卵圆孔未闭与偏头痛的关系及其封堵术后的临床疗效观察

目的:评估偏头痛与卵圆孔未闭(patent foramen ovale, PFO)之间的关系,以及PFO封堵术治疗偏头痛的效果。方法:采用前瞻性病例研究方法,选取2012年1月至2015年5月就诊的PFO病人,收集病人的基本信息、完成头痛问卷、记录手术情况。根据是否行PFO封堵术将合并偏头痛的PFO病人分为手术组及对照组,根据病人是否伴有先兆将其中手术组分为先兆偏头痛组与无先兆偏头痛组两个亚组。结果:就诊的PFO病人共288例,根据纳入排除标准有55例病人入选,其中50例病人完成了6个月的随访。50例PFO中合并偏头痛病人23例,偏头痛发病率为23/50 (46%)。23例合并偏头痛的PFO病人,手术组17例,对照组6例。手术组中先兆偏头痛8例,无先兆偏头痛9例。手术组病人术后头痛频率、头痛持续时间、疼痛数字评分(numerical rating scale, NRS)、头痛影响评分(Headache Impact Test-6, HIT-6)均显著降低,手术前后对比差异有统计学意义(P <0.01);对照组头痛频率、头痛持续时间、NRS评分、HIT-6评分治疗前后差异无统计学意义;手术组与对照组相比两者性别、年龄、BMI、术前头痛频率、头痛持续时间、头痛NRS评分、HIT-6评分差异无统计学意义,术后两者的头痛频率及头痛持续时间差异无统计学意义,头痛评分及HIT-6评分差异有统计学意义(P <0.01)。先兆组与无先兆组相比术前及术后头痛频率、头痛持续时间、NRS评分、HIT-6评分差异均无统计学意义。结论:①PFO病人中偏头痛发病率较高;②PFO封堵术后病人NRS评分、HIT-6评分明显降低;③偏头痛病人的头痛情况及手术治疗效果与病人是否存在先兆无关。     

TCD发泡试验对偏头痛合并卵圆孔未闭的诊断价值

目的：探讨TCD发泡试验对偏头痛合并卵圆孔未闭（PFO）的诊断价值。方法：偏头痛患者75 例纳入 研究,经食道心脏超声确诊合并PFO 45 例（PFO组）,未合并PFO 30 例（无PFO组）,同期选择在我院健康体 检的健康人40 例对照组。所有入组者都给予TCD发泡试验检查及疼痛评分。结果：PFO组、无PFO组和对 照组TCD发泡试验阳性率分别为71.1%、33.3%和15.5%,3 组差异有统计学意义（P＜0.05）。PFO组的疼痛 评分、头痛频率、头痛时间都显著高于无PFO组（P＜0.05）;PFO组的不同栓子分级患者疼痛情况差异有统 计学意义（P＜0.05）。TCD发泡试验诊断偏头痛合并PFO 的敏感性和特异性分别为97.8%和100.0%。结 论：TCD发泡试验对偏头痛合并PFO具有很好的鉴别与诊断价值,对患者头痛的严重程度可能有一定的辅 助判断作用。     

偏头痛患者血清中过氧化物酶体增殖物激活受体γ水平研究

目的：观察不同时期及不同亚型偏头痛患者血清中过氧化物酶体增殖物激活受体γ（peroxisome proliferator-activated receptorγ,PPARγ）水平变化,探讨其与偏头痛的关系及临床意义。方法收集偏头痛患者105例,随机分成偏头痛发作期组（A 组,n＝47）和偏头痛发作间期组（B 组,n＝58）,再根据患者有无先兆症状进一步分成四个亚组,同时选取100例健康者作为对照组。采用酶联免疫法（ELISA）检测受试者血清PPARγ水平,采用SPSS系统软件进行统计分析。结果偏头痛患者发作期PPARγ水平明显低于发作间期及健康对照者（P＜0.01）;发作间期的 PPARγ水平与健康对照者相比无明显统计学差异（P＞0.05）;有先兆与无先兆发作期PPARγ水平比较无明显差异（P＞0.05）;有先兆和无先兆发作间期PPARγ水平无明显统计学差异（P＞0.05）。结论偏头痛发作时血清PPARγ下调,其可能是偏头痛发病的潜在机制之一。有无先兆对PPARγ水平无明显影响。     

