偏头痛患者个性特征、应对方式及其与头痛发作相关性的研究

目的:探讨偏头痛患者个性特征、应对方式及其与头痛发作的相关性.方法:选择113例偏头痛作为观察组,另设76例健康人作为对照组,采用艾森克个性同卷、应对方式同卷、偏头痛诊断疗效评定标准进行测评.结果:观察组神经质、自责、退避等因子分显著高于对照组,内倾向和求助因子分显著低于对照组(P<0.01);自责、退避等与神经质呈显著正相关,解决问题、求助与精神质呈显著负相关(P<0.01);内向不稳定患者头痛程度、发作频率显著高于外向稳定患者(P<0.01).结论:多数偏头痛患者个性特征和应对方式存在一定的缺陷,头痛发作与个性缺陷和不成熟的应对方式密切相关.     

通心络胶囊治疗偏头痛（气虚血瘀型）的疗效观察

目的 评价通心络胶囊治疗轻中度气虚血瘀型偏头痛的疗效和安全性。方法 将120例轻中度气虚血瘀型偏头痛患者随机分为治疗组、对照组，每组各60例。治疗组给予通心络胶囊，对照组给予布洛芬缓释胶囊（芬必得）和盐酸氟桂利嗪胶囊治疗。结果 对总体疗效而言，意向性分析（intention—to—treat，ITT）结果显示两组总有效率分别为81．67％、83．33％，方案数据分析（per—protocol population，PP）结果显示两组总有效率分别为82．00％、84．31％，疗效差异均无统计学意义，P〉0．05，两组具有临床上的非劣性，P〈0．05。ITT分析与PP分析结果一致。临床观察中未发现通心络胶囊有任何毒副作用和不良反应。结论 通心络胶囊治疗轻中度气虚血瘀型偏头痛安全有效，值得在临床上推广应用。     

针刺少阳经特定穴治疗偏头痛疗效观察

目的:观察针刺少阳经的特定穴治疗偏头痛的临床疗效。方法:45例偏头痛患者以针刺少阳经特定穴进行治疗。结果:特定经穴组有效率93.33%。结论:少阳经特定经穴治疗偏头痛有显著的特异性。     

清脑灵对硝酸甘油型偏头痛模型大鼠下丘脑NE和5-HT的影响

目的观察清脑灵对硝酸甘油型偏头痛模型大鼠下丘脑去甲肾上腺素（NE）和5-羟色胺（5-HT）的影响。方法Wistar大鼠50只随机分为空白组、模型组、阳性药物组、中药1组（模型＋清脑灵小剂量组）、中药2组（模型＋清脑灵大剂量组），每组10只。模型组及治疗组大鼠皮下注射硝酸甘油，按Cristina等报道的方法复制实验性偏头痛模型。给药复制动物模型90min后将大鼠断头处死，采用高效液相色谱法HPLC测定大鼠下丘脑中NE和5-HT含量。结果用药后，阳性药物组及中药1，2组NE、5-HT水平均明显下降。结论清脑灵能提高大鼠下丘脑5-HT、NE等单胺类递质的含量。     

Efficacy of the non-peptide CGRP receptor antagonist BIBN4096BS in blocking CGRP-induced dilations in human and bovine cerebral arteries: potential implications in acute migraine treatment

Calcitonin gene-related peptide (CGRP) is a potent vasodilator in brain vessels and it has been implicated in the pathogenesis of migraine headache. Blocking post-junctional CGRP receptors, mediators of trigeminal-induced vasodilation, has been suggested as a potential antimigraine strategy. In this study, we tested the ability of a new non-peptide CGRP receptor antagonist, BIBN4096BS, to inhibit the CGRP-induced dilation in human and/or bovine brain vessels and compared it to that of the antagonist alpha-CGRP(8-37). BIBN4096BS and alpha-CGRP(8-37) both blocked the alpha-CGRP-induced dilation in bovine middle artery segments with respective potency (pK(B) values) of 6.3 and 7.8. In human pial vessels, BIBN4096BS was particularly potent. When tested at 10(-14)-10(-9) M concentrations, it induced a rightward shift in the alpha-CGRP concentration-response curve and yielded a biphasic Schild plot suggesting interaction with more than one receptor population, as was also indicated by the significant best fit of the alpha-CGRP-induced dilation in human brain vessels with a two receptor site interaction. Schild plot analysis in the linear portion of the BIBN4096BS inhibition curve revealed interaction with one high affinity site (pA(2) value approximately 14). In bovine vessels, both alpha-CGRP(8-37) and BIBN4096BS concentration-dependently reversed a pre-established CGRP-induced dilation ( approximately 59 and 85%, respectively), BIBN4096BS being approximately tenfold more potent than alpha-CGRP(8-37) (respective pIC(50) values of 7.5 and 6.75). In human middle cerebral and middle meningeal arteries, BIBN4096BS reversed the alpha-CGRP-induced dilation (> or =70%) by interaction with two different receptor populations: it exhibited a high affinity for one population (pIC(50) value approximately 13) and a lower affinity for the other (pIC(50) value approximately 8). The present data demonstrate that BIBN4096BS is a very potent antagonist that could, depending on its bioavailability and in vivo affinity, be of potential benefit in the acute treatment of migraine headache by blocking and/or reversing the CGRP-mediated dilation of intracranial vessels induced by activation of trigeminovascular afferents.     

