盐酸洛美利嗪治疗偏头痛的疗效观察

目的评价国产盐酸洛美利嗪治疗偏头痛的疗效及安全性。方法采取随机、双盲、安慰剂对照进行观察,将入选的53例患者随机分为盐酸洛美利嗪治疗组(27例,口服盐酸洛美利嗪片5mg,每日2次)及对照组(26例,口服安慰剂每日2次),疗程共12周。以头痛发作频率为主要评定指标,发作持续时间、程度、伴随症状及头痛综合评分为次要评定指标;并记录不良反应。结果(1)治疗组治疗第4周、第8周及第12周末时,头痛发作频率、头痛持续时间、头痛程度、伴随症状及头痛综合评分较对照组极显著降低(均P<0.01);(2)总有效率治疗组为81.5%,极显著优于对照组(7.7%)(P<0.005)。两组治疗期间均无严重不良反应。结论国产盐酸洛美利嗪是安全有效防治偏头痛发作的药物。     

氟桂利嗪和托吡酯单用及合用预防偏头痛发作的临床研究

目的观察氟桂利嗪、托吡酯及氟桂利嗪合用托吡酯对偏头痛发作的预防作用。方法将101例偏头痛患者随机分为氟桂利嗪合用托吡酯组(34例,A组)、氟桂利嗪组(34例,B组)及托吡酯组(33例,C组),疗程2个月,观察上述3组治疗前后头痛发作程度、头痛发作频率及头痛持续时间的变化。结果A组、B组治疗前后上述3项指标均有改善,评分差值均有统计学意义,P< 0.05;而C组治疗前后仅头痛发作的程度、频率有改善,评分差值有统计学意义,P<0.05;3组间治疗前后比较;上述3项指标F值分别为24.23、12.44、9.86,P均小于0.05;其中A组3方面改善均最为明显;而B组及C组之间没有明显差异。结论氟桂利嗪、氟桂利嗪合用托吡酯对偏头痛发作的程度、频率及持续时间均有较好的预防作用,而托吡酯对偏头痛持续时间没有减少的作用;氟桂利嗪合用托吡酯较单独应用其中的一种有更好的预防偏头痛的效果。     

托吡酯和普萘洛尔预防儿童偏头痛的临床疗效观察

目的 比较和评价托吡酯和普萘洛尔在儿童偏头痛预防中的临床疗效。方法 采用随机、对照、前瞻性的研究方法,共纳入了93例5～17岁的偏头痛患儿进行研究。将患儿随机分为两组,其中A组46例给予托吡酯50mg·d^-1治疗,B组47例给予普萘洛尔1 mg·kg^-1·d^-1治疗,持续观察3个月。分别记录患儿的在治疗后第1个月,第2个月及第3个月头痛发作次数、严重程度、持续时间及不良反应。结果治疗3个月后,托吡酯组和普萘洛尔组患儿的头痛发作频率、严重程度和持续时间均较用药前显著降低,在治疗的第2个月和第3个月,托吡酯每月头痛发作频率及持续时间较普萘洛尔下降更显著(P<0.05);在治疗的第3个月,托吡酯组患儿的头痛严重程度(VAS评分)低于普萘洛尔组(P<0.05)。两组均未出现严重不良反应。结论 托吡酯和普萘洛尔均能有效的减少儿童偏头痛发作频率,严重程度及持续时间;且托吡酯比普萘洛尔效果更为显著。两种药物的安全性良好。     

