偏头痛与中枢敏化陈春富PPT课件.ppt
《偏头痛与中枢敏化陈春富PPT课件.ppt》由会员分享,可在线阅读,更多相关《偏头痛与中枢敏化陈春富PPT课件.ppt(35页珍藏版)》请在得力文库 - 分享文档赚钱的网站上搜索。
1、陈春富山山东省立医院神省立医院神经内科内科1.Amin FM,Asghar MS,Hougaard A,et al.Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura:a cross-sectional study.Lancet Neurol,2013;12(5):454-61.荷兰学者研究发现,偏头痛发作时并不存在颅外动脉扩张,仅有轻度的颅内动脉扩张。提示未来有关偏头痛的研究应关注于外周和中枢性疼痛
2、通路而非单纯的动脉扩张。2.1983年Woolf首次提出外伤后疼痛的中枢敏感化的概念,用来描述中枢神经系统在生理或解剖上任何增强基底敏感性、疼痛感知、神经兴奋性的变化。头痛:因重复或长时间的疼痛刺激,外周炎症或神经受损,使中枢神经系统的痛觉通路尤其是三叉神经尾核、脊髓背角感觉神经元等产生一种长期的可逆的兴奋性增高,兴奋阈值降低,突触效能增加的现象。Woolf CJ.Evidence for a central component of post-injury pain hypersensitivity.Nature,1983;306:686-8.Aguggia M.Allodynia and
3、migraine.Neurol Sci,2012;33(Suppl 1):S9-11 3.4.1832年,头痛伴发头皮压痛被首次报道。1999年Burstein等在第九届世界疼痛大会首次报道了偏头痛患者存在中枢敏感化现象,随后相关研究相继证实了这一发现。Burstein R,Goor-Aryeh I,Yamitsky D,et al.Cutaneous allodynia during migraine:a new neurological finding and a new insight into the pathophysiology.Program and abstracts of t
4、he Ninth World Congress on Pain;August 22-27,1999;Vienna,Austria 5.Afridi SK,et al.Brain,2005,128:932-939;6.偏偏头痛患者下丘痛患者下丘脑功能的激活功能的激活 Denuelle et al.Headache,20077.偏偏头痛患者可出痛患者可出现疼痛的下行疼痛的下行调制制系系统中灰中灰质密度或密度或体体积的减少的减少:扣扣带回皮回皮质 岛叶叶 前前额叶皮叶皮质 杏仁核杏仁核 顶叶皮叶皮质 颞上回和上回和颞极极 Valfr W et al.Headache,2008;48(1):109-1
5、17.Rocca MA etal.Stroke,2006;37(7):1765-1770.Kim JH etal.Cephalalgia,2008;28(6):598-604.8.痛觉过敏:轻微疼痛刺激即感到疼痛难忍异常性疼痛:非疼痛性刺激引起痛觉感受疼痛感知区域大于疼痛刺激区域在极短的伤害性刺激后出现持续的疼痛感觉自发性疼痛 Tuchman M,Barrett JA,Donevan S,et al.Central sensitization and Ca(V)2 ligands in chronic pain syndromes:pathologic processes and pharma
6、cologic effect.J Pain.2010;11(12):1241-1249Ninan T.Mathew,MD.Pathophysiology of chronic migraine and mode of action of preventive medications.Headache.2011;51(Suppl 2):84-92.Bigal ME,Ashina S,Burnstein R,et al.Prevalence and characteristic of allodynia in headache sufferers:a population study.Neurol
7、ogy.2008;70(17):152515339.偏头痛 伴有广泛的感觉敏感性提高的脑功能状态 先兆 语语言症状言症状运运动动功能障碍功能障碍打哈欠打哈欠,尿意尿意自发性神经化学改变感感觉觉症状症状视觉视觉症状症状头晕头晕 眩眩晕晕皮肤痛敏皮肤痛敏皮肤痛敏皮肤痛敏 头 痛对对光、声、气味光、声、气味光、声、气味光、声、气味 敏感敏感敏感敏感恶恶心心心心 呕吐呕吐呕吐呕吐疲乏疲乏 情情绪绪改改变变认认知功能失知功能失调调10.Clinical presentation of cephalic and extracephalic allodynia during migraine.Number
8、depict pain intensity,cold pain threshold,heat pain threshold and mechanical pain threshold.Areas shaded in green indicate values considered as allodynic.CL:contralateral,IL:ipsilateral,VFH:von-fray hair.Brain,2000,123:1703-1709Brain,2000,123:1703-1709 11.Calandre EP,et al.Calandre EP,et al.Trigger
