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Kortikale Dysbalance des Migränikerhirns – Hyperexzitabilität als Folge einer Sensitisierung?

Cortical dysbalance in the brain in migraineurs – hyperexcitability as the result of sensitisation?

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Zusammenfassung

Eine kortikale Dysbalance spielt in der Pathophysiologie der Migräne eine zentrale Rolle. Zahlreiche elektrophysiologische Studien sowie Untersuchungen mittels transkranieller Magnetstimulation eruierten das Exzitabilitätsniveau von Migränikern im interiktualen Intervall. Repliziert wurde mehrfach, dass Migränepatienten unfähig sind, bei einer repetitiven Reizung eines Stimulus zu habituieren. In der aktuellen Literatur wird indes kontrovers diskutiert, ob dieses Defizit auf einem erniedrigten oder erhöhten neuronalen Präaktivierungslevel basiert. Vermutlich ist diese Debatte jedoch verfehlt. Vielmehr scheint eine Vielzahl externer und intrinsischer Faktoren die kortikale Exzitabilität sowie die Attackenfrequenz und -intensität zu beeinflussen. So ist ein Habituierungsdefizit nicht spezifisch für die Migräne und noch nicht einmal für Schmerz, dasselbe Phänomen findet sich u. a. bei Tinnituspatienten, sofern der Tinnitus chronisch ist. Vermutlich ist eine kortikale Hyperexzitabilität die Folge einer Chronifizierung und dem damit einhergehenden zentralen Sensitisierungsprozess.

Abstract

A cortical dysbalance has a pivotal role in the pathophysiology of migraine. Numerous electrophysiological and transcranial magnetic stimulation (TMS) studies have investigated the interictal excitability level in migraineurs and have shown a consistent lack of habituation during repetitive stimulation. There is some controversy in the current literature over whether this deficit is based on a lowered or an elevated preactivation level. However, the current discussion may be misguided. It seems that multiple external and intrinsic factors influence the level of cortical excitability and the frequency and intensity of attacks: Habituation is specific neither to migraine nor even to pain; the same phenomenon is found in tinnitus patients, for example. Cortical hyperexcitability is presumably the result of chronicity and the concomitant central sensitisation process.

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  1. Institut für systemische Neurowissenschaften, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    A. Stankewitz &  A. May

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  1. A. Stankewitz
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Correspondence to A. May.

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Stankewitz, A., May, A. Kortikale Dysbalance des Migränikerhirns – Hyperexzitabilität als Folge einer Sensitisierung?. Schmerz 22 (Suppl 1), 17–21 (2008). https://doi.org/10.1007/s00482-007-0612-x

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