Beyond Neurovascular: Migraine as a Dysfunctional Neurolimbic Pain Network
Beyond Neurovascular: Migraine as a Dysfunctional Neurolimbic Pain Network
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DOI：
10.1111/j.1526-4610.2012.02209.x
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发表时间：
2012-11-01
期刊：
影响因子：
5
通讯作者：
Heinricher, Mary
中科院分区：
文献类型：
--
作者：
Maizels, Morris;Aurora, Sheena;Heinricher, Mary
没有一个单一的偏头痛模型可以解释这种疾病的所有已知特征。偏头痛最近被描述为脑干中疼痛调节回路的异常。中脑导水管周围灰质似乎在偏头痛的发生中起着关键作用，并已被标记为偏头痛发生器。疼痛矩阵的概念，而不是一个特定的疼痛位点，在疼痛文献中被广泛接受，并提供了一个新的维度来理解偏头痛。最近对偏头痛患者的神经影像学研究表明，脑干疼痛调节回路和皮质（边缘）中心之间的功能连接发生了改变。大量的临床观察表明，边缘系统的影响在偏头痛的表达中起着重要的作用。我们提出了一个偏头痛的神经边缘疼痛网络功能障碍的模型。脑干和皮层中枢之间的影响是双向的，反映了疼痛和情绪的双向相互作用。神经边缘功能障碍可能会增加偏头痛变得更加慢性或顽固。神经边缘系统模型扩展了偏头痛作为脑干核团功能障碍的模型。神经边缘系统模型可能有助于弥合理解偏头痛发作、发作性偏头痛的发作间期功能障碍、慢性偏头痛的进展以及与其他疾病（如纤维肌痛、肠易激综合征、情绪和焦虑障碍）的常见合并症的差距，这些疾病也可能被认为是神经边缘系统的。偏头痛的神经边缘系统模型可能是一个有用的启发，将影响临床治疗和研究议程，以及医生和患者的教育。
No single model of migraine explains all of the known features of the disorder. Migraine has recently been characterized as an abnormality in pain-modulating circuits in the brainstem. The periaqueductal gray appears to have a critical role in migraine genesis and has been labeled the migraine generator. The concept of a pain matrix, rather than a specific locus of pain, is widely accepted in the pain literature and offers a new dimension to understanding migraine. Recent neuroimaging studies of migraineurs suggest altered functional connectivity between brainstem pain-modulating circuits and cortical (limbic) centers. Numerous clinical observations suggest that limbic influences play an important role in migraine expression. We propose a model of migraine as a dysfunction of a neurolimbic pain network. The influence between brainstem and cortical centers is bidirectional, reflecting the bidirectional interaction of pain and mood. Neurolimbic dysfunction may increase as migraine becomes more chronic or refractory. The neurolimbic model expands the model of migraine as a dysfunction of brainstem nuclei. A neurolimbic model may help bridge a gap in understanding the migraine attack, the interictal dysfunctions of episodic migraine, the progression to chronic migraine, and the common comorbidities with other disorders (such as fibromyalgia, irritable bowel syndrome, and mood and anxiety disorders), which may also be considered neurolimbic. A neurolimbic model of migraine may be a useful heuristic that would impact both clinical treatment and research agendas, as well as education of physicians and patients.