The migraine eye: distinct rod-driven retinal pathways' response to dim light challenges the visual cortex hyperexcitability theory.
The migraine eye: distinct rod-driven retinal pathways' response to dim light challenges the visual cortex hyperexcitability theory.
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DOI：
10.1097/j.pain.0000000000001434
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发表时间：
2019-03
期刊：
影响因子：
7.4
通讯作者：
Burstein R
中科院分区：
文献类型：
--
作者：
Bernstein CA;Nir RR;Noseda R;Fulton AB;Huntington S;Lee AJ;Bertisch SM;Hovaguimian A;Buettner C;Borsook D;Burstein R
偏头痛型畏光，最常见的描述为头痛加剧的光，影响了近90%的患者。它被归类为伴随发作的最严重的致残症状之一。通过主观心理物理评估，我们最近发现偏头痛患者在发作期比间歇期对所有颜色的光都更敏感，而对照组受试者在暴露于不同颜色的光时不会感到疼痛。基于这些发现，我们认为颜色偏好是偏头痛患者所特有的（因为在对照组中没有发现），而不是偏头痛阶段（因为在发作期和发作期发现）。为了确定偏头痛患者畏光的起源，我们使用基于颜色的视网膜电图和视觉诱发电位范式，比较了46名偏头痛患者的视网膜和视觉皮层产生的波形与42名健康对照者产生的波形。出乎意料的是，偏头痛患者视网膜杆状驱动的b波振幅始终比对照组大（光适应组为14-19%，暗适应组为18-34%），而视网膜锥状驱动的a波或视觉诱发电位在两组之间的差异最为显著。从机制上讲，这些发现表明偏头痛患者固有的对光过敏可能起源于视网膜杆而不是视网膜锥或视觉皮层。从临床角度来看，这些发现或许可以解释为什么偏头痛患者抱怨光线太亮，即使光线很暗，但非偏头痛患者却觉得自己好像住在山洞里。
Migraine-type photophobia, most commonly described as exacerbation of headache by light, affects nearly 90% of the patients. It is classified as one of the most disabling symptoms that accompany an attack. Using subjective psychophysical assessments, we showed recently that migraine patients are more sensitive to all colors of light during the ictal than during the interictal phase and that control subjects do not experience pain when exposed to different colors of light. Based on these findings, we suggested that color preference is unique to migraineurs (as it was not found in control subjects) rather than migraine phase (as it was found in the ictal and interictal phases). To identify the origin of this photophobia in migraineurs, we compared the electrical waveforms that were generated in the retina and visual cortex of 46 interictal migraineurs to those generated in 42 healthy controls using color-based electroretinography and visual evoked potential paradigms. Unexpectedly, it was the amplitude of the retinal rod-driven b-wave, which was consistently larger (by 14-19% in the light-adapted and 18-34% in the dark-adapted flash ERG) in the migraineurs than in the controls, rather than the retinal cone-driven a-wave or the visual evoked potentials that differ most strikingly between the two groups. Mechanistically, these findings suggest that the inherent hypersensitivity to light among migraine patients may originate in the retinal rods rather than retinal cones or the visual cortex. Clinically, the findings may explain why migraineurs complain that the light is too bright even when it is dim to the extent that non-migraineurs feel as if they live in a cave.
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