褪黑素和丙戊酸在预防偏头痛中的临床研究

目的探讨褪黑素与丙戊酸(VPA)预防偏头痛的疗效。方法选取2014年6月至2015年8月本院收治的偏头痛患者192例,随机分为3组:安慰剂组(n=64)、VPA组(n=64)和褪黑素组(n=64)。安慰剂口服安慰剂600mg·d~(-1);VPA组口服VPA 600mg·d~(-1);褪黑素组每晚睡前服用3mg·d~(-1)褪黑素,3组持续治疗2个月。比较3组治疗前、治疗后1个月和治疗后2个月头痛发作频率、头痛发作持续时间、头痛程度评分(VAS)、镇痛剂使用、偏头痛残疾程度(MIDAS评分)、不良反应。结果治疗期间失访34例(17.7%)。158例患者中安慰剂组54例、VPA组52例、褪黑素组52例。治疗后,VPA组和褪黑素组头痛发作频率、头痛持续时间、VAS评分、镇痛剂使用次数及MIDAS评分均显著低于治疗前和治疗后安慰剂组(P0.05)。治疗期间,安慰剂组1例(1.9%)、VPA组11例(21.2%)、褪黑素组3例(5.8%)出现不良反应。VAP组不良反应发生率显著高于安慰剂组和褪黑素组(χ~2=12.738,P=0.002)。结论褪黑素辅助治疗优于安慰剂,与VPA临床疗效相当,且不良反应少。褪黑激素能够作为VPA替代品用于预防偏头痛。     

黛力新与西比灵治疗偏头痛疗效比较

目的　比较黛力新与西比灵治疗偏头痛的疗效。方法　将 70例偏头痛患者随机分成两组 ,黛力新组服黛力新每日 2片 ,早晨、中午各 1次 ;西比灵组服西比灵 5mg ,每晚 1次。 结果　黛力新组能显著减少头痛发作次数 (第 4周P <0 .0 5 ,第 8周P <0 .0 1) ,显著减轻头痛程度 (第 2周P <0 .0 5 ,第 4周 P <0 .0 1) ,缩短头痛发作持续时间 (第 2、4、8周均 P <0 .0 1)。结论　黛力新治疗偏头痛疗效优于西比灵 ,不良反应轻微     

黛力新治疗伴有精神症状偏头痛的临床分析

目的探索偏头痛伴有抑郁和(或)焦虑症状的有效治疗方法。方法将伴有抑郁和(或)焦虑症状的偏头痛患者128例随机均分为2组,即治疗组用黛力新(氟哌噻吨美利曲辛合剂)+醋氯芬酸钠片,对照组用醋氯芬酸钠片进行随机对照研究,同时用汉密尔顿抑郁量表评分(HAMD)和汉密尔顿焦虑量表评分(HAMA);对其抑郁和(或)焦虑情况进行治疗前及治疗后(第2、4、6周)进行评估。结果治疗组能显著减少头痛发作次数(第4周P0.05,第6周P0.01),显著减轻头痛程度(第2周P0.05,第4、6周均P0.01),缩短头痛发作持续时间(第2、4、6周均P0.01),同时能显著减少HAMD(第2周P0.05,第4、6周均P0.01)及HAMA(第2、4、6周均P0.01)。结论伴有抑郁和(或)焦虑症状的偏头痛患者,除对症治疗外,合并应用黛力新疗效更佳。     

A型肉毒毒素预防性治疗偏头痛有效性及安全性的随机对照试验的meta分析

目的评价A型肉毒毒素预防性治疗偏头痛的有效性和安全性。方法计算机检索PubMed、Embase、Cochrane Library、SinoMed (CBM)、中国知网、万方等数据库中相关随机对照试验(RCT),采用Review manager 5. 3软件对数据进行meta分析。结果共纳入12项RCT,纳入4131例患者。meta分析结果显示,与安慰剂组比较,A型肉毒毒素组在平均每月偏头痛发作频率减少方面无明显差异(MD=-0. 1,95%CI:0. 41-0. 21,P=0. 53)。按偏头痛类型进行亚组分析后结果显示,A型肉毒毒素组在亚组慢性偏头痛组平均每月偏头痛发作频率减少方面优于安慰剂组(MD=-0. 43,95%CI:-0. 70～-0. 17,P=0. 001);而在亚组发作性偏头痛组,A型肉毒毒素组和安慰剂组在每月平均偏头痛发作频率减少方面无明显差异(MD=0. 08,95%CI:-0. 16～0. 33; P=0. 51)。与安慰剂组相比,A型肉毒毒素组平均每月偏头痛天数减少、平均每月急性头痛用药日数减少、生活质量量表评分改善情况等方面均优于安慰剂组(P 0. 05);总不良事件发生率均高于安慰剂组(OR=1. 38,95%CI:1. 20～1. 58; P 0. 00 001),但无严重不良反应发生。结论 A型肉毒毒素能有效地减少慢性偏头痛每月偏头痛发作频率、偏头痛天数和急性头痛用药的时间及改善生活质量,但对发作性偏头痛效果不明显,不良反应可耐受。     