卵圆孔未闭与偏头痛发病相关性的Meta分析

目的:采用Meta分析探讨卵圆孔未闭(PFO)与偏头痛发病的相关性。方法:计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CNKI、VIP、WanFang Data及CBM数据库,收集观察PFO与偏头痛发病相关性的病例对照研究或横断面研究或队列研究,检索时限从建库至2018年8月1日。由两名评价者按照纳入与排除标准筛选文献、提取资料,并进行NOS文献质量评价,采用RevMan 5.3软件进行Meta分析。结果:共纳入30篇文献,样本量为9 177例。Meta分析结果显示偏头痛组与健康对照组PFO发生率差异有统计学意义(OR=3.19,95%CI为2.20～4.63,P0.01),先兆偏头痛组与健康对照组PFO发生率差异有统计学意义(OR=3.71,95%CI为2.13～6.46,P0.01),无先兆偏头痛组PFO发生率高于健康对照组(OR=1.48,95%CI为1.09～2.00,P=0.01),先兆性偏头痛组PFO发生率高于无先兆性偏头痛组(OR=2.32,95%CI为1.96～2.76,P0.01)。PFO组的偏头痛率高于健康对照组(OR=2.58,95%CI为1.57～4.25,P0.01)。结论:PFO与偏头痛存在明显相关性。     

洛美利嗪胶囊联合对乙酰氨基酚片治疗偏头痛效果观察

目的：探讨洛美利嗪胶囊联合对乙酰氨基酚片在偏头痛治疗中的效果。方法：选取2019年10月~2020年11月潢川县人民医院接收的80例偏头痛患者作为研究对象,采用双盲法分为观察组和对照组,各40例。对照组采用对乙酰氨基酚片治疗,观察组在对照组基础上采用盐酸洛美利嗪胶囊治疗。比较两组患者治疗前、治疗8周后头痛发作频率和24 h内头痛缓解持续时间,比较两组患者治疗前、治疗8周的头痛程度[采用视觉模拟评分法（VAS）评估],记录两组患者治疗期间不良反应发生情况。结果：治疗8周,两组患者头痛发作频率低于治疗前,24 h内头痛缓解持续时间长于治疗前,且观察组头痛发作频率低于对照组,24 h内头痛缓解持续时间长于对照组,差异有统计学意义（P＜0.05）;两组治疗8周VAS评分低于治疗前,且观察组低于对照组,差异有统计学意义（P＜0.05）;治疗期间两组不良反应总发生率比较,差异无统计学意义（P＞0.05）。结论：洛美利嗪胶囊联合对乙酰氨基酚片治疗偏头痛可降低头痛发作频率,减轻头痛程度,且安全性高。     

托吡酯联合普萘洛尔预防偏头痛发作的效果

目的：观察托吡酯联合普萘洛尔对预防偏头痛发作的效果。方法：将65例偏头痛患者分为托吡酯联合普萘洛尔组（34例）和普萘洛尔组（31例），疗程8周，观察两组治疗前后头痛发作程度、头痛发作天数等指标的改变。结果：托吡酯联合普萘洛尔组和普萘洛尔组治疗前后头痛发作程度、头痛发作天数指标均有改善．差异均有统计学意义，P〈0．01；同时托吡酯联合普萘洛尔组同普萘洛尔组相比，前者头痛发作程度、头痛发作天数较后者低，差异有显著性，P〈0．01。结论：普萘洛尔、托吡酯联合普萘洛尔对预防偏头痛发作有较好的作用。托吡酯联合普萘洛尔较单独使用普萘洛尔预防偏头痛发作的效果更好。[著者文摘]     

