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はじめに
片頭痛における視覚性前兆は5分以上かけて徐々に進展し，多くは20分ほど持続し1時間以内に消失するのが特徴で，閃輝性暗点（scintillation scotoma）として知られている。陽性徴候（刺激性）である閃光様のきらきらした光・点・線に続き陰性徴候（抑制性）である暗点や同名性の半盲を呈することが多い1）。視野の異常は網膜部位再現性（retinotopic representation）があり，視覚一次中枢（V1）に関連して出現すると考えられてきた。
前兆のある片頭痛（migraine with aura：MA）の亜型である家族性片麻痺型片頭痛（familial hemiplegic migraine：FHM）の遺伝子解析や分子生物学の近年の研究成果にはめざましいものがある。一方，視覚性前兆を自覚するものは約20％で典型的な症状は必ずしも多くはないが，片頭痛の病態を考えるうえで視覚に関連するアプローチは重要である。本稿では，皮質拡延性抑制（cortical spreading depression：CSD）と最近の視覚性前兆に関連する研究について概説する。そのなかで特に神経生理に関連した発作間欠期の心理物理学的な研究を紹介し，片頭痛の発症機序について簡単に触れてみたい。
片頭痛における視覚性前兆は5分以上かけて徐々に進展し，多くは20分ほど持続し1時間以内に消失するのが特徴で，閃輝性暗点（scintillation scotoma）として知られている。陽性徴候（刺激性）である閃光様のきらきらした光・点・線に続き陰性徴候（抑制性）である暗点や同名性の半盲を呈することが多い1）。視野の異常は網膜部位再現性（retinotopic representation）があり，視覚一次中枢（V1）に関連して出現すると考えられてきた。
前兆のある片頭痛（migraine with aura：MA）の亜型である家族性片麻痺型片頭痛（familial hemiplegic migraine：FHM）の遺伝子解析や分子生物学の近年の研究成果にはめざましいものがある。一方，視覚性前兆を自覚するものは約20％で典型的な症状は必ずしも多くはないが，片頭痛の病態を考えるうえで視覚に関連するアプローチは重要である。本稿では，皮質拡延性抑制（cortical spreading depression：CSD）と最近の視覚性前兆に関連する研究について概説する。そのなかで特に神経生理に関連した発作間欠期の心理物理学的な研究を紹介し，片頭痛の発症機序について簡単に触れてみたい。
参考文献
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