偏头痛患者右心声学造影的特点及影响因素

目的 利用右心声学造影检查探究有无先兆偏头痛患者卵圆孔未闭(PFO)情况及二者的相关性。方法 选取2019-07—2021-07郑州大学附属中心医院收治的118例明确诊断的偏头痛患者为研究对象,根据头痛类型将其分为先兆偏头痛组(n=50)和无先兆偏头痛组(n=68),并选取同期体检的40名健康者为对照组,对所有受试者进行右心声学造影评估有无PFO及房水平右向左分流(RLS)程度。此外,统计偏头痛患者治疗前头痛发作频率、发作时间及头痛程度,分析其与有无PFO及RLS程度的相关性。结果 先兆偏头痛组和无先兆偏头痛组患者治疗前发作频率、头痛发作时间、头痛程度比较差异无统计学意义(t=1.295、1.490、1.235,P>0.05)。先兆偏头痛组PFO发生率及PFO-RLS分流程度均明显高于无先兆偏头痛组和对照组,差异均有统计学意义(P<0.05),无先兆偏头痛组和对照组间PFO发生率和PFO-RLS分流程度比较未见统计学差异(χ²=32.372、2.157、9.928、10.867,P>0.05)。Spearman相关性分析显示,偏头痛患者PFO分流...     

黛力新治疗48例伴有抑郁或焦虑的偏头痛患者的临床分析

目的探索治疗偏头痛伴有抑郁和/或焦虑患者的有效方法以及研究加用抗抑郁/焦虑药物是否比头痛发作时单用镇痛药物疗效更佳。方法将88例伴有抑郁和/或焦虑的偏头痛患者随机分为2组,治疗组48例,用氟哌噻吨及美利曲辛合剂(黛立新) 非言(非甾体抗炎药,主要成份是双氯芬酸钠)治疗,对照组40例,用散立痛治疗,并进行随机单盲对照研究,同时用汉密尔顿抑郁量表评分(HAMD)和汉密尔顿焦虑量表评分(HAMA),对其抑郁和/或焦虑进行治疗前及治疗后(第4,8周)的评估。结果治疗组患者头痛发作次数显著减少(第4周P<0.05,第8周P<0.01),头痛程度显著减轻(第4周P<0.05,第8周P<0.01),头痛发作持续时间缩短(第4,8周均P<0.01);同时能显著减少HAMD(第4,8周均P<0.01)及HAMA(第4,8周均P<0.01)。结论伴有抑郁和/或焦虑的偏头痛患者,除对症治疗外,可以合并应用黛立新。     

A型肉毒毒素重复治疗偏头痛的临床疗效

目的 探讨A型肉毒毒素重复注射治疗偏头痛的疗效与安全性。方法 对30例偏头痛患者均进行2次A型内毒毒素注射治疗,两次均采用颅周固定位点注射,初次治疗间隔6个月以上后进行第2次治疗,2次治疗后分别于第1,2,3个月评定头痛发作天数、头痛发作次数、疼痛程度、偏头痛残疾程度及不良反应。结果 二次A型肉毒毒素注射治疗后偏头痛发作天数、发作次数、疼痛程度、残疾程度均较治疗前缓解（F分别为3．86,5．23,9．37,5．67;P〈0．05）,但两次治疗后各观察点评定指标比较差异无统计学意义（P〉0．05）。结论 A型肉毒毒素重复治疗偏头痛有效、安全,较初次治疗无差异．     