9、point evaluation in migraine patients.Eur J Neurol,2006,13:2449Trigger point evaluation in migraine patients.Eur J Neurol,2006,13:244912.Liu B,et al.Analysis of the Development of Allodynia:Correlation Between Migraine Duration and Severity.Study funded by MAP Pharmaceuticals,Inc.201213.中重度CA的患者具有更多
10、的诱发因素(OR=2.8)(诱发因素7)Baldacci F,et al.Triggers in allodynic and non-allodynic migraineurs.A clinic setting study.Headache,2013;53(1):152-60.14.CA是中枢敏感化的一个标志 1CA是偏头痛慢性化的一个危险因素 21.Louter MA,et al.Brain,2013;136(Pt 11):3489-96.2.Bigal ME,et al.Neurology,2008;70(17):1525153315.l24项研究荟萃:偏头痛患者RLS发生率 8.7%39
11、.0%,不受性别、先兆的影响RLS患者偏头痛发生率15.1%62.6%缺陷:其他类型头痛RLS情况?l47%的不宁腿综合症患者有头痛家族史 Schrks M,et al.Migraine and restless legs syndrome:A systematic review.Cephalalgia,2014;34(10):777-94.16.慢性偏慢性偏头痛痛RLS发生率34.3%34.3%,发作性偏作性偏头痛痛组16%16%(P=0.0006)P=0.0006)RLS患者偏头痛MIDAS评分高 28.5%的偏头痛患者有RLS家族史 Lucchesi C,et Evidence of i
12、ncreased restless legs syndrome occurrence in chronic and highly disabling migraineLucchesi C,et Evidence of increased restless legs syndrome occurrence in chronic and highly disabling migraine.Functional NeurologyFunctional Neurology,2012;27(2):91-942012;27(2):91-9417.THANK YOUSUCCESS2023/5/2518.偏头
13、痛 OR=2.353.22除了偏头痛发作频率外,CA列第二位Breslau N,Davis GC.Migraine physical health and psychiatric disorder:a prospective epidemiologic study i n young adults.J Psychiatr Res,1 993,27:211-221.Louter M1,Wardenaar K,Veen G,et al.Allodynia is associated with a higher prevalence of depression in migraine patient
14、s.Cephalalgia,2014Epub ahead of printBreslau N,Schultz L R,Stewart AT,et al.Headache and major depression:is the association specific to migraine?Neurology,2000,54:308-313.19.OR=1.52,95%CI 1.26-1.841OR=1.22 in mild depression(95%CI 1.10 to 1.35)OR=1.62 in severe depression(95%CI 1.34 to 1.96).21.Lou
15、ter MA1,et al.Brain,2013;136(Pt 11):3489-96.2.Bigal ME,et al.Prevalence and characteristics of allodynia in headache sufferers:a population study.Neurology,2008;70(17):1525-33.20.22.2%女性偏头痛患者伴发FMS 131.4%偏头痛患者伴发FMS,与先兆无关235%-88%FMS伴发头痛 3,伴发偏头痛63%,MOH 8%41.Ifergane G,et al.Prevalence of fibromyalgia s
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 偏头痛 中枢 敏化陈春富 PPT 课件
限制150内