背景:偏头痛是一种历史上单方面的头部疼痛疾病,其原因目前尚不清楚。越来越多的文献表明,患有左侧头痛的偏头痛(“左侧偏头痛”)的人可能与患有右侧头痛的偏头痛(“右侧偏头痛”)的人有区别。
目的:在本范围审查中,我们通过总结目前对左侧和右侧偏头痛的了解来探讨偏头痛的单边性.
方法:两位资深医学图书馆员与主要作者合作,构建和完善了一组搜索词,以确定1988年之间发表的左侧或右侧偏头痛受试者的研究。和2021年12月8日(进行搜索的日期)。搜索了以下数据库:Medline,Embase,PsycINFO,PubMed,科克伦图书馆,和WebofScience。摘要被加载到Covidence审查软件中,去重复,然后由两名作者进行筛选以确定研究资格。合格的研究是涉及被诊断为偏头痛的受试者(根据ICHD标准)的研究,其中作者:a)比较左右侧偏头痛;或b)描述(分析)区分两者的特征。数据由主要作者提取,包括ICHD版本,作者使用的单侧偏头痛的定义,样本量,研究结果是在攻击期间还是在攻击之间收集的,以及他们的关键发现。主要发现分为以下主题:惯用手,症状,精神病学评估,认知测试,自主神经功能,和成像。
结果:重复数据删除后,搜索产生了5428篇用于筛查的摘要.其中,179符合资格标准,并接受了全文审查。最终分析包括26篇文章。所有的研究都是观察性的。一项研究是在攻击期间进行的,攻击之间的十九,在攻击期间和攻击之间有6个。发现左侧和右侧偏头痛在多个领域不同。在一些情况下,在左侧和右侧偏头痛中报告了相互的结果.例如,左侧和右侧偏头痛均与同侧利手有关,耳鸣,首次出现帕金森症状,面部血流的变化,MRI上的白质高强度,激活背桥,海马硬化,和丘脑NAA/Cho和NAA/Cr浓度。在其他情况下,然而,该发现仅针对1例偏头痛偏侧.例如,左侧偏头痛与较差的生活质量有关,焦虑,双相情感障碍,创伤后应激障碍,较低的交感神经活动,和更高的副交感神经活动。而右侧偏头痛在多项认知测试中表现较差,更大程度的不等眼,皮肤温度的变化,更高的舒张压,大脑中动脉和基底动脉的血流变化,和脑电图的变化。
结论:左侧和右侧偏头痛在广泛的领域有所不同,增加左偏头痛和右偏头痛的病理生理学可能不相同的可能性。
BACKGROUND: Migraine is a historically
unilateral head pain condition, the cause of which is not currently known. A growing body of literature suggests individuals who experience migraine with left-sided headache (\"left-sided migraine\") may be distinguished from those who experience migraine with right-sided headache (\"right-sided migraine\").
OBJECTIVE: In this scoping
review, we explore migraine unilaterality by summarizing what is currently known about left- and right-sided migraine.
METHODS: Two senior medical librarians worked with the lead authors to construct and refine a set of search terms to identify studies of subjects with left- or right-sided migraine published between 1988, which is the year of publication of the first edition of the International Classification of Headache Disorders (ICHD), and December 8, 2021 (the date the searches were conducted). The following databases were searched: Medline, Embase, PsycINFO, PubMed, Cochrane Library, and Web of Science. Abstracts were loaded into Covidence
review software, deduplicated, then screened by two authors to determine study eligibility. Eligible studies were those involving subjects diagnosed with migraine (according to ICHD criteria) in which the authors either: a) compared left- to right-sided migraine; or b) described (with analysis) a characteristic that differentiated the two. Data were extracted by the lead author, including ICHD version, the definition of
unilateral migraine used by the authors, sample size, whether the findings were collected during or between attacks, and their key findings. The key findings were grouped into the following themes: handedness, symptoms, psychiatric assessments, cognitive testing, autonomic function, and imaging.
RESULTS: After deduplication, the search yielded 5428 abstracts for screening. Of these, 179 met eligibility criteria and underwent full text
review. 26 articles were included in the final analysis. All of the studies were observational. One study was performed during attack, nineteen between attacks, and six both during and between attacks. Left- and right-sided migraine were found to differ across multiple domains. In several cases, reciprocal findings were reported in left- and right-migraine. For example, both left- and right-sided migraine were associated with ipsilateral handedness, tinnitus, onset of first Parkinson\'s symptoms, changes in blood flow across the face, white matter hyperintensities on MRI, activation of the dorsal pons, hippocampal sclerosis, and thalamic NAA/Cho and NAA/Cr concentrations. In other cases, however, the findings were specific to one migraine laterality. For example, left-sided migraine was associated with worse quality of life, anxiety, bipolar disorder, PTSD, lower sympathetic activity, and higher parasympathetic activity. Whereas right-sided migraine was associated with poorer performance on multiple cognitive tests, a greater degree of anisocoria, changes in skin temperature, higher diastolic blood pressure, changes in blood flow through the middle cerebral and basilar arteries, and changes on EEG.
CONCLUSIONS: Left- and right-sided migraine differed across a wide range of domains, raising the possibility that the pathophysiology of left- and right-migraine may not be identical.