A typical migraine susceptibility region localizes to chromosome 1q31

Migraine (with and without aura) is a prevalent neurovascular disease that shows strong familial aggregation, although the number of genes involved and the mode of inheritance is not clear. Some insight into the disease has been gained from genetic studies into a rare and very severe migraine subtype known as familial hemiplegic migraine (FHM). In this study, we took a family-based linkage and association approach to investigate the FHM susceptibility region on chromosome 1q31 for involvement in typical migraine susceptibility in affected Australian pedigrees. Initial multipoint ALLEGRO analysis provided strong evidence for linkage of Chr1q31 markers to typical migraine in a large multigenerational pedigree. The 1-LOD* unit support interval for suggestive linkage spanned approximately 18 cM with a maximum allele sharing LOD* score of 3.36 obtained for marker D1S2782 (P=0.00004). Subsequent analysis of an independent sample of 82 affected pedigrees added support to the initial findings with a maximum LOD* of 1.24 (P=0.008). Utilising the independent sample of 82 pedigrees, we also performed a family-based association test. Results of this analysis indicated distortion of allele transmission at marker D1S249 [global χ² ₍₅₎ of 15.00, P=0.010] in these pedigrees. These positive linkage and association results will need further confirmation by independent researchers. However, overall they provide good evidence for the existence of a typical migraine locus near these markers on Chr1q31, and reinforce the idea that an FHM gene in this genomic region may also contribute to susceptibility to the more common forms of migraine. Electronic Publication     

Placebo effect in the acute treatment of migraine: subcutaneous placebos are better than oral placebos

We carried out a meta-analysis of 22 trials to determine the comparative placebo effect of (a) subcutaneous vs. oral and (b) in-hospital vs. at-home administration in the treatment of migraine. The headache relief rates were combined from the placebo arms of these randomised clinical trials assessing the value of sumatriptan in acute treatment of migraine. The main outcome measure was the proportion of patients reclassified from severe or moderate headache severity to no or mild headache severity 2 h after the beginning of treatment. In the oral regimen 222 of 865 patients (25.7%) reported no or mild headache severity after 2 h, compared to 279 of 862 patients (32.4%) of those receiving subcutaneous placebo (6.7% difference; 95% CI 2.4-11.0%). Adjusting for treatment setting and severity of headache at baseline did not change the observed difference. After placebo treatment at home 285 of 1,054 patients (27.0%) reported no or mild headache severity after 2 h, compared to 216 of 673 patients (32.1%) among those receiving placebo in hospital (5.1 % difference; 95% CI 0.6-9.5%). When adjusted for route of administration and severity of headache at baseline, the difference in relief rates between home and hospital setting disappeared. These findings indicate that subcutaneous administration enhances the placebo effect of acute treatment of migraine. Future trials of antimigraine drugs assessing the relative efficacy of various routes of administration should use a double-dummy technique. The interpreting of placebo-controlled trial results must therefore consider that the effect in the drug arm of the trial depends in part on the route of administration.     

推拿和神灯照射同时进行治疗偏头痛的临床观察

目的:观察推拿和神灯照射同时进行治疗偏头痛的疗效。方法:对144例偏头痛的患者,进行随机数字表法分组治疗观察。治疗组:采用在神灯照射的同时进行指揉法、指梳法、指尖击法、掌揉法、点穴法等推拿治疗。对照组:采用谷维素,脑清片,镇痛剂和降低颅内压等药物治疗。结果:治疗组:优:24例(33.33%),良;41例(56.94%),差;4例(5.55%),有效率:95.82%。对照组;优:9例(12.50%),良:26例(36.11%),差;8例(11.11%)有效率59.72%。结论:推拿加神灯照射治疗偏头痛疗效显著。     

偏头痛性眩晕的神经耳科学表现

目的研究偏头痛相关的眩晕（migrainous vertigo，MV）的临床特点，了解听觉与前庭系统受累的情况以及功能障碍的范围和程度，判断偏头痛相关眩晕是中枢性抑或外周性眩晕。方法22例急性（5例）或亚急性（17例）MV检查包括神经一耳科学检查、自发性眼震和位置性眼震记录以及听力学检查。结果22例患者男6例，女16例。15例次有偏头痛，17例次有运动病，15例次有偏头痛或运动病家族史，1例次有视觉先兆，7例次对运动敏感（身体运动或改变头位出现眩晕），4例次畏光，6例次畏声，5例次失眠、情绪影响易引起眩晕发作，2例次与月经期关系密切。眩晕持续数分钟到1天。纯音测听异常9例，均为轻至中度感音神经性聋。高刺激率听性脑干反应双侧异常3例，单侧异常10例。主观垂直视觉检查均正常。前庭诱发的肌源性电位异常14例（13例为患侧低振幅，1例为患侧P13波潜伏期延长）。前庭双温检查异常3例；中枢性异常眼动11例，其中视动性眼震低增益9例，1例扫视过冲，1例摇头试验出现垂直眼震，同时高刺激听性脑干反应异常者10例，1例正常。4例患者有位置性眩晕，但均不符合良性阵发性位置性眩晕的诊断。结论偏头痛性眩晕应作为外周或中枢性眩晕的一种常规鉴别诊断的疾病，可为中枢性或外周性眩晕。     

电针合刺络治疗偏头痛205例疗效观察

目的观察针刺治疗偏头痛的疗效。方法采用电针合刺络治疗偏头痛205例，并与西药组进行对照。结果针刺组总有效率为90．24％，对照组74．60％，两组疗效具有显著性差异。结论电针合刺络治疗偏头痛疗效优于西药治疗。