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Enxaqueca e disfunção microcirculatória
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Uma das cefaleias primárias mais comuns e com grande impacto na vida dos doentes é a
enxaqueca. É uma doença crónica caracterizada por múltiplos sintomas que incluem
cefaleias, náuseas, hipersensibilidade a estímulos como luz e som e, em alguns casos,
aura está presente. A etiologia é multifatorial, sendo necessário a ativação e sensibilização do
sistema trigeminal. Inclui neuroinflamação, depressão alastrante cortical, que é causa
mais provável para o desenvolvimento de aura, fatores hormonais e genéticos.
Existem também variantes monogénicas raras, como o caso da enxaqueca hemiplégica
familiar. A gestão farmacológica desta doença inclui anti-inflamatórios não esteroides para
episódios ligeiros e triptanos para episódios moderados a graves. Para tratamento preventivo
incluem-se fármacos que pertencem às classes dos antiepiléticos, bloqueadores beta,
antidepressivos e anticorpos monoclonais que têm como alvo o péptido relacionado com o
gene da calcitonina ou o seu recetor, sendo estes últimos as opções mais recentes. Apesar da
investigação sobre a fisiopatologia da enxaqueca, não existe atualmente nenhuma
teoria completamente definida. Um dos mecanismos fisiopatológicos da enxaqueca pode ser
a disfunção microcirculatória, tendo em conta a existência de diversas doenças
caracterizadas por disfunção microvascular que se acompanham por enxaquecas, como é o
caso de Arteriopatia Cerebral Autossómica Dominante com Enfartes Subcorticais
e Leucoencefalopatia (CADASIL) e Hemiparesia Infantil Hereditária com
Tortuosidade Arteriolar Retiniana e Encefalopatia (HIHRATL).
A enxaqueca pode acompanhar-se de diversas alterações morfológicas e funcionais,
nomeadamente hipoperfusão no córtex cerebral durante períodos de aura prolongada, ou uma
maior pulsatilidade dos vasos intracranianos da dura-máter. Esta última, conduz ao
estímulo mecânico dos nociceptores que inervam a vasculatura daquela estrutura, o que
sugere a lateralização do fluxo sanguíneo, durante o período entre episódios de enxaqueca.
Migraine is one of the most common primary headaches and has the greatest impact on patients' lives. It is a chronic condition characterized by multiple symptoms including headache, nausea, hypersensitivity to stimuli such as light and sound, and in some cases aura is present.The etiology is multifactorial, with activation and sensitization of the trigeminal system being essential. It includes neuroinflammation, cortical spreading depression, which is a more likely cause for the development of aura, hormonal and genetic factors. There are also rare monogenic variants, such as familial hemiplegic migraine. Pharmacological management of this condition includes nonsteroidal antiinflammatory drugs for mild episodes and triptans for moderate to severe episodes. Preventive treatment includes drugs belonging to the classes of antiepileptic drugs, beta blockers, antidepressants, and monoclonal antibodies targeting CGRP or its receptor, the later ones being the most recent options. Despite research into the pathophysiology of migraine today, there is presently no completely defined theory. One of the etiological factors may be microcirculatory dysfunction due to the existence of several diseases characterized by microvascular dysfunction that have in common the symptom of migraine headaches, such as Autosomal Dominant Cerebral Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) or Hereditary Infantile Hemiparesis with Retinal Arteriolar Tortuosity and Encephalopathy (HIHRATL). Another cause is the various morphological and functional changes that migraine patients exhibit such as hypoperfusion in the cerebral cortex during periods of prolonged aura, or increased pulsatility of the intracranial vessels of the dura, which leads to mechanical stimulation of the nociceptors innervating the vasculature of this structure, or asymmetric pulsations of blood and asynchronous blood supply from the right and left side of the face in migraine patients, which suggests lateralization of blood flow, during the period between migraine episodes.
Migraine is one of the most common primary headaches and has the greatest impact on patients' lives. It is a chronic condition characterized by multiple symptoms including headache, nausea, hypersensitivity to stimuli such as light and sound, and in some cases aura is present.The etiology is multifactorial, with activation and sensitization of the trigeminal system being essential. It includes neuroinflammation, cortical spreading depression, which is a more likely cause for the development of aura, hormonal and genetic factors. There are also rare monogenic variants, such as familial hemiplegic migraine. Pharmacological management of this condition includes nonsteroidal antiinflammatory drugs for mild episodes and triptans for moderate to severe episodes. Preventive treatment includes drugs belonging to the classes of antiepileptic drugs, beta blockers, antidepressants, and monoclonal antibodies targeting CGRP or its receptor, the later ones being the most recent options. Despite research into the pathophysiology of migraine today, there is presently no completely defined theory. One of the etiological factors may be microcirculatory dysfunction due to the existence of several diseases characterized by microvascular dysfunction that have in common the symptom of migraine headaches, such as Autosomal Dominant Cerebral Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) or Hereditary Infantile Hemiparesis with Retinal Arteriolar Tortuosity and Encephalopathy (HIHRATL). Another cause is the various morphological and functional changes that migraine patients exhibit such as hypoperfusion in the cerebral cortex during periods of prolonged aura, or increased pulsatility of the intracranial vessels of the dura, which leads to mechanical stimulation of the nociceptors innervating the vasculature of this structure, or asymmetric pulsations of blood and asynchronous blood supply from the right and left side of the face in migraine patients, which suggests lateralization of blood flow, during the period between migraine episodes.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2022, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
Enxaqueca Fisiopatologia Vasculatura Disfunção microcirculatória Mestrado integrado - 2022