The evolving concept of multimorbidity and migraine.

Q2 Medicine
Claudia Altamura, Gianluca Coppola, Fabrizio Vernieri
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引用次数: 0

Abstract

Migraine presents with high prevalence and similar clinical course with different disorders such as neurological, psychiatric, cardio- and cerebrovascular, gastrointestinal, metabolic-endocrine, and immunological conditions, which can often cooccur themselves. Multifaceted mechanisms subtend these comorbidities with a bidirectional link. First, a shared genetic load can explain the cooccurrence. Second, comorbid pathologies can promote disproportionate energetic needs, thalamocortical network dysexcitability, and systemic transient or persistent proinflammatory state, which may trigger the activation of a broad self-protective network that includes the trigeminovascular system in conjunction with the neuroendocrine hypothalamic system. This response results in maintenance of brain homeostasis by modulating subcortical-cortical excitability, energetic balance, osmoregulation, and emotional response. In this process, the CGRP is released in the trigeminovascular system. However, the calcitonin gene-related peptide (CGRP) plays several actions also outside the brain to maintain the homeostatic needs and is involved in the physiological functions of different systems, whose disorders are associated with migraine. This aspect further increases the complexity of migraine treatment, where standard therapies often have systemic adverse effects. On the other hand, some preventives can improve comorbid conditions. In summary, we propose that migraine management should involve a multidisciplinary approach to identify and mitigate potential risk factors and comorbidity and tailor therapies individually.

多病与偏头痛概念的演变。
偏头痛的发病率很高,临床过程与神经、精神、心脑血管、胃肠道、代谢内分泌和免疫等不同疾病相似,这些疾病常常同时并发。这些合并症与多方面的机制有着双向联系。首先,共同的遗传负荷可以解释这种并发症。其次,合并病症会导致能量需求不成比例、丘脑皮质网络兴奋性减弱以及全身短暂或持续的促炎症状态,这可能会触发一个广泛的自我保护网络的激活,其中包括三叉神经血管系统和下丘脑神经内分泌系统。这种反应通过调节皮层下-皮层兴奋性、能量平衡、渗透调节和情绪反应来维持大脑的平衡。在此过程中,三叉神经血管系统会释放 CGRP。然而,降钙素基因相关肽(CGRP)在大脑之外也发挥着多种作用,以维持体内平衡的需要,并参与不同系统的生理功能,而这些系统的紊乱与偏头痛有关。这进一步增加了偏头痛治疗的复杂性,因为标准疗法往往会产生全身性不良反应。另一方面,一些预防药物可以改善合并症。总之,我们建议偏头痛的治疗应采用多学科方法,以识别和减轻潜在的风险因素和合并症,并为患者量身定制治疗方案。
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来源期刊
Handbook of clinical neurology
Handbook of clinical neurology Medicine-Neurology (clinical)
CiteScore
4.10
自引率
0.00%
发文量
302
期刊介绍: The Handbook of Clinical Neurology (HCN) was originally conceived and edited by Pierre Vinken and George Bruyn as a prestigious, multivolume reference work that would cover all the disorders encountered by clinicians and researchers engaged in neurology and allied fields. The first series of the Handbook (Volumes 1-44) was published between 1968 and 1982 and was followed by a second series (Volumes 45-78), guided by the same editors, which concluded in 2002. By that time, the Handbook had come to represent one of the largest scientific works ever published. In 2002, Professors Michael J. Aminoff, François Boller, and Dick F. Swaab took on the responsibility of supervising the third (current) series, the first volumes of which published in 2003. They have designed this series to encompass both clinical neurology and also the basic and clinical neurosciences that are its underpinning. Given the enormity and complexity of the accumulating literature, it is almost impossible to keep abreast of developments in the field, thus providing the raison d''être for the series. The series will thus appeal to clinicians and investigators alike, providing to each an added dimension. Now, more than 140 volumes after it began, the Handbook of Clinical Neurology series has an unparalleled reputation for providing the latest information on fundamental research on the operation of the nervous system in health and disease, comprehensive clinical information on neurological and related disorders, and up-to-date treatment protocols.
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