搐鼻散治疗偏头痛74例疗效观察

目的　观察搐鼻散治疗偏头痛的疗效。方法　 74例偏头痛患者随机分为 2组。治疗组 38例采用搐鼻散纱条鼻腔施药治疗 ,对照组 36例口服镇脑宁胶囊治疗。观察 2组疗效。结果　治疗组治愈率、总有效率分别为 36 .84 %、94 .74 % ,对照组治愈率、总有效率分别为 2 2 .2 2 %、77.78% ,2组比较具有统计学意义(P <0 .0 5 ) ;止痛起效时间治疗组 [(1 .1 6± 0 .94 )min]较对照组 [(5 .79± 6 .0 2 )min]明显缩短 (P <0 .0 0 1 ) ;治疗组治疗后症状积分 (1 .2± 0 .3)较对照组 (2 .3± 0 .5 )明显下降 (P <0 .0 5 )。结论　搐鼻散鼻腔施药治疗偏头痛止痛迅速 ,疗效确切     

Risk for ischemic stroke and coronary heart disease associated with migraine and migraine medication among older adults

BackgroundMigraine has been associated with cardiovascular disease (CVD) events among middle-aged adults. The objective of this study was to determine the risk for ischemic stroke and coronary heart disease (CHD) events among older adults with versus without migraine.MethodsThis retrospective cohort study was conducted using data from US adults ≥66 years of age with Medicare health insurance between 2008 and 2017. After stratification by history of CVD, patients with a history of migraine were matched 1:4 to those without a history of migraine, based on calendar year, age, and sex. Patients were followed through December 31, 2017 for ischemic stroke and CHD events including myocardial infarction or coronary revascularization. All analyses were done separately for patients with and without a history of CVD.ResultsAmong patients without a history of CVD (n = 109,950 including n = 21,990 with migraine and n = 87,960 without migraine), 1789 had an ischemic stroke and 3552 had a CHD event. The adjusted hazard ratio (HR) among patients with versus without migraine was 1.20 (95% confidence interval [95%CI], 1.07–1.35) for ischemic stroke and 1.02 (95%CI, 0.93–1.11) for CHD events. Compared to patients without migraine, those with migraine who were taking an opioid medication had a higher risk for ischemic stroke (adjusted HR 1.43 [95%CI, 1.20–1.69]), while those taking a triptan had a lower risk for CHD events (adjusted HR 0.79 [95%CI, 0.67–0.93]). Among patients with a history of CVD (n = 79,515 including n = 15,903 with migraine and n = 63,612 without migraine), 2960 had an ischemic stroke and 7981 had a CHD event. The adjusted HRs (95%CI) for ischemic stroke and CHD events associated with migraine were 1.27 (1.17–1.39) and 0.99 (0.93–1.05), respectively. Patients with migraine taking an opioid medication had a higher risk for ischemic stroke (adjusted HR 1.21 [95%CI, 1.07–1.36]), while those taking a triptan had a lower risk for CHD events (adjusted HR 0.83 [95%CI, 0.72–0.95]), each versus those without migraine.ConclusionsOlder adults with migraine are at increased risk for ischemic stroke. The risk for ischemic stroke among older adults with migraine may differ by migraine medication classes.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-021-01338-z.     

The evolution of headache from childhood to adulthood: a review of the literature

Headache is one of the most common disorders in childhood, with an estimated 75% of children reporting significant headache by the age of 15 years. Pediatric migraine is the most frequent recurrent headache disorder, occurring in up to 28% of older teenagers. Headaches rank third among the illness-related causes of school absenteeism and result in substantial psychosocial impairment among pediatric patients.The aim of this study was to clarify the evolution of the clinical features of primary headache in the transition from childhood to adulthood through a review of relevant data available in the PubMed and Google Scholar databases for the period 1988 to July 2013.The search strategy identified 15 published articles which were considered eligible for inclusion in the analysis (i.e. relevant to the investigation of pediatric headache outcome). All were carried out after the publication of the first version of the International Classification of Headache Disorders (ICHD-I).The availability of data on the evolution of primary headaches over a period of time is important from both a clinical and a public health perspective. The identification of prognostic factors of the evolution of headache (remission or evolution into another headache form) over time should be an objective of future headache research for the development of prevention strategies. Given that headache is a major factor contributing to school absenteeism and poorer quality of life not only in childhood but also in adolescence, understanding the natural history and the management of the different headache forms is vital for our future.     

