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曾被视为现代贵族病的偏头痛:你得知道的几件事

更新时间:2018-7-15 12:02:07 来源:千亿千亿国际娱乐官网 作者:佚名

Why don't we know more about migraines?
曾被视为现代贵族病的偏头痛:你得知道的几件事

The first time I experienced a migraine was one evening after school. A dull headache turned into splitting pain, blurring my vision and converting my bedroom light into a source of pure agony. Then came the vomiting. It’s a cycle I’ve experienced countless times in recent years – one that forced me to quit my job and left me feeling helpless.

我第一次偏头痛是在一个放学后的晚上。隐约的头痛变成了头像是要裂开似的巨疼,我的视线模糊,卧室的灯光也让我痛苦不堪,紧接着我就呕吐。这样的循环我近些年来经历了无数次——让我不得不辞职,也让我倍感无助。

A migraine attack has long been passed off as ‘just a headache’. But while ‘normal’ headaches can usually be held at bay with a paracetamol or two, a migraine is aggressive, sometimes enough to be severely debilitating. It has no conclusive cause (hormones and abnormal brain activity are just two potential reasons) or sustainable treatment on offer.

偏头痛很长时间被认为只是头痛。但是"正常的"头痛服一两片扑热息痛就好了,但偏头痛厉害得多,有时足以让人的身体严重衰弱。偏头痛的病因尚不明确(荷尔蒙和大脑活动异常只是两个可能因素)也没有持续的治疗方法。

Perhaps it’s little surprise, then, that the world’s leading survey of health conditions across 195 countries found that, in every year from 1990 to 2016, migraine attacks remained the second-largest global contributor to years lived with disability. They come with a huge economic cost, too, causing an estimated 25 million sick days to be taken in the UK alone each year. But compared to their health and economic burden, migraines remain one of the world’s most under-funded diseases.

或许有点让人惊讶,横跨195个国家的世界领先的健康状况调查发现,从1990年至2016年,偏头痛是全球每年导致长期残疾失能生活的第二大疾病。偏头痛因此也造成了巨大的经济损失,仅在英国每年因偏头痛引起的病假就有约2,500万天。但与其沉重的健康和经济负担相比,偏头痛是世界上最缺乏研究资金的疾病之一。

The disorder is also much more prevalent in women. In general, one in five women suffer compared to one in 15 men.

偏头痛多发于女性。一般来说,每五位女性中有一位患有偏头痛,而每十五位男性中仅有一位患有偏头痛。

Reasons remain unclear – though a University of Arizona study of male and female rats, published in April 2018, suggests that it may be because of the link between higher oestrogen levels and lower levels of the sodium proton exchanger NHE1. Without enough NHE1, pain signalling increases. "Based on our findings, we think that women are more susceptible to migraine because the larger magnitude sex hormone fluctuations lead to changes in NHE1 expression," researcher Emily Galloway explained.

原因尚不清楚——但2018年四月发表的亚利桑那大学做的公鼠和母鼠的研究表明,可能是雌激素越多,钠氢交换蛋白NHE1越少的原因。没有足够的NHE1,疼痛信号就会增加。研究员盖洛韦(Emily Galloway)解释道,"根据我们的研究结果,我们认为偏头痛多发于女性是因为性激素的大幅波动改变了NHE1的表达。"

But when it comes to research and funding, migraines have been less investigated than other ailments. Despite the enormous economic costs, they continue to receive the least public funding of any neurological illness in Europe. In the US, where migraines affect an estimated 15% of people, the condition received $22m in research funding (£17m) in 2017. Asthma, which affects half as many people, received 13 times that amount ($286m or £218m); diabetes, affecting two-thirds as many people, received 50 times as much ($1.1bn or £84m). (Of course, it’s worth noting that asthma and diabetes are potentially life-threatening conditions).

但说到研究和研究资金,与其他疾病相比,偏头痛研究得还不够多。尽管有着巨大的经济损失,偏头痛是欧洲收到最少公共资助的神经疾病。在美国,约15%的人受偏头痛的困扰,2017年偏头痛研究收到了2,200万美元(1700万英镑)的研究资金。患哮喘的人仅有患偏头痛的人的一半,但哮喘研究却收到了13倍的资金支持(2.86亿美元或2.18亿英镑);患糖尿病的人数是患偏头痛人数的三分之二,收到了50倍之多的资金研究支持(110亿美元或8,400万英镑)。(当然,值得注意的是哮喘和糖尿病可能会危及生命)。

When the condition is studied, it often is affected by a trend seen in other healthcare research: most migraine research on animals has been done on males even though women suffer from migraines more.