头痛宁联合盐酸氟桂利嗪对偏头痛患者症状改善及脑血流速度的影响

目的：探究头痛宁联合盐酸氟桂利嗪治疗对偏头痛患者症状改善及脑血流速度的影响。方法：按随机数字表法将2019年9月至2022年9月收治的86例偏头痛患者分为对照组和观察组各43例。对照组给予盐酸氟桂利嗪胶囊治疗,观察组在对照组基础上加用头痛宁胶囊治疗,两组均连续治疗1个月。比较两组临床疗效、症状指标（发作频率、持续时间、头痛程度）、脑血流速度[大脑前动脉（ACA）、大脑中动脉（MCA）、大脑后动脉（PCA）、椎动脉（VA）和基地动脉（BA）]、5-羟色胺（5-HT）水平和降钙素基因相关肽（CGRP）水平及不良反应发生情况。结果：观察组治疗总有效率高于对照组（P＜0.05）;两组治疗后发作频率、持续时间、头痛程度均降低,且观察组低于对照组（P＜0.05）;两组治疗后ACA、MCA、PCA、VA、BA平均速度均降低,且观察组低于对照组（P＜0.05）;两组治疗后5-HT与CGRP水平均改善,且观察组5-HT水平高于对照组,CGRP水平低于对照组（P＜0.05）;两组不良反应发生率比较,差异无统计学意义（P＞0.05）。结论：头痛宁联合盐酸氟桂利嗪可提高偏头痛患者的治疗效果,能有效改善患者临床症状,提高其生活质量,利于缓解脑血管痉挛,改善脑血流速度,促进脑部微循环,减轻和控制偏头痛发作,且无明显不良反应,临床应用安全性较高。     

免疫自血疗法在偏头痛患者治疗中的应用效果观察及护理

目的探讨免疫自血疗法在偏头痛患者治疗中的应用效果及护理措施。方法选取2016年4月至2018年4月本院收治的偏头痛患者168例作为研究对象,依据随机数字表法将其等分为观察组和对照组,对照组给予常规药物治疗和护理,观察组在对照组基础上给予免疫自血疗法治疗和护理,比较两组患者头痛发作频率、持续时间、视觉模拟评分法(VAS)得分、治疗效果、不良反应。结果护理干预后,两组患者头痛发作频率、持续时间、VAS得分明显低于干预前,观察组患者头痛发作频率、持续时间、VAS得分明显低于对照组,差异均有统计学意义(P 0. 05);观察组治疗效果明显高于对照组,差异有统计学意义(P 0. 05);两组患者不良反应发生率比较差异无统计学意义(P 0. 05)。结论应用免疫自血疗法可有效提高偏头痛患者治疗效果,降低其偏头痛发作频率、持续时间、VAS得分,具有良好的安全性,值得临床推广。     

不同时期和不同亚型偏头痛患者血清基质金属蛋白酶-9水平的临床研究

目的对不同时期及不同亚型偏头痛患者血清中基质金属蛋白酶-9(MMP-9)水平变化进行观察,对其与偏头痛的关系及临床意义进行探讨。方法以110例偏头痛患者为对象,随机分成偏头痛发作期组(n=53)和偏头痛发作间期组(n=57),再根据患者有无先兆症状进一步分成四个亚组,同时选取100例健康者作为对照组。采用酶联免疫法检测受试者血清MMP-9水平,采用SPSS系统软件进行统计分析。结果偏头痛患者发作期组血清MMP-9水平均明显高于健康对照组,有统计学差异(P0.01);相对偏头痛发作间期患者,偏头痛发作期组血清中MMP-9水平明显高出(P0.01),其中有先兆偏头痛和无先兆偏头痛患者发作期血清MMP-9水平均比偏头痛发作间期高(P0.01);相对健康组来说,偏头痛患者发作间期组MMP-9水平略高但无统计学差异(P0.05),有先兆与无先兆发作期MMP-9水平比较无明显差异(P0.05);有先兆和无先兆发作间期MMP-9水平差异无统计学意义(P0.05)。结论偏头痛发作期时血清MMP-9上调,可能是偏头痛发病的潜在相关机制之一。偏头痛发作期时有无先兆对MMP-9水平无明显影响。     