临床护理路径在头痛(偏头痛)辨证施护中的应用

目的探求头痛(偏头痛)患者的临床护理模式。方法对2013年5月—2015年1月在我院住院的偏头痛患者28例,采取临床护理路径护理,观察患者对护理服务满意率、健康知识掌握达标率、住院天数的情况。结果患者对护理服务满意率≥96.4%,健康知识掌握达标率≥89.3%、平均住院天数≤14天。结论临床护理路径应用于头痛(偏头痛)辨证施护中,使临床护理工作标准化与规范化,提高了护理质量,是适宜临床护理应用的护理模式。     

Migraineurs were reliably identified using administrative data

BackgroundMigraine is a common and important source of pain and disability in society. Accurately identifying such people using routinely collected health data would be beneficial for health services research.ObjectiveExternally validate a previously published method to identify migraineurs using health administrative data; and determine if a better model can be derived using data-mining techniques.MethodsMigraine status was determined for Ontarians participating in a population-based, cross-sectional survey. Consenting participants were linked to population-based health administrative data to identify age, sex, and coded diagnoses. Discrimination and calibration measures were used to appraise the models. A de novo technique we term “double threshold analysis” was used to determine optimal lower and upper expected probabilities to identify migraine status in the newly derived model.ResultsA total of 1,01,114 people (mean age 46 years, 46% male) were included in the study, of which 11,314 (11.2%) had migraines. Using data-driven parameter estimates, the previous model to identify migraineurs had adequate discrimination (c-statistic 0.707 [95% CI 0.701–0.712]) and calibration (Hosmer–Lemeshow [H–L] statistic 20.8). A new model that included diagnostic code scores for physician visits, emergency visits, and hospitalizations with nonlinear terms for age and interactions significantly improved the model (c-statistic 0.724 [0.716–0.733], 16.4). Categorizing all people with a predicted migraine probability less than 10% or greater than 90% as without and having the disease, respectively, resulted in a sensitivity of 3.1%, a specificity of 99.96%, and a positive predictive value of 81.0% while capturing 57.0% of the cohort and 29.3% of migraineurs.ConclusionA previously derived model to identify migraineurs was improved using data-mining techniques permitting accurate cohort identification using routinely collected health administrative data.     

Lesión permanente de las capas internas de la retina en una paciente con migraña: un caso diferente de maculopatía paracentral aguda media

We report the case of a 20-year-old patient who presented a paracentral scotoma in her left eye that had not disappeared after a migraine attack 2 days before. Ocular examination showed 2 pale paracentral areas suggesting an acute ischemia insult. Several causes of retinal ischemia were ruled out and the patient was diagnosed with secondary retinal vasospasm. One year later, the patient suffers an atrophy of the inner layers of the affected retina and has a paracentral chronic scotoma in her left eye. Retinal vasospasms can result in irreversible lesions and chronic symptoms due to ischemia and cell destruction. This unusual case reports a permanent damage due to retinal vasospasm secondary to migraine attack. The finding of typical lesions and the history of migraine could be compatible with the diagnosis of paracentral acute middle maculopathy.     

Effects of omega-3 fatty acids on the frequency,severity, and duration of migraine attacks: A systematic review and meta-analysis of randomized controlled trials

The present systematic review with meta-analysis of randomized controlled trials (RCTs) aimed to analyze the effectiveness of omega-3 fatty acids on the frequency, severity, and duration of migraine. This systematic review was performed by searching several databases for controlled clinical trials. Of the 13 trials, five, two, and three RCTs met the eligibility criteria to evaluate the efficacy of omega-3 on the frequency, duration, and severity of migraine attacks, respectively. The Jadad scale was used to evaluate the risk of bias analysis. Overall estimates of the intervention effect were obtained from random-effect meta-analysis. The studies’ heterogeneity was evaluated using the chi-squared test (χ²) (Cochran’s test (Q test)) and I² Index. Potential sources of heterogeneity among the trials were investigated by meta-regression analyses. The results showed that omega-3 intake had no effect on frequency (WMD?=??0.20; 95%CI ?0.67, 0.27; P?=?0.401, and I²?=?4.6%; P?=?0.380) and severity (SMD?=??0.59; 95%CI??1.85, 0.66; P?=?0.35, and I²?=?88.8%; P?=?0.000) of migraine but had a reduction effect on the duration of migraine attacks (WMD?=??3.44; 95%CI ?5.70, ?1.19; P?=?0.003, and I²?=?0.0%; P?=?0.926). In conclusion, omega-3 intake leads to a significant reduction of approximately 3.44 hours in the duration of migraine. Further randomized controlled trials of high methodological quality with adequate sample sizes are required to confirm the results of the meta-analyses.