前言
偏头痛是一种反复发作的头痛疾患，多为一侧或两侧颞部反复发作的严重血管搏动性头痛，发作前可伴视觉、体觉先兆，发作时常伴呕吐，对患者的正常工作和睡眠都会产生较大影响，生活质量严重下降。其中女性多发，约为男性的3～4倍，发病年龄25～34岁，少数发生于儿童期或中年后。在我国，这一疾病的年发病率约为9.3%，在全球范围，其年发病率为15%。
常见病因
SAR
偏头痛的症状
1. 先兆的偏头痛（见图1）
图1 典型偏头痛发病过程
▲ 先兆期：发作前出现短暂的先兆，如视觉先兆：闪光、闪烁的锯齿形线条、暗点、黑蒙和偏盲等；还可有视物变形和物体颜色改变等。其次为躯体感觉先兆，如一侧肢体或面部麻木、感觉异常等；运动先兆如轻偏瘫和失语等，但相对少见。先兆可持续数分钟至1小时。
2. 无先兆的偏头痛
又称普通偏头痛，是最常见的类型，约占偏头痛的80%。相对于有先兆的偏头痛，缺乏典型先兆，常为双侧颞部及眶周疼痛，可为搏动性，头痛反复发作，伴呕吐。头痛持续时间较长，可达数日，疼痛持续时伴颈肌收缩可使症状复杂化。发作时常有头皮触痛，呕吐偶可使头痛终止。本型偏头痛常与月经有明显的关系。与有先兆偏头痛相比，无先兆偏头痛具有更高的发作频率，可严重影响患者工作和生活，常需要频繁应用止痛药治疗。
3. 特殊型偏头痛
辅助检查
如：血、尿常规、电解质及脑脊液检查，排除器质性病变。脑电图、脑血流图、颅脑CT或MRI，必要时行脑血管造影检查，均具有重要的鉴别诊断意义。
引发偏头痛的生理功能失衡
1. 机体促炎因子
2. 线粒体功能障碍、氧化应激和触发因素
3. 诱因
4. 胃肠疾病
5. 荷尔蒙失衡
未完待续：
本期我们一起了解了偏头痛的病因、症状及生理失衡，下期我们一起学习偏头痛的功能医学干预。
参考文献
滑动查看参考文献：
GBD 2016 Headache Collaborators. Global, regional and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17(11):954-976. doi:10.1016/S1474-4422(18)30322-3. Razeghi Jahromi S, Ghorbank Z, Martelletti P, Lampl C, Togha M. Association of diet and headache. J Headache Pain. 2019;20(1):106. doi:10.1186/s10194-019-1057-1. Aurora SK, Brin MF. Chronic migraine: an update on physiology, imaging, and the mechanism of action of two available pharmacologic therapies. Headache. 2017;57(1):109-125. doi:10.1111/head.12999. Fila M, Paw?owska E, Blasiak J. Mitochondria in migraine pathophysiology – does epigenetics play a role? Arch Med Sci. 2019;15(4):944-956. doi:10.5114/aoms.2019.86061. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27(5):394-402. doi:10.1111/j.1468-2982.2007.01303.x Min C, Lim H, Lim JS, Sim S, Choi HG. Increased risk of migraine in patients with psoriasis: a longitudinal follow up study using a national sample cohort. Medicine (Baltimore). 2019;98(17):e15370. doi:10.1097/MD.0000000000015370. Scher AI, Midgette LA, Lipton RB. Risk factors for headache chronification. Headache. 2008;48(1):16?25. doi:10.1111/j.1526-4610.2007.00970.x. Sarchielli P, Tarducci R, Presciutti O, et al. Functional 1H-MRS findings in migraine patients with and without aura assessed interictally. Neuroimage. 2005;24(4):1025-1031. doi:10.1016/j.neuroimage.2004.11.005. Kraya T, Deschauer M, Joshi PR, Zierz S, Gaul C. Prevalence of headache in patients with mitochondrial disease: a cross-sectional study. Headache. 2018;58(1):45-52. doi:10.1111/head.13219. Borkum JM. Migraine triggers and oxidative stress: a narrative review and synthesis. Headache. 2016;56(1):12-35. doi:10.1111/head.12725. Talafi Noghani M, Namdar H. Migraine associated with gastrointestinal disorders: a pathophysiological explanation. Med Hypotheses. 2019;125:90-93. doi:10.1016/j.mehy.2019.02.041. Martami F, Ghorbani Z, Abolhasani M, et al. Comorbidity of gastrointestinal disorders, migraine, and tension-type headache: a cross sectional study in Iran. Neurol Sci. 2018;39(1):63-70. doi:10.1007/s10072-017-3141-0. Lankarani KB, Akbari M, Tabrizi R. Association of gastrointestinal functional disorders and migraine headache: a population base study. Middle East J Dig Dis. 2017;9(3):139-145. doi:10.15171/mejdd.2017.64. van Hemert S, Breedveld AC, Rovers JMP, et al. Migraine associated with gastrointestinal disorders: review of literature and clinical implications. Front Neurol. 2014;5:241. doi:10.3389/fneur.2014.00241. Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A. Gastrointestinal disorders associated with migraine: a comprehensive review. World J Gastroenterol. 2016;22(36):8149-8160. doi:10.3748/wjg.v22.i36.8149. Slavin M, Li HA, Frankenfeld C, Cheskin LJ. What is needed for evidence-based dietary recommendations for migraine: a call to action for nutrition and microbiome research. Headache. 2019;59(9):1566-1581. doi:10.1111/head.13658. Arzani M, Jahromi SR, Ghorbani Z, et al. Gut-brain axis and migraine headache: a comprehensive review. J Headache Pain. 2020;21(1):15. doi:10.1186/s10194-020-1078-9. Gross EC, Klement RJ, Schoenen J, D’Agostino DP, Fischer D. Potential protective mechanisms of ketone bodies in migraine prevention. Nutrients. 2019;11(4):E811. doi:10.3390/nu11040811. Gazerani P. Migraine and diet. Nutrients. 2020;12(6):1658. doi:10.3390/nu12061658. Silberstein SD. Preventive migraine treatment. Continuum. 2015;21(4 Headache):973-989. doi:10.1212/CON.0000000000000199. Pareek A, Suthar M, Rathore GS, Bansal V. Feverfew (Tanacetum parthenium L.): a systematic review. Pharmacogn Rev. 2011;5(9):103-110. doi:10.4103/0973-7847.79105. Guilbot A, Bangratz M, Abdellah SA, Lucas C. A combination of coenzyme Q10, feverfew and magnesium for migraine prophylaxis: a prospective observational study. BMC Complement Altern Med. 2017;17(1):433. doi:10.1186/s12906-017-1933-7. Lipton RB, Silberstein SD. Episodic and chronic migraine headache: breaking down barriers to optimal treatment and prevention. Headache. 2015;55(Suppl 2):103-122. doi:10.1111/head.12505_2.
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