针刺对无先兆偏头痛病人热痛阈作用的临床研究

目的:结合耐热痛阈检测评估针刺治疗无先兆偏头痛的临床疗效。方法:本研究采用随机对照临床试验设计,将35例无先兆偏头痛病人随机分为治疗组18例和对照组17例,其中治疗组接受临床有效的常规针刺治疗,对照组接受非经非穴的假穴进行对照针刺治疗。2组治疗前后分别进行耐热痛阈的检测以及头痛日记的记录,比较2组间针刺治疗后的头痛天数以及前额耐热痛阈的变化情况。结果:治疗组治疗后偏头痛发作天数较治疗前降低(P <0.05),对照组治疗后偏头痛发作天数较治疗前差异无统计学意义(P> 0.05)。治疗组和对照组进行耐热痛阈治疗前后的比较,认为治疗后治疗组的耐热痛阈显著高于对照组(P <0.01)。结论:针刺可以升高无先兆偏头痛病人的前额耐热痛阈。     

Relationship between migraine and patent foramen ovale: a study of 121 patients with migraine

BACKGROUND: Migraine is a common neurological disorder, the origins of which remain unknown. Patent foramen ovale (PFO) is considered to have a role in migraine. The relationship between migraine and patent foramen ovale may be stronger in patients suffering from migraine with aura compared to patients with common migraine. OBJECTIVES: The aim of the study was to evaluate the frequency of PFO in patients with migraine with aura (MA+) and compare it with the prevalence of PFO in migraine patients without aura (MA-), and in a healthy age-matched control group. We investigated PFO association with migraine, considering such factors as: A type of migraine aura, frequency of attacks, familial occurrence, sex and age of patients. Patients.-121 patients: 61 patients suffering from migraine with aura, 60 without aura and 65 normal controls. The group of patients with migraine with aura was divided into subgroups regarding to the type of aura. METHODS: In order to detect PFO the contrast transcranial Doppler was performed during Valsalva maneuver. RESULTS: The presence of PFO was found in 33/61 (54%) patients with MA(+) compared to 15/60 (25%) without aura and 16/65 (25%) control subjects. The difference between MA(+) patients and MA(-) patients and the difference between MA(+) patients and control group was statistically significant (P < .05). There was no association between type of migraine aura and PFO, as well as we found no association between PFO and frequency of attacks, familial occurrence, sex and age of patients and PFO. CONCLUSIONS: Our findings suggest possible association of migraine with aura and PFO. It seems that PFO does not influence the type of aura and frequency of attacks of migraine as well as it is not associated with familial occurrence of migraine.     

Prevalence of patent foramen ovale in migraine patients with and without aura compared with stroke patients. A transcranial Doppler study

The aim of this study was to investigate the prevalence of patent foramen ovale (PFO) in a consecutive unselected cohort of migraine patients (with and without aura) and compare it with a group of ischaemic young and elderly stroke patients. One hundred and forty-one migraine patients were compared with 330 stroke patients (130 young patients; 200 elderly patients) selected from our hospital stroke data bank. PFO was assessed with transcranial Doppler sonography with i.v. injection of agitated saline. The prevalence of PFO was 51.7% in migraine with aura (MA) patients, 33.7% in migraine without aura (MoA) patients, 33.8% in young stroke patients and 20.5% in elderly stroke patients (P < 0.001). The prevalence of PFO in cryptogenic stroke in young and elderly stroke patients was, respectively, 41.1% and 25% (P = 0.04). The difference between MA and MoA patients was significant (odds ratio = 2.1). The prevalence of PFO in MA patients is higher than in MoA patients and in young cryptogenic stroke patients.     

