Glyceryl trinitrate induces attacks of migraine without aura in sufferers of migraine with aura
Glyceryl trinitrate induces attacks of migraine without aura in sufferers of migraine with aura
复制标题
DOI：
10.1046/j.1468-2982.1999.019007660.x
复制
发表时间：
1999-09-01
期刊：
影响因子：
4.9
通讯作者：
Olesen, J
中科院分区：
文献类型：
--
作者：
Christiansen, I;Thomsen, LL;Olesen, J
有先兆偏头痛和无先兆偏头痛具有相同的疼痛时相，从而表明有先兆偏头痛和无先兆偏头痛共享共同的伤害感受途径。近年来，越来越多的证据表明，信使分子一氧化氮（NO）参与了无先兆偏头痛的疼痛机制。为了澄清是否同样是真的偏头痛的先兆，在本研究中，我们检查了头痛反应静脉滴注甘油三硝酸酯（GTN）（0.5 μ g/kg/min，20分钟）在12例偏头痛患者的先兆。具体目的是阐明是否可以诱导先兆和/或无先兆偏头痛发作。14名健康受试者作为对照。任何受试者均未出现先兆症状。在GTN输注期间和输注后立即（p = 0.037）以及随后的11小时（p = 0.008），偏头痛患者的头痛比对照组更严重。在对照组中，GTN引起的头痛逐渐消失，而在偏头痛患者中，头痛强度峰值发生在平均输注后240分钟。此时，12名偏头痛患者中有6名的诱发性头痛符合国际头痛协会的无先兆偏头痛诊断标准。因此，结果表明，NO参与了先兆偏头痛的疼痛机制。由于皮质扩散性抑制已被证明在动物中释放NO，这一发现可能有助于我们理解皮质扩散性抑制和先兆偏头痛之间的耦合。
Migraine with aura and migraine without aura have the same pain phase, thus indicating that migraine with aura and migraine without aura share a common pathway of nociception. In recent years, increasing evidence has suggested that the messenger molecule nitric oxide (NO) is involved in pain mechanisms of migraine without aura. In order to clarify whether the same is true for migraine with aura, in the present study we examined the headache response to intravenous infusion of glyceryl trinitrate (GTN) (0.5 mu g/kg/min for 20 min) in 12 sufferers of migraine with aura. The specific aim was to elucidate whether an aura and/or an attack of migraine without aura could be induced. Fourteen healthy subjects served as controls. Aura symptoms were not elicited in any subject. Headache was more severe in migraineurs than in the controls during and immediately after GTN infusion (p = 0.037) as well as during the following 11 h (p = 0.008). In the controls, the GTN-induced headache gradually disappeared, whereas in migraineurs peak headache intensity occurred at a mean time of 240 min post-infusion. At this time the induced headache in 6 of 12 migraineurs fulfilled the diagnostic criteria for migraine without aura of the International Headache Society. The results therefore suggest that NO is involved in the pain mechanisms of migraine with aura. Since cortical spreading depression has been shown to liberate NO in animals, this finding may help our understanding of the coupling between cortical spreading depression and headache in migraine with aura.