臨床神経学

<シンポジウム(1)―10―3>片頭痛の病態研究Update

片頭痛発作時の脳血流解析

渡邉 由佳, 田中 秀明, 高嶋 良太郎, 高野 雅嗣, 木元 一仁, 平田 幸一

獨協医科大学神経内科〔〒321―0293 栃木県下都賀郡壬生町北小林880〕

The pathophysiology of migraine includes the vascular theory, the trigeminovascular theory, and cortical spreading depression; however, the pathophysiology of a spontaneous migraine attack has not yet been clarified. The vascular theory became negative, and it was considered that the pain of migraine was not associated with vascular expansion. However, recent studies have again attracted attention toward the vascular theory of migraine. The aim of the present study was to provide effective tools for monitoring hemodynamic changes in the cortical and scalp surface during migraine attack and treatment. Using a near-infrared spectroscopy system and laser doppler skin blood flow (SkBF) monitoring device in combination, we monitored changes in extra- and intracranial vasculature upon sumatriptan injection during spontaneous migraine attack. There was a marked reduction of oxy-Hb/SkBF in all patients after sumatriptan injection, and this was consistent with pain relief. Moreover, the changes in oxy-Hb and SkBF were significantly correlated. In contrast, saline injection did not cause any significant changes. These data suggest that sumatriptan induces the vasoconstriction of the vascular bed region, including the arteriovenous anastomosis in the scalp and cortex. On the basis of these data, we suggest that it is now justifiable to reconsider the vascular theory of migraine.
Full Text of this Article in Japanese PDF (241K)

(臨床神経, 52:1009−1011, 2012)
key words:片頭痛,近赤外線分光法,脳血液量変化,高磁場核磁気共鳴血管撮影,血管説

(受付日:2012年5月23日)