Migraine,patent foramen ovale and migraine triggers

Little information exists about a causal association between PFO and migraine. Some patients identify Valsalva-provoking activities (VPA) as migraine triggers. Therefore, we speculate about a pathogenic connection. The object of the study is to investigate the prevalence of right-to-left shunt (RLS) in a cohort of patients suffering migraine with aura (MA) and its possible association with migraine attacks triggered by VPA. We investigated the circumstances triggering the migraine attacks, in a consecutive series of 72 MA patients and in a series of migraine without aura age and gender-matched. The presence and extent of RLS was assessed by transcranial Doppler. Massive RLS appeared in 38.9% of MA and in 6.5% of migraine without aura (p<0.001). MA patients identified at least one VPA as headache trigger in 45.8%. A trend was found between these triggering activities and massive RLS, both in MAgroup OR 2.7 [1.02–7.17] and in all migraine patients OR 2.5 [1.01–6.11]. According to our results, patients with migraine who have larger RLS tend to recognize activities that increase the extent of the shunt as a trigger of their migraine attacks.     

以头痛和（或）头晕为主诉的儿童卵圆孔未闭三例

头痛、头晕是儿童和青少年常见的躯体症状之一,但其诊断无客观生物学指标,且儿童不能准确理解与描述头痛和头晕的性质,因此以头痛和（或）头晕为主诉的卵圆孔未闭（PFO）患儿易被误诊或漏诊。该文报道3例患儿,均以头痛和（或）头晕为主诉。例1经心脏彩色多普勒超声（彩超）、右心声学造影、经颅多普勒超声（TCD）发泡试验确诊为无先兆型偏头痛合并PFO,接受卵圆孔封堵术后恢复良好。例2经右心声学造影、经食管超声心动图确诊PFO,予口服硫酸氢氯吡格雷片治疗,出院后仍有头晕,无明显头痛,未规律用药。例3经右心声学造影及TCD发泡试验诊断为PFO,予口服阿司匹林片治疗,规律用药,症状未再发。对于表现为头痛和（或）头晕的患儿,在排除常见病因后,行右心声学造影及TCD发泡试验有助于早期发现PFO及相关异常,值得临床推广应用。     

Prevalence of patent foramen ovale in a large series of patients with migraine with aura, migraine without aura and cluster headache, and relationship with clinical phenotype

A relationship between migraine and patent foramen ovale (PFO) has been observed in relatively small series of patients so far. Furthermore, the exact mechanism underlying such an association remains unknown. In the present study we determined the prevalence of PFO by contrast–enhanced transcranial Doppler (TCD) in a group of 260 patients with migraine with aura (MA+), 74 patients with migraine without aura (MA–), and 38 patients with cluster headache (CH). One–hundred–sixty–one MA+subjects (61.9%), 12 MA–subjects (16.2%), and 14 CH–subjects (36.8%) were PFO–carriers. The association was independent on the frequency of migraine attacks and complexity of aura. Finally, among the 15 patients who had a history of at least one migraine attack occurring during a Valsalva maneuver only one subject turned out to be PFO–carrier. Our findings confirm previous observations of a link between MA+, CH, and PFO. They also suggest that such an association is independent on migraine clinical phenotype and is probably unrelated to the pathogenic mechanism of paradoxical embolism.     