偏头痛的研究经常受到其他医疗研究趋势的影响:大多数偏头痛的动物研究用的是雄性动物,尽管人类受到偏头痛困扰的以女性居多。

Given the prevalence of migraines among women, this apparent neglect could be a result of how physicians tend to underrate pain in female patients. It may also reflect the historic – and similarly gendered – associations between migraines and mental illness.

鉴于偏头痛多发于女性,这明显的忽视可能是因为医生往往低估女性患者的疼痛。这可能也反映了将偏头痛看作精神疾病的历史偏见,同样也与性别有关。

Heady history

头痛历史

These throbbing headaches are one of the human race’s oldest recorded ailments. Ancient Egyptian scriptures from 1200 BC detail migraine-like headaches; Hippocrates wrote about the visual disturbances and vomiting commonly associated with the disorder.

这种悸动性的头痛是人类最早有记载的疾病之一。古埃及公元前1200年的文献中详细描述了类似偏头痛的头痛;古希腊医师希波克拉底在他的着作中提到了通常与偏头痛有关的视力影响和呕吐。

The actual discovery of migraines, however, is routinely credited to the ancient Greek doctor Aretaeus of Cappadocia, who accurately described their one-sidedness and symptom-free periods in the second century. (In fact, the word ‘migraine’ is derived from the Greek term ‘hemicrania’, meaning half skull).

不过偏头痛的真正最早发现,普遍认为应归功于卡帕多西亚(现属于土耳其)的古希腊医生阿莱泰乌斯,他在公元二世纪准确描述了偏头痛的偏侧性和无先兆阶段。(事实上,偏头痛('migraine')一词即来源于希腊词汇('hemicrania'),意思是半个头骨)。

Historically, the believed cause and treatment of migraines had deep superstitious links. A number of questionable treatments arose in the Middle Ages from blood-letting and witchcraft to a clove of garlic being inserted into an incision in the temple. Some medical experts recommended trepanation – the drilling of holes into the skull – as a migraine remedy. The gruesome procedure was commonly used to release evil spirits from people who were more likely to have been suffering from a mental illness than demonic possession, and is one of the first supposed links between migraines and the mind.

在历史上,人们对偏头痛的病因的认识和疗法都有浓重的迷信色彩。欧洲中世纪,出现了许多相当可疑的疗法,比如放血,还有把蒜瓣插进太阳穴的巫术等。一些医术专家推荐用头部穿孔术(trepanation )——在头骨上钻一个孔来治疗偏头痛。这种可怕的疗法常用来驱逐恶灵,实际上被治疗的人可能是精神病患者,而不是什么恶灵附体。这可能是人类最早将偏头痛与精神病联系在一起。

The greater number of females with migraines initially was noticed by doctors in the 19th Century. They believed the mind was to blame, describing the condition as a disorder of “mothers in the lower classes” whose minds were weak due to daily work, little sleep, frequent lactation and malnourishment. Women experiencing acute headaches were often ridiculed and seen as hysterical, starting the stigma of neurosis that still exists today.

偏头痛多发于女性是19世纪的医生最初发现的。他们把这归咎于精神状况,把偏头痛看作是"下层母亲"的疾病,她们由于日常劳动,缺少睡眠,频繁哺乳和营养不良而导致精神虚弱。患有剧烈头痛的女性常被嘲笑,被认为歇斯底里,起于那个时代神经官能症的性別成见至今日仍然存在。

“For a long time, migraine was considered a disease of modern luxury, the kind of thing that struck down intelligent upper class men and women,” says Joanna Kempner, associate professor of sociology at Rutgers University. “People with this upbringing were thought to have delicate nervous systems which enabled at least the men to engage in artistic and scientific pursuits.

罗格斯大学社会学副教授肯普纳( Joanna Kempner)说:"很长一段时间,偏头痛被视为现代贵族病,上流知识分子男女常患有偏头痛。人们认为患有偏头痛的人有着脆弱的神经系统,让他们,至少是男性,能够追求艺术或者探索科学。"

“Of course, women were believed to have a much diminished capacity for intellectual work and, as a result, could more easily overload their ‘delicate nervous systems’.”

"当然,人们认为女性从事智力工作的能力较低,很容易超出她们'脆弱的神经系统'的负荷。"

Indeed, the father of modern headache medicine, American neurologist Harold G Wolff, defined a distinct difference between male and female migraine patients. To him, men were ambitious and successful (only getting a migraine when tired). But women had a migraine attack because they were incapable of accepting the female role, particularly when it came to sex. Wolff said his female patients accepted sex as “a reasonable marital duty, at best. In several instances, it was deemed frankly unpleasant and was resented.”

