《migraine偏头痛》

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1、migraineMigraineismanifestedbyheadachethatisarecurrence,usuallyunilateralandfrequentlypulsatileinquality;Itisoftenassociatedwithnausea,vomiting,photophobia,phonophobiaandlassitude.Visualorotherneurologicaurasoccurinabout10%ofpatients.Theonsetisearlyinlifeapproximately25%beginningduringthefirstd

2、ecade,55%by20yearsofage,morethan90%beforeage40.A.CauseandpathogenesisTherealcausesandthepathogenesisandpathophysiologiccourseofmigraineisunknown.1.Certainfoods:tyraminecontainingcheeses,meat,suchashotdogsorbacon,withNitritepreservatives,chocolatecontainingbutnotchocolatealone.Foodadditivesmonos

3、odiumglutamateDrugsespeciallyoralcontraceptiveagents;vasodilators(nitriglycerin)Brightslightsmayalsotriggerorprecipitateattacks.2.Genetics:About60%patientsofmigrainehavefamilies.Threegeneticlociforfamilialhemiplegicmigrainehavebeenidentified33.EndocrinefactorGender:women>men(2/3to3/4ofcasesoccu

4、rinwomen);Headachemostlyoccursbeforeormenacmeinwomen,andtheheadachebecomesreductionorstoppinginpregnancyandaftermenopause.Themigrainealsostopsinmenofafterclimacterium.4.vasomotorandautonomicIntracranialvasoconstrictionandextracranialvasodilatationhavelongbeenheldtobetherespectivecausesoftheaura

5、andheadachephasesofmigraine.ButthestudyyofCBFcan’tconfirm.5.spreadingdepressionMorerecentstudiesofrCBFduringmigraineattackshavedemonstratedareductioninregionalflow,whichbeginsintheoccipitalregionandthentowardswith1cm/svelocityduringtheauraphase.6.NeurotransmitterSerotonininplateletsdecreasesand

6、urinaryserotoninincreasesduringtheacutephaseofamigraineattack.Depletionofserotoninbyreserpinemayprecipitatemigraineanddecreasedbyserotoninantagonists(sumatriptan)B.Theclassificationofmigraine1.classicmigraine2.commonmigraine3.specialtype:a.ophthalmoplegicM.b.hemiplegicM.c.basilararteryM.d.late-

7、-lifeM.e.migraineEquivalentsC.Clinicfigures1.MigrainewithAura(Classicmigraine)1)Auras:visualalteration,particularlyhemianopicfielddefectsandscotomas,hemiparansthesia。2)Headache:50%ofpatientsexperiencenomorethanonceattackperweek,th