慢性偏头痛患者超敏性疼痛的病理生理机制研究

目的:利用血氧水平依赖(BOLD)功能核磁成像探讨慢性偏头痛患者产生皮肤超敏性疼痛(CA)的病理生理机制。方法:采用前瞻性研究方法,将研究对象分为四组。A组(n=29):伴有一侧前臂(颈8支配区)CA和/或同时有V1区和/或C2-C3区CA者;B组(n=31):伴有一侧额区(三叉神经第一支)和/或伴有一侧颈区(C2-C3支配区)CA者;C组(n=30):不伴CA者;D组(n=30):正常对照。采用BOLD功能核磁成像技术研究慢性偏头痛患者诱发CA时三叉神经感觉系统不同级别神经元激活情况。结果:在诱发CA时,A组的三叉神经节、三叉神经脊束核和丘脑的神经元均被激活致敏,B组的三叉神经节、三叉神经脊束核受到激活致敏,C组则只有三叉神经节受到激活致敏,D组则三级神经元均未激活致敏。结论:慢性偏头痛出现的头痛和躯体不同部位的CA与三叉神经感觉系统不同级别神经元受到激活致敏有关。     

Population-based door-to-door survey of migraine in Japan: the Daisen study

OBJECTIVES: To determine prevalence and characteristics of migraine in Japan, and to investigate use of medical care and whether food preference is associated with risk of migraine. METHODS: Structured questionnaires were given to all adult residents (N = 5758; 2681 men and 3077 women) in Daisen, a rural community in western Japan. Second questionnaires, specific to headache, were given to 1628 residents with headache. A telephone survey was also carried out. Statistical Packages for the Social Sciences analyzed the data. RESULTS: The 1-year prevalence of migraine was 2.3% (migraine with aura, 0.4% and without aura, 1.9%) in men and 9.1% (migraine with aura, 1.0% and migraine without aura, 8.1%) in women. Overall prevalence of migraine in Daisen was 6.0% (95% confidence interval [CI], 5.4% to 6.6%). Women observed a 5.9-fold higher risk of migraine than men (odds ratio, 5.9; 95% CI, 4.5 to 8.0; P <.0001, after age adjustment, by logistic analysis). Fatigue and loss of vigor were predominant premonitory symptoms of migraine. Fatigue, mental stress, and lack of sleep were the main headache triggers. Over a 3-month period, 20.3% of migraineurs experienced time or days off work due to headache. Only 7.3% of those with migraine with aura and 5.3% of those with migraine without aura had consulted a physician, and of those with migraine, 61.0% with aura and 71.8% without aura had never visited a medical doctor for their headache. Consumption of alcohol and cigarette smoking did not influence the risk for migraine or tension-type headache, after age and gender adjustment (logistic analysis). Migraineurs consume significantly more fatty/oily foods, coffee, and tea than nonheadache subjects of the same community. Migraineurs consume significantly fewer fish than nonheadache residents. CONCLUSIONS: Only a few Japanese migraineurs receive benefits of medical services and recent advances of headache medicine. Public education concerning headaches is one of the most urgent issues in Japan.     

Patent foramen ovale and migraine: a quantitative systematic review

Initial studies indicate an increased prevalence of patent foramen ovale (PFO) in migraineurs with aura, and an increased prevalence of migraine and migraine with aura in persons with PFO. Retrospective analyses of PFO closure suggest clinically significant improvements in migraine patterns. The aim of this study was to examine the prevalence of migraine in patients with PFO, the prevalence of PFO in migraineurs, and the effect of PFO closure on migraine. We conducted a quantitative systematic review of articles on migraine and PFO that met inclusion criteria, then reviewed, appraised, and subjected them to data extraction. Of 134 articles identified, 18 met a priori selection criteria. The estimated strength of association between PFO and migraine, reflected by summary odds ratios (ORs), was 5.13 [95% confidence interval (CI) 4.67, 5.59], and between PFO and migraine with aura the OR was 3.21 (95% CI 2.38, 4.17). The grade of evidence was low. The association between migraine and PFO was OR 2.54 (95% CI 2.01, 3.08). The grade of evidence was low to moderate. Six studies of PFO closure suggested improvement in migraine, but had a very low grade of evidence. The low-to-moderate grade of evidence from observational studies supports an apparent association between PFO and migraine. Although PFO closure seemed to affect migraine patterns favourably, the very low grade of available evidence to support this association precludes definitive conclusions.