偏头痛前驱症状临床表型及其病理生理机制探讨  

Clinical phenotype and potential physiological mechanism of prodromal symptoms of migraine

作　　者：张祉昱 裴月红[1] 于玲 王军[2] 傅瑜[1] Zhang Zhiyu;Pei Yuehong;Yu Ling;Wang Jun;Fu Yu(Department of Neurology,Peking University Third Hospital,Beijing 100191,China;Department of Acupuncture and Moxibustion,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100007,China)

机构地区：[1]北京大学第三医院神经内科,100191 [2]北京中医药大学东直门中医院针灸科,100007

出　　处：《中华脑血管病杂志（电子版）》2024年第1期64-70,共7页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：2023年北京市重大疑难疾病中西医协同攻关项目示范项目(2023BJSZDYNJBXTGG-015);北京大学第三医院临床队列建设项目(BYSYDL2023014)。

摘　　要：偏头痛发作通常分为前驱期、先兆期、头痛期和恢复期,2018年国际头痛疾病分类第3版重新定义了前驱症状。过去30年,许多临床研究关注成人和儿童前驱症状的发生率和常见表型。现有的神经电生理和功能影像学证据提示下丘脑的激活和疼痛调制通路改变与前驱症状的产生密切相关,其中导水管周围灰质-延髓头端腹内侧区-三叉神经脊束核通路发挥了重要作用。迄今未有大型随机对照研究验证在前驱期给药能否有效预防疼痛发作,尽早识别前驱症状并采取措施对减轻头痛负担乃至阻止偏头痛发作有益。本篇综述梳理了偏头痛前驱症状的患病率及临床表型、与诱因及先兆的区别和可能的病理生理机制,提出未来偏头痛前驱期预防和管理方向。Migraine attacks are usually divided into a prodromal phase,an aura phase,a headache phase,and a postdromal phase.Prodromal symptoms are redefined in the International Classification of the Headache Disorders,3rd edition(ICHD-3)in 2018.Over the past three decades,numerous clinical studies have focused on the incidence and common phenotypes of prodromal symptoms in adults and children.The existing evidence of nerve electrophysiology and functional imaging suggest that the activation of the hypothalamus and the change of pain modulation pathway are closely related to the development of prodromal symptoms,in which periaqueductal gray(PAG)-rostral ventromedial medulla(RVM)-trigeminal spinal nucleus(SpV)pathway plays an important role.So far,there are no large randomized controlled trials to verify whether prodromal administration can effectively prevent pain attacks.It is beneficial to identify prodromal symptoms as early as possible and take measures to reduce the burden of headaches and even prevent migraine attacks.This review focuses on the prevalence,clinical phenotype,differences between a trigger and an aura,and possible pathophysiological mechanisms of prodromal symptoms,hoping to guide the prevention and management of migraine prodromes in the future.

关 键 词：偏头痛 前驱症状 病理生理机制 下丘脑 神经电生理 功能影像学 

分 类 号：R745.1[医药卫生—神经病学与精神病学]