Serum cortisol level and disc displacement disorders of the temporomandibular joint

Temporomandibular disorders (TMD) are a significant public health problem, affecting approximately 5–12% of the population. Objectives: This retrospective cross‐sectional study investigated the relationship between 8 AM serum cortisol levels (8ASC) and disc displacement disorders (DDD) of TMD. One hundred and forty patients with DDD were recruited. Among them, 60 patients comprised the case group of disc displacement without reduction with limited opening (DDWORWLO, age 37·7 ± 17·22), and 80 were ‘other DDD’ for the control group (age 36·4 ± 13·08). The independent variables included domains of demography, history, malocclusion, comorbid symptoms, comorbid TMD and 8ASC. Data were analysed with the chi‐square test, logistic regression and receiver operating characteristic (ROC) curve. Results of multiple logistic regression showed that 8ASC was the only factor significantly related to DDWORWLO (P = 0·006). Receiver operating characteristic analysis of DDWORWLO and 8ASC indicated an area under the curve of 0·669, standard error of 0·049 and P value of 0·001. The adequate cut‐off point of 8ASC was 12·45 (μg dL^?1), with sensitivity of 0·636, and specificity of 0·729. 8 AM serum cortisol level can be used as a clinical clue to differentiate DDWORWLO from other DDD.     

La vasodilatation a-t-elle un rôle dans la migraine ? Non

IntroductionThe hypothesis that migraine pain is caused by vasodilation has been challenged by clinical and experimental evidence.State of artThe most convincing arguments against the vascular hypothesis come from neuroimaging data. Magnetic resonance imaging studies show that spontaneous migraine attacks are not accompanied by extracranial vasodilation, and by only slight dilation of the intracranial arteries. Pharmacologically-induced migraine attacks also provide further evidence against the role of vasodilation in migraine. Vasodilators such as sildenafil and nitroglycerine trigger attacks without dilation of the middle cerebral artery diameter, whereas VIP (vasoactive intestinal peptide) markedly dilates intra- and extracranial arteries but does not induce migraine attacks. Clinical studies also show a lack of correspondence between the subjective experience of throbbing headache and the arterial pulse. Moreover, many acute anti-migraine agents are not vasoconstrictors.PerspectivesFurther studies are necessary to clarify the mechanisms of migraine headache generation.ConclusionsContrary to a longstanding and widespread belief, vasodilatation is neither sufficient nor necessary to cause migraine headache and is probably an epiphenomenon.     

The association between obesity and migraine in a population of Iranian adults: a case-control study

Aim

To assess the association between obesity and risk of migraine with aura and features of migraine attacks among a population of Iranian adults.

养血清脑颗粒联合盐酸氟桂利嗪治疗偏头痛的疗效探讨

目的：探讨养血清脑颗粒联合盐酸氟桂利嗪治疗偏头痛的临床疗效。方法将82例偏头痛患者随机分为对照组(盐酸氟桂利嗪,n=41)和观察组(盐酸氟桂利嗪+养血清脑颗粒,n=41),连续治疗1个月后,观察并对比两组的治疗效果。结果观察组的临床总有效率为92.7%,对照组的临床有效率为70.7%,对比两组有效率差异有统计学意义(字2=4.546,P<0.05)。结论养血清脑颗粒联合盐酸氟桂利嗪在临床上对偏头痛的治疗效果显著,比单独应用盐酸氟桂利嗪效果要好。     

通心络胶囊与盐酸氟桂嗪治疗偏头痛的临床对比分析

目的：研究通心络胶囊与盐酸氟桂嗪治疗偏头痛的临床治疗效果。方法整群选取2012年9月-2014年5月间在该院接受治疗的偏头痛患者288例,将其随机分为观察组和对照组,两组各有患者144例。观察组患者服用通心络胶囊进行治疗;对照组患者服用盐酸氟桂嗪胶囊。治疗结束后对比两组治疗效果。结果观察组偏头痛患者治疗前评分为(17.61±1.32),治疗后评分(6.14±2.11);对照组偏头痛患者治疗前评分为(16.94±1.59),治疗后评分为(10.51±3.12),两组偏头痛患者的数据差异有统计学意义(P<0.05)。观察组144例偏头痛患者经过治疗后,治疗后效果为控制的患者有49例(34.03%),治疗总有效率为91.67%;对照组144例偏头痛患者经过治疗后,治疗后效果为控制的患者有26例(18.06%),治疗总有效率为88.19%。两组偏头痛患者在接受治疗后治疗效果差异无统计学意义(P>0.05),但观察组控制率明显优于对照组,且差异有统计学意义(P<0.05)。结论通心络胶囊与盐酸氟桂嗪对偏头痛患者均有着较好的治疗效果,但通心络胶囊综合方面优势明显,患者控显率较高,治疗后评分优于盐酸氟桂嗪。     

氟桂利嗪联合泰必利治疗偏头痛疗效分析

目的：探讨氟桂利嗪联合泰必利治疗偏头痛的临床疗效。方法：将2011年6月-2013年10月本院收诊的60例偏头痛患者随机分成对照组和治疗组各30例,对照组采用氟桂利嗪治疗,治疗组采用氟桂利嗪联合泰必利治疗。治疗前后对两组患者的症状进行量化评分,比较组间疗效差异。结果：治疗2个月后,治疗组痊愈率显著高于对照组,无效率显著低于对照组,两组比较差异有统计学意义（P<0.05）;治疗组总有效率为90.0%,显著高于对照组的73.3%,两组比较差异有统计学意义（P<0.05）。治疗2个月后治疗组疼痛程度、头痛发作次数、持续时间均显著低于对照组,两组比较差异有统计学意义（P<0.05）。结论：氟桂利嗪联合泰必利治疗偏头痛能有效改善偏头痛症状,疗效优于单用氟桂利嗪。     

Modafinil in the treatment of idiopathic hypersomnia without long sleep time—a randomized,double‐blind,placebo‐controlled study

In 2010 the European Medicines Agency withdrew the indication of modafinil for the treatment of obstructive sleep apnea, shift work sleep disorder and for idiopathic hypersomnia (IH). In uncontrolled studies, modafinil has been reported to be efficacious in the treatment of sleep disorders. We therefore performed a randomized, placebo‐controlled study with the aim of proving the efficacy of modafinil treatment in these patients. Drug‐free IH patients without long sleep according to ICSD2 criteria, age >18 years and disease duration >2 years were included. After a washout phase, patients at baseline received placebo or 100 mg modafinil in the morning and at noon over 3 weeks, followed by 1 week without medication. At each visit the Epworth Sleepiness Scale (ESS) and Clinical Global Impression (CGI) rating scale were performed. At baseline and on days 8 and 21 four Maintenance of Wakefulness Tests (MWTs)/day or per day were performed. Patients kept a sleep–wake diary throughout the study. Between 2009 and 2011 three sleep centres recruited 33 participants. Compared to placebo, modafinil decreased sleepiness significantly and improved mean sleep latency in the MWT non‐significantly. The CGI improved significantly from baseline to the last visit on treatment. The most frequent adverse events were headaches and gastrointestinal disorders; skin and psychiatric reactions were not reported. The number of reported naps and duration of daytime sleepiness decreased significantly. Total sleep time of nocturnal sleep was slightly reduced. The sleep diaries showed increases in feeling refreshed in the morning; the diurnal diaries showed significant improvement of performance and of exhaustion. Modafinil is an effective and safe medication in the treatment of IH. Adverse events are mild to moderate.