A case of migrainous infarction accompanying idiopathic thrombocytopenic purpura]

We reported a 31 year-old man with repeated episodes of migraine at a frequency of about once a week on and after January, 2000. In January 2001, scintillating scotoma and pulsating headache appeared followed by left hemianopsia. His platelet count decreased to 80,000/microliter and high intensity areas were observed in the right occipital lobe and hippocampal gyrus on the FLAIR image of brain MRI. Subsequently performed brain MRA and vertebral angiography revealed segmental stenosis and obstruction in the right posterior cerebral artery. Under the diagnosis of migrainous infarction, sodium ozagrel and lomerizine hydrochloride were administered. Idiopathic thrombocytopenic purpura was additionally diagnosed based on the decreased platelet count which was then treated with predonisolone. After these treatment, his migraine attack disappeared. In this patient, platelet destruction due to idiopathic thrombocytopinic purpura and subsequent release of serotonin seemed to have involved in the occurrence of migrainous infarction.     

Treatment with telmisartan,a long-acting angiotensin II receptor blocker,prevents migraine attacks in Japanese non-responders to lomerizine

Lomerizine, calcium channel blocker, is the most used medication for migraine prophylaxis in Japan. The effectiveness of this drug is reported as 50–75%. Telmisartan is angiotensin II receptor blockers which plasma half-life is 24 h. We examined whether telmisartan has preventative benefits in lomerizine non-responsive migraineurs. Lomerizine non-responders received telmisartan (20 mg/day) for 3 months after the investigation period of 3 months. Blood pressure, frequency of headache days/month, headache severity, and doses of triptans and analgesics were analyzed by Wilcoxon signed rank test. Thirty-three migraineurs (25 women and 8 men) participated in this study. Seven patients had migraine with aura and 26 patients had migraine without aura. Mean age (SD) was 46.6 (10.3) years. Mean duration (SD) of migraine was 20.4 (12.5) years. Headache severity exhibited mild degree in 5 patients, moderate degree in 9 patients and severe degree in 19 patients. Mean frequency (SD) of headache days was 10.9 (8.5) days/month. Mean usage (SD) of triptans was 4.8 (5.1) tablets/month and that of analgesics was 15.2 (22.2) tablets/month. Five patients (15%) had hypertension. Telmisartan administration had benefits in 30 patients (90%). This medication significantly decreased frequency of headache days (P < 0.01) and headache severity (P < 0.01). Doses of triptans were reduced at one-third (P < 0.05) and those of analgesia at one-fifth after telmisartan treatment (P < 0.01). After telmisartan, mean (SD) of systolic blood pressure was significantly decreased (P < 0.05). The present study supported that telmisartan treatment had preventive effects in 90% of lomerizine non-responders. Telmisartan non-responders (10%) exhibited chronic migraine and long migraine duration.     

不同药物联合治疗药物过度使用性头痛的疗效及安全性

目的观察药物过度使用性头痛(medication overuse headache,MOH)的临床特征及不同药物联合治疗MOH的疗效及安全性。方法对头痛门诊序贯就诊的480例偏头痛患者详细采集病史,筛选很可能的MOH患者,与周期性发作偏头痛患者比较其临床特征,并行偏头痛残疾程度评估问卷(migraine disabilityassessment questionnaire,MIDAS)调查。对所有MOH患者强烈建议停用各种止痛剂,随机分组分别给予盐酸氟桂利嗪+普萘洛尔(Ⅰ组)或托吡酯+阿米替林(Ⅱ组)治疗,疗程3个月。观察两组治疗转归及不良反应发生率。结果 46例为很可能的MOH。MOH组起病年龄与周期性偏头痛组无明显差异(30.2±9.3岁;31.1±9.5岁)(P>0.05)。MOH组头痛家族史比例(67.4%)稍高于周期性偏头痛组(54.9%)(P>0.05),MOH组服用复方止痛药及中重度残疾的比例均显著高于周期性偏头痛组(分别为89.1%与39.3%;76.1%与19.5%)(P均<0.001)。治疗3个月后,Ⅰ组与Ⅱ组服用止痛药的比例为10.5%与10.0%,每月头痛天数为(3.21±0.85)d与(3.05±0.83)d,MIDAS总分(19.70±7.00)与(18.30±6.77),不良反应发生率分别为10.5%(Ⅰ组)与10.0%(Ⅱ组),两组间均无统计学差异(P>0.05)。结论有头痛家族史长期频繁使用复方止痛剂更易导致MOH,造成残疾。撤用止痛剂,盐酸氟桂利嗪+普萘洛尔或托吡酯+阿米替林均可明显缓解症状,耐受性好,值得临床推广。     

