前庭性偏头痛中头痛与前庭症状共现的研究现状

Research Status of Headache and Vestibular Symptoms in Vestibular Migraine

摘要:

前庭性偏头痛（VM）的核心临床挑战在于头痛与前庭症状的共现。当前研究已明确其共现的解剖基础在于三叉神经血管系统与前庭系统在脑干、丘脑等部位的神经汇合。在分子机制上，降钙素基因相关肽（CGRP）通过与中枢敏化形成的双向协同放大效应，被认为是共现的核心机制，下游的神经炎症、5-羟色胺紊乱及新兴的自噬功能障碍也参与其中。基于此，靶向CGRP的治疗已成为重要突破。然而，关键问题仍未解决，比如自噬在调节炎症介质清除中的具体作用不明；小脑的确切角色不清；且临床症状的时序分离提示可能存在未知的新机制。因此，未来可以利用多模态技术解析疼痛－前庭整合网络；在分子层面深入揭示CGRP-中枢敏化轴与自噬等通路的交互；并探索小脑环路及新治疗靶点，以此为开发VM精准诊疗策略提供理论基础。

Abstract:

Vestibular Migraine (VM)? presents a core clinical challenge in the co-occurrence of headache and vestibular symptoms. Current research has clarified that the anatomical basis for this co-occurrence lies in the neural convergence of the trigeminovascular system and the vestibular system within the brainstem, thalamus, and other regions. At the molecular level, Calcitonin Gene-Related Peptide (CGRP), through its bidirectional synergistic amplification effect with central sensitization, is considered the core mechanism of this co-occurrence, with downstream processes like neurogenic inflammation, serotonin dysregulation, and the emerging role of autophagy dysfunction? also involved. Consequently, therapies targeting CGRP represent a significant breakthrough.However, key questions remain unresolved: the specific role of autophagy in clearing inflammatory mediators is unclear; the precise function of the cerebellum is not well-defined; and the temporal dissociation of clinical symptoms suggests the potential existence of unknown novel mechanisms. Therefore, future research should utilize multimodal technologies to analyze the pain-vestibular integration network, delve deeper into the interaction between the CGRP-central sensitization axis and pathways like autophagy at the molecular level, and explore cerebellar circuits and new therapeutic targets. This will provide a theoretical foundation for developing precise diagnostic and treatment strategies for VM.