女性叢發性頭痛在不同發病年齡致病機轉的探討

A Different Age-Related Pathomechanism for Cluster Headache in Women

陳偉熹(Wei-Hsi Chen) ； 盧燕褀(Yen-Chi Lu) ； 蘇承珊(Chan-San Su) ； 林宏昇(Hung-Sheng Lin) ； 王淑惠(Suk-Huey Wang) ； 彭明照(Ming-Chao Peng) ； 吳紹琛(Shaw-Shun Wu) ； 鄭碧華(Bi-Hwa Cheng) ； 陳順勝(Shun-Sheng Chen) ； 劉家壽(Jia-Shou Liu)

《東港安泰醫護雜誌》 10卷3期 (2004/09) Pp. 117-126

https://doi.org/10.7078/TSMHMNJ.200409.0117

摘要

叢發性頭痛已廣泛地被知道在女性族羣中，其發生頂點時間為停經前和停經後兩個不同時期。然而，兩者間之差異卻很少被論及。本文主旨為收集23位叢發性頭痛之女性病例，她們先前並沒有接受特定藥物治療，分析她們的臨床症狀、影像學檢查、顱內血管血流速度和血流量，在停經前和停經後發病之女性，究竟有何差別，進而了解其致病機轉是否有不同。結果顯示，停經後發病女性較停經前發病女性，其視自律神經失調症狀和非發病期間顳側血流量減少明顯較多，但誘發和緩解因素卻較少。雖然國外尚無相關研究作參考，也不能完全排除有可能是人種差異所致。無論如何，這些發現可以佐證患叢發性頭痛之亞洲婦女，其發病依發病年齡，應有不同機轉。這必頇考慮治療之差異性。

關鍵字

叢發性頭痛 ； 女性 ； 自律神經 ； 年齡

並列摘要

It has already been known that there are two peaks for cluster headache in women, premenopause and postmenopause. However, the difference is rarely mentioned between them. In this study, we collected 23 cluster headache women who did not receive regular anticluster treatment before and analysed their clinical profile, image study, transcranial doppler and cerebral blood flow in order to understand if there is any difference between premenopausal and postmenopausal women with cluster headache. A difference would suggest a distinct pathogenesis of pain between them. The results showed that ocular dysautonomia, decreased interictal temporal hypoperfusion, and a low frequency of triggering and relieving factors were prevalent for postmenopausal cluster women. Although these findings have not been reported in other countries, confounding effect by ethnicity could not be excluded. Nevertheless, our results support an age-dependent pathogenesis of cluster headache in Asian women. The pharmacological measure should consider this difference.

並列關鍵字

cluster headache ； woman ； autonomic system ； age