事实上,现代头痛药之父,美国神经学家沃尔夫(Harold G Wolff)即认为男性和女性偏头痛患者间有明显的差别。他认为,男性雄心勃勃,功成名就,只有感到疲倦时有偏头痛,但是女性患有偏头痛是因为她们不能接受其女性角色,特别是性生活方面。沃尔夫说他的女性病患者认为"性充其量是合理的婚姻责任,有些人直截了当地说自己不喜欢甚至讨厌性行为。"

Kempner adds: “by the end of the 20th Century, migraine became nearly synonymous with the neurotic housewife – in fact, some thesauruses even list ‘migraine’ as a synonym for ‘spouse’.”

肯普纳补充道;"20世纪之前,偏头痛几乎成了神经质的家庭主妇的同义词——事实上,一些词典还把'偏头痛'列为'配偶'的同义词。"

Mind matters

精神问题

It can’t be denied that there appears to be a link between the headache disorder and mental health. Several studies have concluded that migraines are commonly associated with a range of psychiatric disorders. A 2016 review found high rates of correlation between migraines and bipolar; meanwhile, people with migraines are 2.5 times more likely to develop generalised anxiety disorder (GAD), and people with depression are three times more likely to experience migraine attacks. Another study found that around one in every six migraine sufferers have seriously considered suicide at some point in their lives. (One in 10 people in the general population are said to have had suicidal thoughts.)

不可否认,偏头痛与精神健康有关。已有几项研究表明偏头痛通常与很多精神疾病都有关系。2016年的一项综述发现偏头痛与躁郁症高度相关;同时,偏头痛患者患有广泛性焦虑症的概率是普通人的2.5倍,抑郁症患者患有偏头痛的概率是普通人的三倍。另一项研究发现,每六位偏头痛患者中就有一位曾认真考虑过自杀。(通常情况下,10人中仅有一人有自杀的想法。)

“But whether it is causal is a big question,” says Messoud Ashina, neurology professor and director of the Danish Headache Centre’s Human Migraine Research Unit. “When you have a very prevalent disorder like migraine, the likelihood that it can overlap with other diseases is quite high.”

阿史那(Messoud Ashina) 是神经学教授和丹麦头痛研究中心偏头痛研究部的主任,他说"到底有没有因果关系,是个大问题,因为如果患有像偏头痛这样的多发性疾病,同时患有其他疾病的概率很高。"

Of course, suffering from migraines may also lead to poor mental health – rather than a ‘delicate constitution’ leading to migraines, as Victorian physicians would have had it.

当然,患有偏头痛可能导致精神状况不佳,而不是维多利亚时期的医生所说的"脆弱的神经系统"导致了偏头痛。

“It’s not surprising that anxiety levels are high when one is never sure when a migraine will occur and if the pain will interfere with work and family responsibilities,” points out Esme Fuller Thomson, director of the Institute for Life Course & Ageing at the University of Toronto who has researched migraine-suicide links.

汤姆森(Esme Fuller Thomson)是多伦多大学生命历程与老化研究所(Institute for Life Course & Ageing)所长,研究过偏头痛与自杀的关联,她指出:"患偏头痛的人大多都很焦虑,这并不奇怪,因为你不知道头痛什么时候会发作,会不会影响工作和家庭。"

Depression, meanwhile, also may be exacerbated by the feelings of helplessness that people with migraines often experience.

同时,偏头痛患者时常经受的无助感也有可能发展成精神抑郁。

Despite the effect of migraine attacks on such a vast sum of the population, the condition is surprisingly little understood or researched. “Many people in neurology and society consider migraine as a benign disease – it is not a cancer, it is not Parkinson’s,” Ashina says. “But if you look at its public and personal impact, migraine is a huge issue.”

虽然偏头痛患者人数如此之巨大,但是对此症状的认识和研究却令人吃惊地稀少。阿史那说:"很多神经学界和社会上的人认为偏头痛是良性疾病——毕竟不是癌症也不是帕金森,但如果你认真看一看偏头痛对社会和个人的影响,你会发现是个大问题。"

Amaal Starling, assistant professor of neurology at Mayo Clinic in Scottsdale, Arizona, says some specialists don’t see it as a ‘real neurology’. Headache specialists therefore have found it difficult to legitimise their practice and convince others that funding is a necessity, not a luxury.