星瑙灵治疗偏头痛的疗效研究

目的通过观察星瑙灵对偏头痛的头痛程度和压痛、及其伴发症状的改善程度和起效时间,了解星瑙灵治疗偏头痛的疗效。方法偏头痛试验组126例,对照组125例。试验组给予星瑙灵10mg.d-3和银杏叶片4mg.d-3,连服8周。对照组仅予银杏叶片4mg.d-3,连服8周。观察服药前、服药4周和8周的头痛症状(使用MIDAS量表)、压痛、伴发症状的改善程度及其起效时间。结果偏头痛患者治疗组的头痛症状及其伴发症状的改善和起效时间均明显优于对照组,但压痛疗效组间无明显差异。结论星瑙灵对偏头痛有较好的疗效。     

A comparative study of the effects of low-dose topiramate versus sodium valproate in migraine prophylaxis

The present study was performed to evaluate the efficacy of low-dose topiramate and compare it with sodium valproate that is prevalently prescribed as a migraine prophylaxis. This was a randomized, double-blind, parallel-group clinical trial on 56 patients who completed the course of study. Topiramate and valproate were administered at 50 mg/day and 400 mg/day, respectively, during the follow-up period. Frequency, intensity, duration, associated symptoms with headaches, analgesics use, as well as drugs' side effects were studied. Participants completed MIDAS and HIT-6 questionnaires before and after treatment. Frequency, intensity, and duration of migraine headaches as well as MIDAS score and symptomatic medications decreased significantly between repeated follow-up visits in both groups. Responder rate for patients treated with topiramate and valproate were 71.6% and 64.3%, respectively, and the difference between the two groups was not statistically significant. The reduction of headache severity in the topiramate group was significantly more than that in the valproate group (p = .027). During the study, no statistically significant reduction in associated symptoms with migraine were observed in both the groups. Topiramate dose of 50 mg/day with fewer side effects in comparison with its higher doses may be an appropriate substitution for first-line migraine prophylaxis such as valproate.     

Do bilateral and unilateral greater occipital nerve block effectiveness differ in chronic migraine patients?

We aimed to compare the effectiveness of bilateral and unilateral block application in chronic migraine patients and whether there were differences in their effectiveness retrospectively. In chronic migraine patients undergoing Greater occipital nerve (GON) block, mean number of days with pain per month before and after block, mean duration of pain in attacks (in hours), and mean Visual Analog Scale (VAS) in attack and pain severity were recorded from files. The patients underwent one block a week for the first 1 month, thereafter one block a month according to GON block protocol used by our institute. Of 41 patients included in the study, 23 underwent unilateral block (group 1) and 18 underwent bilateral block (group 2). In both groups, number of days with migraine decreased significantly in 2 and 3 months as compared to pre-block treatment (P < 0.001). Mean duration of headache decreased in group 2 during treatment (P < 0.001). In group 1, mean duration of headache also decreased but did not differ significantly (P = 0.051). Mean severity of migraine decreased significantly differ in group 1 in 2, 3 months as compared to pre-block treatment (P < 0.001). No differences were observed in frequency, severity and duration of headache between groups during 3-month treatment period. GON block is effective in chronic migraine and bilateral application is no superior over unilateral application.     

