Terminating Migraine-Associated Allodynia Using Oral Suspension Diclofenac: A Prospective Non-Randomized Drug Trial.
Terminating Migraine-Associated Allodynia Using Oral Suspension Diclofenac: A Prospective Non-Randomized Drug Trial.
复制标题
使用口服混悬液双氯芬酸终止偏头痛相关的异常性疼痛：一项前瞻性非随机药物试验。
作者：
Buettner,Catherine;Melo-Carrillo,Agustin;Burstein,Rami
抗曲普坦偏头痛发作通常与治疗前开始小时的头部异常性疼痛相关。1，2这种攻击似乎是由于缺乏5HT1d受体5的二级脊髓三叉神经血管神经元1，3，4的致敏作用，从而成为曲坦作用的直接靶点。6在成人中，皮肤异常性疼痛的发展和维持被认为涉及功能上不同的早期和晚期阶段。[7]在早期阶段（也称为发育阶段），敏化三叉神经血管神经元的活动倾向于依赖于传入的伤害性信号，而在晚期阶段（也称为建立阶段），它们的活动变得独立于传入的伤害性信号。[8]因为曲坦类药物在背角的主要作用部位是突触前，所以它们很好地干扰了伤害性信号从外周到中央三叉神经血管神经元的传递。6这使得曲坦类药物在逆转异常性疼痛和致敏方面非常有效，只要中央三叉神经血管神经元的兴奋性仍然由来自脑膜的传入信号驱动，而不是在它们已经发展出自主活动之后。编辑评论这封给编辑的信最初是作为研究提交的。由于这是一个开放标签的未注册试验，以这种形式接受它将违反期刊政策。我将这篇文章作为一封致编辑的信发表，因为它引起了评论者的兴趣，并希望未来的双盲安慰剂对照注册研究将随之而来。托马斯N. Ward MD
Triptan-resistant migraine attacks are typically associated with cephalic allodynia that begin hours before time of treatment. 1, 2 Such attacks appear to be compounded by sensitization of second-order spinal trigeminovascular neurons1, 3, 4 lacking the 5HT1d receptors5 and consequently the ability to become a direct target for triptan action. 6 In adults, the development and maintenance of cutaneous allodynia is thought to involve the functionally distinct early and late phases. 7 Whereas in the early phase (also called the developmental phase), the activity of the sensitize trigeminovascular neurons tend to depend on the incoming nociceptive signals, in the late phase (also called the established phase), their activity becomes independent of the incoming nociceptive signals. 8 Because triptans’ main site of action in the dorsal horn is presynaptic, they are well-positioned to interfere with the transmission of nociceptive signals from the peripheral to the central trigeminovascular neurons. 6 This allows triptans to be highly effective in reversing allodynia and sensitization as long as the excitability of the central trigeminovascular neurons remains driven by incoming signals from the meninges, but not after they have developed autonomous activity.Editor’s comment This letter to the editor was originally submitted as a research submission. As it is an open-label unregistered trial it would violate journal policy to accept it in that form. I am publishing this as a letter to the editor due to the level ofinterest it generated among reviewers and in the hopes that a future double-blind placebo-controlled registered study will follow. Thomas N. Ward MDs