH的发病机制；但两组病例无明显差异，MWOA和CTFH在内源性疼痛调节系统的某个部位如三叉神经或脑干系统，存在共同的功能障碍。Objective To study the clinical application of trigemino-cervical reflex （TCR） in migraine without aura （MWOA） and chronic tension-type headache （CTTH）. Methods The TCR was recorded using surface electromyographic recordings bilaterally from the sternocleidomastoid muscle after stimulation of infraorbital branch of the trigcminal nerve. The reflex was investigated in 25 patients with unilateral MWOA, 25 patients with CTTH and 36 healthy subjects. The patients were outpatients who visited Fujian provincial institution hospitals from January 2009 to February 2010. Results Compared with the healthy subjects, the bilateral peak latency of P19/N31 （PLP19 and PLN31 ） was significantly shortened in the subjects with MWOA （ left and right side were （ 19.49 ± 1.95 ） ms and （ 19. 81 ± 1.79） ms respectively） or CTTH （left： （19.56 ±2.02） ms, and right： （19. 16 ± 1.67） ms）, t values were between 2.027 and 3. 654, all P 〈 0. 05. The values of PLp19 and PLN31 between the patients with MWOA and with CTTH were not significantly different. Conclusions The peak latency of P19/N31 was shortened in the subjects with MWOA or CTTH, suggesting that the trigeminal and brainstem may participate in the pathophysiology of MWOA and CTFH. There was no significant difference in PLp19 and PLN31 between the patients with MWOA and CTFH, indicating similar abnormalities in the endogenous pain control mechanisms in both migraine and CTTH.

关 键 词：三叉神经 反射 偏头痛 紧张性头痛 

分 类 号：R741[医药卫生—神经病学与精神病学]