Central sensitization theory of migraine: Clinical implications
Central sensitization theory of migraine: Clinical implications
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DOI：
10.1111/j.1526-4610.2006.00602.x
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发表时间：
2006-11-01
期刊：
影响因子：
5
通讯作者：
Silberstein, Stephen
中科院分区：
文献类型：
--
作者：
Dodick, David;Silberstein, Stephen
偏头痛的临床科学不断发展。偏头痛的病理生理学理论已经从偏头痛的早期血管基础发展到强调神经元功能障碍的中心地位的更复杂的当前理论。偏头痛的最新阐明的理论是中枢致敏假说，该假说提出脑干（主要是三叉神经尾侧核）中感觉输入的处理改变，可以解释偏头痛的许多时间和症状特征，以及当疼痛发作后数小时开始曲坦治疗时对曲坦治疗的不良反应。临床前和临床数据都支持中枢致敏理论。这一理论的一个重要临床意义是，能够中止或阻止中枢致敏过程的药物，最突出的是双氢麦角胺，可能在治疗偏头痛中具有独特的作用。另外一个非常实用的含义是基于这样的发现：皮肤异常性疼痛--由皮肤的无害刺激引起的疼痛，如在梳头或化妆品的应用中--是中枢致敏的一个容易识别的标志。因此，皮肤异常性疼痛的存在或不存在可以整合到偏头痛的常规临床评估中，并用作治疗的决定因素。中枢致敏的未来基础和临床研究可能对该领域具有持续的重要性。
The clinical science of migraine headache continues to evolve. Theories of the pathophysiology of migraine have progressed from the early vascular basis of migraine to more complex current theories that emphasize the centrality of neuronal dysfunction. The most recently articulated theory of migraine is the central sensitization hypothesis, which proposes that altered processing of sensory input in the brainstem, principally the trigeminal nucleus caudalis, could account for many of the temporal and symptomatic features of migraine, as well as its poor response to triptan therapy when such treatment is initiated hours after the onset of pain. Both preclinical and clinical data support the central sensitization theory. A critical clinical implication of this theory is that drugs that are capable of either aborting or arresting the process of central sensitization, most prominently dihydroergotamine, may have a unique role in the treatment of migraine. An additional, and highly practical, implication is based upon the finding that cutaneous allodynia-pain arising from innocuous stimulation of the skin, as in hair brushing or the application of cosmetics-is an easily identifiable marker of central sensitization. Thus, the presence or absence of cutaneous allodynia can be integrated into the routine clinical assessment of migraine and utilized as a determinant of treatment. Future basic and clinical research on central sensitization is likely to be of ongoing importance to the field.