超越发作期的偏头痛：发作间期的洞见

文献信息

中文摘要

背景： 传统上，偏头痛以其阵发性发作为特征，发作间期被视为无症状的间歇期。然而，新出现的证据表明，“偏头痛脑”在发作之间仍处于神经兴奋性改变和习惯化受损的状态，表现为使人衰弱的发作间期症状。本叙述性综述旨在描述发作间期症状的谱系、其潜在机制及其对累积疾病负担的影响，同时探讨其对临床管理的意义。
方法： 使用与偏头痛周期、发作间期和疾病负担相关的术语对PubMed数据库进行了广泛的文献检索。优先纳入近10年内发表的原创文章，重点关注临床试验、真实世界证据和神经生理学研究。
结果： 发作间期症状，包括感觉过敏（畏光、畏声、畏嗅、异常性疼痛）、认知功能障碍（“脑雾”）、前庭症状和情感调节障碍，影响26%至76%的患者。这些症状显著加重了偏头痛的社会经济负担，导致大量生产力损失（缺勤和带病出勤）和生活质量下降。虽然非特异性预防药物往往无法缓解发作间期症状，但降钙素基因相关肽通路靶向治疗和onabotulinumtoxinA在减轻发作间期负担方面显示出有希望的结果，这是通过偏头痛发作间期负担量表（MIBS-4）等标准化工具测量的。
结论： 偏头痛管理需要从仅关注发作频率转向包括发作间期在内的更整体化的方法。标准化发作间期症状的定义并在临床实践中实施特定的结局测量，对于恢复完全功能能力和为患者提供全面照护至关重要。

英文摘要

BackgroundTraditionally, migraine has been characterized by its paroxysmal attacks, with the interictal phase considered to be a symptom-free interval. However, emerging evidence suggests that the "migraine brain" remains in a state of altered neuro-excitability and impaired habituation between attacks, manifesting as debilitating interictal symptoms. This narrative review aims to describe the spectrum of interictal symptoms, their underlying mechanisms, and their impact on the cumulative disease burden, at the same time as exploring the implications for clinical management.MethodsAn extensive literature search of the PubMed database was performed using terms related to the migraine cycle, interictal phase, and disease burden. Original articles published within the last 10 years were prioritized, focusing on clinical trials, real-world evidence, and neurophysiological studies.ResultsInterictal symptoms, including sensory hypersensitivity (photophobia, phonophobia, osmophobia, allodynia), cognitive dysfunction ("brain fog"), vestibular symptoms, and affective dysregulation, affect between 26% and 76% of patients. These symptoms significantly contribute to the socioeconomic burden of migraine, leading to substantial productivity losses (absenteeism and presenteeism) and reduced quality of life. While non-specific preventives often fail to alleviate interictal symptoms, calcitonin gene-related peptide-pathway targeted therapies and onabotulinumtoxinA have demonstrated promising results in reducing the interictal burden, as measured by standardized tools such as the Migraine Interictal Burden Scale (MIBS-4).ConclusionsMigraine management requires a paradigm shift from focusing solely on attack frequency to a more holistic approach that includes the interictal period. Standardizing interictal symptoms definitions and implementing specific outcome measures in clinical practice are essential to restore full functional capacity and provide comprehensive care for patients.