偏头痛和脑白质病变
翻译：解洪荣，上海东方医院神经内科
Migraines and White Matter Lesions - What We Should Know
关于偏头痛和脑白质病变－我们应该知道什么？
We all have questionsand concerns about Migraine disease and it's impact. We want and need to understand both the immediate and long-term impact. Some of the most frequently asked questions that arise are related to white matter lesions on the brain, also known as white matter intensities.
我们对偏头痛以及它的影响很多的问题和担忧。我们不仅希望而且需要知道偏头痛的短期和长期影响。最常见的问题是偏头痛与脑白质病变（也称为脑白质高信号）有关系吗？
We do know that Migraines can cause white matter lesions, also called white matter hyperintensities (WMH), to form on the brain. White matter is the whitish part of the brain that is made up of cells called axons. Axons facilitate nerve communication. White matter hyperintensities are sections of the white matter that appear as brighter white patches on the white matter on MRIs. They're small infarcts (areas of tissue that undergoes tissue death due to cessation of the blood supply) and indicate damage to the axons.
偏头痛确实能导致脑白质病变，也称为脑白质高信号（WMH）。白质是脑内由轴突组成的白色区域，轴突促进神经联系。WMH在MRI上表现为脑白质片状高信号，他们可能是小的梗死灶，也可能代表了轴突的损害。
There have now been several studies on Migraine and WMHs, and they're produced some interesting information:
关于偏头痛和WMH的几个研究提供了一些有趣的信息：
"White matter lesions and posterior circulation strokes were more likely to occur in persons with migraine, particularly migraine with aura and in individuals with high attack frequency."
脑白质病变和前循环卒中在偏头痛患者中更容易发生，尤其是伴先兆的和发作频率高的偏头痛患者。
Analysis of data from 186 patients with Migraine showed significant associations between the presence of WMHs and longer disease duration and higher Migraine frequency.
来自186名偏头痛患者的数据分析表明，WMH和偏头痛更长的持续时间以及更高的发作频率密切相关。
One study used MRI to evaluate changes in the WMHs in participants with Migraine with aura. The participants were followed over a period of nearly three years and evaluated for cerebrovascular risk factors.
一项研究应用MRI评估伴先兆的偏头痛患者脑白质损害改变，随访近3年，并评估了脑血管病危险因素。
White matter lesions were present in 63.4% of the patients on scans performed at the beginning of the study.
研究开始的MRI发现63.4%的患者存在脑白质损害。
At follow up, 19.5% of the participants exhibited new lesions.
随访发现19.5%的患者出现了新的白质损害。
Researchers found a significant correlation between aura duration and the number of new white matter lesions and between the number of migraine attacks with aura and new white matter lesions. This indicated that in Migraine with aura, the number of abnormalities in white matter may progress over time and suggests an association between aura features and the progression of WMHs.
研究发现，先兆的持续时间与新发脑白质损害的数量之间明显相关，伴先兆的偏头痛发作次数与新发脑白质损害的数量之间也明显相关。这表明伴先兆的偏头痛患者脑白质异常的数量随着时间逐步发展，提示了先兆特征与WMH之间相关。
WMHs can be the consequence of a microvascular ischemic (related to interruption of blood flow) disturbance in Migraine.
偏头痛患者WMH可能是微血管缺血的结果
At this point, it seems that the impact of WMHs for Migraineurs isn't as serious a matter as the definition of WMH sounds. So far, studies are finding WMHs to be subclincial, meaning that they don't cause any symptoms.
因此，似乎WMH对偏头痛患者的影响并没有WMH本身那么严重。到目前为止，研究发现WMH是亚临床的，不会引起任何症状。
Summary and Comments:
总结和评论：
Let's distill this information into some simpler points about Migraine and WMHs:
依据这个信息凝练出偏头痛与WMH间更简单的几个观点：
· People with Migraine, particularly Migraine with aura, are more likely to develop WMHs.
· 偏头痛患者，尤其是伴先兆偏头痛的患者更可能产生WMH
· WMHs are more likely when we have Migraine disease for a longer period of time and when our Migraines are more frequent.
· WMH更容易发生在偏头痛持续时间长和发作频率高的患者中。
· There is also a correlation between WMHs and the length of the Migraine aura.
· WMH与偏头痛先兆的时间也是相关的。
· There seems to be a connection between aura and the progression of WMHs.
· 偏头痛先兆似乎与WMH的进展有关。
· WMHs can occur as a result of disturbances in the blood flow in the areas of the brain where they occur.
· WMH可能是相应脑区血流紊乱的结果。
· To date, research has not found that WMHs cause any symptoms. They're considered "subclinical.
· 至今，研究还没有发现WMH导致任何症状，他们被认为是亚临床的
Although WMHs haven't been shown to cause any symptoms, it stands to reason that these small areas of dead tissue aren't healthy, and we should these small areas of dead tissue aren't healthy, and we should take any steps we can to minimize their occurrence. Given their tie to the frequency of Migraines and the length of Migraine aura, it's logical to work with our doctors to prevent as many Migraines as possible and to stop our Migraines as early in the attacks as possible.
尽管WMH不能引起任何症状，但这些小面积的坏死组织并不是健康的，我们应该采取措施减少其发生。考虑到WMH与偏头痛的发作频率和偏头痛先兆的持续时间有关，逻辑上来讲，医生应该预防尽可能的控制偏头痛患者的早期发作。