偏头痛前驱症状的生物学内涵  

Biological connotation of premonitory symptoms in migraine

作　　者：郑泽华 肖哲曼[1] ZHENG Ze-Hua;XIAO Zhe-Man(Department of Neurology,Renmin Hospital of Wuhan University,Wuhan,Hubei 430060,China)

机构地区：[1]武汉大学人民医院神经内科,湖北武汉430060

出　　处：《国际神经病学神经外科学杂志》2021年第6期559-563,共5页Journal of International Neurology and Neurosurgery

基　　金：国家自然科学基金(81971055)。

摘　　要：近年来,偏头痛前驱期因其可能的头痛预测作用及早期头痛干预机会为人所重视。打呵欠、疲乏、颈强直、感知觉超敏症状(畏光、畏声、畏嗅)均是常见的偏头痛前驱症状。然而,关于偏头痛前驱症状的预测效能及其可能机制,目前结论尚未统一。偏头痛前驱症状可分为感知觉超敏症状、睡眠及认知相关症状、自主神经症状和其他症状。前驱症状与触发因素及偏头痛伴随症状的准确区分,目前仍未达成统一。疲乏、情绪变化、颈强直是青少年期患者常见的前驱症状。目前对偏头痛前驱症状的病理生理机制研究仍处于初步阶段。打呵欠是偏头痛具有预测意义的前驱症状之一,通常认为与多巴胺能神经元改变密切相关,在偏头痛病理生理中,可由多巴胺能D1、D2、D3受体介导。颈强直是偏头痛常见前驱症状,与多巴胺、5-羟色胺能神经元激活有关。下丘脑在偏头痛前驱期激活,可能是导致前驱期颈强直的重要原因。恶心作为偏头痛患者常见前驱症状,其病理生理学起源仍存在争议。目前的研究表明,前驱期恶心与5-羟色胺代谢改变有关。感知觉超敏症状包括皮肤异常性疼痛和畏光、畏声、畏嗅,在前驱期中丘脑激活已被证实与皮肤异常性疼痛和畏光相关。In recent years,the premonitory stage of migraine has attracted much attention due to its role in prediction of headache and intervention of early-stage headache. Yawning,fatigue,neck stiffness,and sensory hyper excitability(photophobia,phonophobia,and osmophobia)are common premonitory symptoms in migraine. However,no unified conclusion has been reached on the predictive performance of premonitory symptoms in migraine and possible mechanism. The premonitory symptoms in migraine can be classified as sensory hypersensitivity symptoms,sleep-and cognition-related symptoms,autonomic symptoms,and other symptoms. No consensus has been reached on the precise distinction between premonitory symptoms/triggers and associated symptoms of migraine. Fatigue,mood changes,and neck stiffness are common premonitory symptoms in adolescents. At present,the research on the path physiological mechanism of premonitory symptoms in migraine is still in the preliminary stage. Yawning is one of the premonitory symptoms in migraine with predictive significance,which is generally believed to be closely associated with the changes in dopaminergic neurons,and in the path physiology of migraine,it can be mediated by dopaminergic D1,D2,and D3 receptors. Neck stiffness is a common premonitory symptom of migraine,which is associated with the activation of dopaminergic and serotonergic neurons,and the hypothalamusis activated in the premonitory phase of migraine,which may be an important cause of neck stiffness in the premonitory phase. Nausea is another common premonitory symptom in migraine,but there are still controversies over its pathophysiological origin,and current studies have shown that nausea in the premonitory phase is associated with the metabolic change in 5-hydroxytryptamine. The symptoms of sensory hyper excitability include cutaneous allodynia,photophobia,phonophobia,and osmophobia,and the activation of the thalamus in the premonitory phase has been proved to be associated with cutaneous allodynia and photophobia in migraine.

关 键 词：偏头痛 前驱症状 感知觉超敏 打呵欠 颈强直 恶心 

分 类 号：R741.041[医药卫生—神经病学与精神病学]