Refractory chronic migraine: is drug withdrawal necessary before starting a therapy with onabotulinum toxin type A?

Onabotulinum toxin A (BT-A) is now one of the authorized prophylaxis treatments for chronic migraine (CM) thanks to previous clinical trials, which usually required a pharmacologic washout as a precondition for demonstrating its efficacy. Aim of our study was to assess the efficacy in daily clinical practice of BT-A injections in refractory CM patients, regardless of medication overuse without any standardized withdrawal protocol and without stopping the ongoing prophylaxis treatment as well. We treated 44 refractory CM patients (37 females and 7 males) trimonthly without any modification in symptomatic, or prophylactic drug therapy. Main efficacy variables included number of headache, or migraine days and episodes, total cumulative headache hours, MIDAS and HIT-6 scores; all items were assessed at baseline and at the 12-, 24-, and 36-week follow-up. All variables showed a statistically significant improvement at week 36. In general, more than 50 % of patients had a good clinical outcome (including all improved patients, either partial or full responder) and that the percentage of drug abuser patients significantly decreased from 75 to 50 %, thanks to a spontaneous reduction of the symptomatic drug intake. Adverse events were uncommon and did not require treatment discontinuation. Onabotulinum toxin A treatment in refractory CM patients with unsatisfactory prophylactic drug treatments and pharmacological abuse is effective in improving clinical outcome and quality of life. This result may be achieved through a flexible pharmacologic approach tailored to each patient’s needs; moreover, the patient himself can be often expected to reduce drug consumption spontaneously.     

偏头痛患者伴发焦虑/抑郁及功能残疾的临床研究

目的调查偏头痛患者伴发焦虑、抑郁、睡眠障碍、偏头痛相关功能残疾及影响因素分析。方法采用焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)、匹兹堡睡眠量表(Pittsburgh sleep quality index,PQSI)、偏头痛残疾程度评估量表(migraine disability assessment scale,MIDAS)、头痛影响测验(headache impact test-6,HIT-6)调查问卷,分别对94例符合ICHD-II诊断标准的偏头痛患者和60例健康对照者焦虑、抑郁、睡眠障碍、偏头痛情况以及相关危险因素进行对比分析。结果偏头痛患者47.9%伴发焦虑;50.0%伴发抑郁,睡眠障碍发生率58.5%。偏头痛组焦虑、抑郁和睡眠障碍发生率都明显高于健康对照组的8.3%,16.7%,30.0%,(掊2分别为28.728,20.755,10.954,P值均<0.01)。多元逐步回归分析显示:头痛程度重、病程长、头痛家族史、睡眠质量差、生活满意度低是偏头痛并发焦虑/抑郁的主要危险因素。头痛程度、发作频率、持续时间、伴发焦虑/抑郁是导致功能残疾的主要影响因素。结论头痛程度、病程、家族史、睡眠质量、生活满意度是偏头痛并发精神心理症状的主要危险因素。     

Primary headaches in an outpatient neurology headache clinic in East Hungary

The majority of patients with primary headache do not seek medical help. In the present study we analyse the characteristics of those patients with primary headaches who consulted a single headache outpatient service in East Hungary. All consecutive patients with primary headaches referred to the headache center between February 2002 and April 2003 were asked to fill in a questionnaire on headache characteristics and the migraine disability score (MIDAS) form. A total of 327 patients had some form of primary headache: 42% migraine, 31% tension-type headache, 1% cluster headache and 26% had combination headache. Of the patients 95% were younger than 60 years of age. Only 16% of the patients were male. Chronic daily headache was found in 41% of patients. Although headache was the least severe in tension-type headache, reported disability occurred on much more days in this group than in migraine patients. The majority of patients with primary headache were in the active age group. Patients with tension-type headache need more attention, as disability is more severe in this patient group than generally assumed. More attention to the headaches of men and the elderly could improve the quality of life in these groups of the Hungarian population.