メタボリックシンドローム治療による片頭痛の予防

Metabolic Syndrome and Prevention of Migraine Headache

　片頭痛の予防療法にはさまざまなものがあるが，近年「メタボリックシンドローム（metabolic syndrome，MetS）治療による片頭痛の予防」という視点での研究が行われ始めている。MetS治療によって，片頭痛の予防が可能かどうかについて，明確なエビデンスはないが，魅力的な課題で，今後，注目されると思われる。片頭痛の共存症研究や，共存症に配慮した治療戦略は極めて重要である。頭痛外来の普及，片頭痛診療を軸にしたトータルヘルスケアなどの観点からも片頭痛とMetSの関連は重要なポイントである。

　本稿ではまず，片頭痛，MetSについて現在の理解を簡単にまとめ，次に，MetSが片頭痛の発症リスクあるいは片頭痛の病態変化のリスク要因となるかどうかを検討し，MetS治療による片頭痛の予防治療について考えてみる。

Abstract

　Metabolic syndrome (MetS) are consist of central obesity, diabetes, dyslipidemia and hypertension.　Previous studies have reported possible association of migraine and MetS were reviewed.　Migraine is a prevalent disabling disorder and have been regarded as an episodic and functional disorder.　However, recent evidence suggests that in some cases, the disease may follow a chronic and progressive course.　On the basis of available evidence, obesity is considered to be associated with migraine frequency and progression.　The association between diabetes and migraine is unclear.　Similarly, association of migraine with hypertension is also unclear.　Female migraineurs commonly have an unfavorable cholesterol profile, i.e. one with high total cholesterol and low HDL levels.　Obesity can be considered as a proinflammatory state in which increased inflammatory mediators, vascular hyperreactivity, plasma calcitonin gene-related peptide (CGRP) concentrations and decreased adiponectin concentrations are observed.　These alterations can cause an increase in the frequency of migraine attacks developed of central sensitization, and thereafter, chronic migraine.

　Migraine and obesity may share some neurobiological abnormalities.　Orexins modulate both pain and metabolism.　Dysfunction in the orexin pathways seems to be a risk factor for both conditions.　The methylene-tetrahydrofolate reductase (MTHFR) gene and the angiotensin converting enzyme (ACE) gene exhibit polymorphism.　C677Tmutation in the MTHFR gene and the D-allele of the ACE gene are the shared risk factors for the development of migraine and cardiovascular disease.　Certain beta-blockers,Ca blockers,ACE inhibitors,and angionten II receptor blocker (ARB) have excellent efficacy in migraine prophylaxis.　The pharmacological mechanism of these agents do not seem to stand on their antihypertensive effect,but the other mechanism of action.　Appropriate meal,sleep,and exercise are important for the management of MetS and migraine headaches.