偏头痛的神经调控机制及相关治疗进展

Neuroregulatory Mechanism of Migraine and Related Treatment Progress

偏头痛是临床常见的原发性血管性头痛,其发病机制尚不明确,目前认为偏头痛发作与三叉神经血管反射关系密切,发病过程涉及三叉神经血管复合体激活导致的神经肽释放、颅内血管扩张和通透性改变以及无菌性炎症的产生。麦角胺类血管收缩剂、5-羟色胺受体激动剂、降钙素基因相关肽受体拮抗剂等偏头痛治疗药物多根据以上机制研发,但仍有大批患者治疗反应差或不耐受。而神经心理变化贯穿偏头痛发病的全过程,多种偏头痛防治措施亦通过神经心理调控起作用,因此近年来偏头痛的神经调控机制再次引起关注,神经调控相关治疗措施亦进展迅速。本文从神经敏化、脑神经元代谢通路以及神经网络的广泛联系3个方面回顾了偏头痛神经调控机制方面的进展,并且介绍了当前偏头痛神经调控治疗的相关措施,包括心理行为干预、神经调控药物、神经调控器具和传统中医疗法,指出神经调控相关疗法因其可靠的疗效、良好的安全性和可获得性,正日益被医患接受,具有推广价值。相信随着对偏头痛神经调控机制认识的深入和更多治疗靶点的突破,临床医生对偏头痛的诊疗水平将不断提高并最终造福广大患者。

Migraine is a common clinical primary vascular headache,and its pathogenesis is still unclear.It is currently believed that migraine attacks are closely related to the trigeminal neurovascular reflex,and the pathogenesis involves the release of neuropeptides caused by the activation of the trigeminal neurovascular complex,intracranial vasodilation and changes in permeability,and aseptic inflammation.Migraine treatment drugs such as ergotamine vasoconstrictors,serotonin receptor agonists,and calcitonin gene-related peptide receptor antagonists are mostly developed based on the above mechanisms,but there are still a large number of patients with poor treatment response or intolerance.Neuropsychological changes run through the entire process of migraine onset,and various migraine prevention and treatment measures also work through neuropsychological regulation.Therefore,in recent years,the neuroregulation mechanism of migraine has attracted attention again,and neuroregulation-related treatment measures have also progressed rapidly.This paper reviews the progress in the neuroregulatory mechanism of migraine from three aspects:neural sensitization,brain neuron metabolic pathways and extensive connections of neural networks,and introduces the current related measures of migraine neuromodulation treatment,including psycho-behavioral interventions,neuromodulation drugs,neuromodulation devices and traditional Chinese medicine therapy,and points out that neuromodulation-related therapies are increasingly accepted by doctors and patients because of their reliable efficacy,good safety and availability,and have promotion value.It is believed that with the in-depth understanding of the neural regulation mechanism of migraine and the breakthrough of more research targets,the level of diagnosis and treatment of migraine will continue to improve and ultimately benefit the majority of patients.