斯塔林(Amaal Starling)是亚利桑那州斯科茨代尔梅奥医院(Mayo Clinic)的神经内科学助理教授,她说,一些专家不把偏头痛当作"真正的神经内科学疾病"。因此,头痛研究专家难以跟别人解释自己的研究是合情合理的,资助也是必要的,而不是奢侈。

And some of that difficulty in getting a predominantly ‘female’ condition taken seriously may be gender bias: in general, women have a harder time getting their pain symptoms taken seriously or getting a correct medical diagnosis than men.

可能是由于性别歧视,多发于女性的疾病有些难以得到认真对待;总体来说,相比男性,女性患者让其疼痛症状得到严肃对待并得到正确诊疗要更加困难。

Common condition

常见情况

The sheer number of patients with migraines means that specialists should be well-versed in the condition, experts say. As one source that Kempner spoke with for her book Not Tonight: Migraine and the Politics of Gender and Health said: “Headache is the commonest symptom found in neurologic outpatients and the least taught to neurology residents. It’s like training electricians, but not telling them about light bulbs.”

专家认为,偏头痛患者数量之多意味着专家本应该精通此症。如肯普纳在写其《今晚不行:偏头痛、性别与健康》一书时访问的知情人士所说的那样:"头痛是神经科门诊患者最常见的症状,但住院实习医生却学得最少,就像训练电工,却不教他们怎么装灯泡。"

Fortunately, a new treatment may be in the works: an injection called Erenumab, administered once a month, which works by blocking a receptor in the brain that activates a migraine attack. (A similar drug that also targets the CGRP receptor was granted approval by the US Food and Drug Administration in May 2018).

幸运的是,新的疗法可能已在試用:每月注射一种叫做Erenumab单克隆抗体,能够阻碍引起偏头痛的细胞受体发挥作用,从而预防偏头痛。(美国食品和药物管理局在2018年五月批准了同样是针对降钙素基因相关肽( CGRP)细胞受体的相似药物)。

“What’s key is that this novel drug was designed for the treatment of migraine, not created for a different disease and then found to also help some people with migraine,” says Starling. “A drug designed for a disease is likely to be more effective and have less ‘off target toxicity’ which leads to reduced side effects.”

斯塔林说:"关键是这种新药是专门为治疗偏头痛研制的,而不是为治疗其他疾病研制,只不过后来发现也能帮助一些人缓解偏头痛。专门为一种疾病研制的药物更加有效,'脱靶毒性'更少,能减少副作用。"

As a person currently prescribed beta blockers for migraines, I wholeheartedly agree. My medication, which is taken three times a day over the course of a few months, is intended to treat angina and high blood pressure. Doctors realised it also prevented migraines. But it wasn’t designed for migraine sufferers. And although a migraine-specific tablet is likely to also come with side effects, beta blockers have a scary-sounding list. including excessive tiredness and dizziness with the potential for a heart attack if you abruptly stop taking them.

作为一个正在服用β-受体阻滞剂的偏头痛患者,我完全同意这种看法。这种药原先是用来治疗心绞痛和高血压的,我需要服用几个月,一日三次。医生发现也能用来预防偏头痛。但是这种药不是特别为偏头痛患者研制的。虽然专门为偏头痛研制的药物也可能有副作用,但是β-受体阻滞剂的副作用实在太吓人,包括过度疲倦,头晕以及突然停用可能会引发心脏病等。

These treatments join the likes of other modern, electrical and magnetic treatments, which involve hand-held devices sending magnetic pulses into the brain in order to alter the electrical environment of neurons and reduce ‘hyperexcitability’.

这种疗法加上现代的电磁疗法(通过手握设备向大脑发射磁脉冲),以改变神经元的电流环境,减少"过度兴奋"。

After almost six migraine-free months, I am now reducing my dose of beta blockers. My end goal? Zero medication. But another a migraine attack recently hit me. And a couple of months earlier, I was rushed to hospital with a suspected heart attack. Luckily, it was a false alarm. But it opened my eyes to the need for migraine treatment that won’t impact my vital organs. Hopefully, that invention is on the horizon.

我已经有几乎六个月没有偏头痛了,现在我正在减少服用β-受体阻滞剂的剂量。我的最终目标?不吃药。但是最近我又偏头痛了一次。几个月前,我因疑似心脏病被送进医院,幸运的只是虚惊一场。但是这使我意识到,我需要不影响我身体重要器官的药物。值得庆幸的是,这种药物即将出现。

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