Is migraine a neuropathic pain syndrome?
Is migraine a neuropathic pain syndrome?
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DOI：
10.1007/s11916-006-0042-y
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发表时间：
2006-06-01
影响因子：
3.7
通讯作者：
Biondi, David M
中科院分区：
文献类型：
--
作者：
Biondi, David M
对偏头痛病理生理学的理解已经从偏头痛是一种血管疾病的信念发展到更好地将偏头痛定义为与脑灌注继发性变化相关的神经源性疾病的证据。有证据表明，偏头痛的早期阶段的结果，神经源性炎症影响颅血管和硬脑膜。异常性疼痛、痛觉过敏和伤害性感受野的扩大发生在大多数确定的偏头痛发作期间。偏头痛的这些临床特征使人联想到那些传统上与神经性疼痛相关的临床特征。将偏头痛定义为一种独特的神经性疼痛障碍的假说可能暗示神经可塑性的潜力，并可能提供对偏头痛从偶发性转变为慢性形式的机制的深入了解。偏头痛病理生理学的神经性疼痛模型不仅为基于机制的治疗策略铺平了道路，这些策略可以改善偏头痛发作的急性和预防性管理，而且还为发现新的治疗靶点打开了大门。它还为理解临床上有趣的主题提供了动力，如阿片类药物诱导的痛觉过敏和药物过度使用头痛（反弹性头痛），慢性头痛治疗中的阿片类药物抵抗，以及预防偏头痛转化的疾病修饰。
The understanding of migraine pathophysiology has evolved from the belief that migraine is a vascular disorder, to evidence that better defines migraine as a neurogenic disorder associated with secondary changes in brain perfusion. There is evidence to suggest that the early phase of migraine pain results from neurogenic inflammation affecting cranial blood vessels and dura. Allodynia, hyperalgesia, and expansion of nociceptive fields occur during most well-established migraine attacks. These clinical features of migraine are evocative of those traditionally associated with neuropathic pain. A hypothesis that defines migraine pain as a unique neuropathic pain disorder can imply the potential for neural plasticity and may provide insight into the mechanisms that underlie the transformation of episodic to chronic forms of migraine. The neuropathic pain model of migraine pathophysiology not only paves the way for mechanism-based treatment strategies that can improve the acute and preventive management of migraine attacks, but also opens the door for the discovery of novel therapeutic targets. It also lends momentum to an understanding of clinically intriguing topics such as opiate-induced hyperalgesia and medication-overuse headache (rebound headache), opioid resistance in the treatment of chronic headache, and disease modification in defending against the potential for migraine transformation.