背景:尽管偏头痛普遍存在,引发偏头痛发作的潜在病理生理机制还远未得到很好的理解,这是科学争论的问题。
目的:在这篇叙述性综述中,我们讨论了提示外周起源或中心起源的关键证据,并为未来可能提供进一步澄清的研究提供了方向.
结论:偏头痛的发病机制被认为涉及三叉神经血管系统,包括三叉神经及其对颅内血管的轴突投射的术语。毫无疑问,外周和中枢机制都参与了偏头痛的发病机制。但是一个未解决的问题是偏头痛发作时最初的激活是如何发生的。支持偏头痛发作的外周起源的证据,即,初始事件发生在血脑屏障之外,包括偏头痛发作早期血管周围感觉传入致敏的重要性。有利于中心起源的证据包括前驱症状的发生,偏头痛先兆,在偏头痛发作的早期和期间激活中枢神经系统内的结构。
结论:外周和中枢机制都可能参与偏头痛发作,例如,外周伤害性输入是疼痛传递所必需的,皮层活动是疼痛感知所必需的.然而,偏头痛发作是由外周还是中枢引起的争论仍未解决.对前驱症状和人类偏头痛先兆模型的发展的日益关注可能会提供在不久的将来回答这个问题所需的关键论据。在那之前,我们无法得出坚定的结论,辩论仍在继续。
UNASSIGNED:第1届国际偏头痛科学进展会议(ICAMS2022,哥本哈根,Denmark)isavailableat:https://www.youtube.com/watch?v=NC0nlcKohz0.
BACKGROUND: Despite the pervasiveness of migraine, the underlying pathophysiological mechanisms initiating migraine attacks are far from well understood and are matter of scientific debate.
OBJECTIVE: In this narrative review, we discuss key evidence for that suggest a peripheral origin or central origin and provide directions for future studies that may provide further clarification.
CONCLUSIONS: Migraine pathogenesis is considered to involve the trigeminovascular system, a term that encompasses the trigeminal nerve and its axonal projections to the intracranial blood vessels. Beyond any doubt both peripheral and central mechanisms are involved in migraine pathogenesis, but an unresolved question is the how the initial activation occurs in a migraine attack. Evidence favoring a peripheral origin of migraine attacks, i.e., initial events occur outside of the blood-brain barrier, include the importance of sensitization of perivascular sensory afferents early on in a migraine attack. Evidence favoring a central origin include the occurrence of prodromal symptoms, migraine aura, and activation of structures within the central nervous system early in and during a migraine attack.
CONCLUSIONS: Both peripheral and central mechanisms are likely involved in a migraine attack, e.g., peripheral nociceptive input is necessary for pain transmission and cortical activity is necessary for pain perception. Yet, the debate of whether migraine attacks are initiated a peripheral or central site remains unresolved. The increased focus on prodromal symptoms and on the development of a human model of migraine aura will possibly provide key arguments needed to answer this question in the near future. Until then, we cannot draw firm conclusions and the debate goes on.
UNASSIGNED: Video recording of the debate held at the 1st International Conference on Advances in Migraine Sciences (ICAMS 2022, Copenhagen, Denmark) is available at: https://www.youtube.com/watch?v=NC0nlcKohz0 .