Trigeminal Nociceptive Transmission in Migraineurs Predicts Migraine Attacks
Trigeminal Nociceptive Transmission in Migraineurs Predicts Migraine Attacks
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DOI：
10.1523/jneurosci.4496-10.2011
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发表时间：
2011-02-09
影响因子：
5.3
通讯作者：
May, Arne
中科院分区：
文献类型：
--
作者：
Stankewitz, Anne;Aderjan, David;May, Arne
有几条证据表明，三叉神经血管系统在偏头痛的发病机制中起着重要作用。使用功能磁共振成像(FMRI)，我们比较了偏头痛患者和健康对照受试者三叉神经疼痛处理过程中的大脑反应。主要的发现是，三叉神经脊束核对伤害性刺激的反应在偏头痛间期表现出循环行为。虽然发作间期(即发作外)偏头痛患者三叉神经脊束核的激活程度低于对照组，但发作前(即发作前不久)患者的三叉神经活动与对照组相似，这表明三叉神经的激活水平在偏头痛无痛期间增加。值得注意的是，到下一次头痛发作的距离可以通过脊髓核中信号强度的高度来预测。偏头痛患者在急性自发性偏头痛发作期间扫描显示，与对照组相比，三叉神经核团的信号强度显著降低，显示出与发作间歇期患者相似的活动水平。此外，我们首次使用功能磁共振成像发现，偏头痛患者脑桥背侧部分的激活显著增加，以前被称为“偏头痛生成器”。与通常与偏头痛发作有关的背侧脑桥激活不同，三叉神经脊椎神经元在伤害性刺激后的梯度式活动可能反映了大脑产生下一次发作的敏感性增加，因为这些区域在头痛开始之前很久就增加了活动。这种振荡行为可能是偏头痛产生的关键因素，而攻击特定的脑桥激活很可能是次要事件。
Several lines of evidence suggest a major role of the trigeminovascular system in the pathogenesis of migraine. Using functional magnetic resonance imaging (fMRI), we compared brain responses during trigeminal pain processing in migraine patients with those of healthy control subjects. The main finding is that the activity of the spinal trigeminal nuclei in response to nociceptive stimulation showed a cycling behavior over the migraine interval. Although interictal (i.e., outside of attack) migraine patients revealed lower activations in the spinal trigeminal nuclei compared with controls, preictal (i.e., shortly before attack) patients showed activity similar to controls, which demonstrates that the trigeminal activation level increases over the pain-free migraine interval. Remarkably, the distance to the next headache attack was predictable by the height of the signal intensities in the spinal nuclei. Migraine patients scanned during the acute spontaneous migraine attack showed significantly lower signal intensities in the trigeminal nuclei compared with controls, demonstrating activity levels similar to interictal patients. Additionally we found-for the first time using fMRI-that migraineurs showed a significant increase in activation of dorsal parts of the pons, previously coined "migraine generator." Unlike the dorsal pons activation usually linked to migraine attacks, the gradient-like activity following nociceptive stimulation in the spinal trigeminal neurons likely reflects a raise in susceptibility of the brain to generate the next attack, as these areas increase their activity long before headache starts. This oscillating behavior may be a key player in the generation of migraine headache, whereas attack-specific pons activations are most likely a secondary event.