偏头痛(Migraine)的治疗

治疗原则 镇静、镇痛、调节血管舒缩功能。 治疗方案 1.麦角胺制剂 能使脑动脉的过度扩张与搏动恢复正常,从而使头痛减轻。 (1)麦角胺咖啡因立即服1～2片,如30分钟后仍不缓解,可再服1～2片,但24小时内不可超过6片。 (2)酒石酸麦角胺0.5mg皮下注射或0.25mg肌肉或静脉注射,用于有剧烈呕吐不能口服者。 (3)其他麦角胺制剂:特制舌下含片,麦角胺喷雾剂,麦角胺栓剂。 禁忌症:孕妇及有末梢血管疾患、高血压、心绞痛、肝肾疾患及严重感染。     

Migraine – the forgotten epidemic: development of the EHF/WHA Rome Declaration on Migraine

Despite the availability of effective treatments, many migraine sufferers in Europe still do not receive optimal treatment. A panel of specialists, primary-care physicians and patient-group representatives met in Rome on 10–11 June 2005, under the auspices of the European Headache Federation (EHF), the World Headache Alliance (WHA) and the University of Duisburg-Essen, to review the scientific background, management issues, and physician, patient and government perspectives on migraine. The goal of the meeting was to produce the EHF/WHA Rome Declaration on Migraine, a statement of the actions required to improve migraine care and the quality of life of people with migraine. The key recommendation of the EHF/WHA Rome Declaration on Migraine is education of migraine sufferers, health professionals and health-policy makers.     

Does Low Atmospheric Pressure Independently Trigger Migraine?

Although atmospheric weather changes are often listed among the common migraine triggers, studies to determine the specific weather component(s) responsible have yielded inconsistent results. Atmospheric pressure change produces air movement, and low pressure in particular is associated with warm weather, winds, clouds, dust, and precipitation, but how this effect might generate migraine is not immediately obvious. Humans are exposed to low atmospheric pressure in situations such as ascent to high altitude or traveling by airplane in a pressurized cabin. In this brief overview, we consider those conditions and experimental data delineating other elements in the atmosphere potentially related to migraine (such as Saharan dust). We conclude that the available data suggest low atmospheric pressure unaccompanied by other factors does not trigger migraine.     

Is Migraine Primarily a Metaboloendocrine Disorder?

Purpose of the Review

The goals of this review are to evaluate recent studies regarding comorbidity between migraine and different metabolic and endocrine disorders and to discuss the role of insulin resistance as a common pathogenetic mechanism of these diseases.

Recent Findings

Recently, several studies showed that migraine is associated with insulin resistance, a condition in which a normal amount of insulin induces a suboptimal physiological response. All the clinical studies that used the oral glucose tolerance test to examine insulin sensitivity found that, after glucose load, there is in migraine patients a significant increase of both plasmatic insulin and glucose concentrations in comparison with controls. On the contrary, no association was found between migraine and type 2 diabetes, while type 1 diabetes seems to have a protective effect in the disease. Obesity and hypertension were shown to be risk factors for both episodic and chronic migraine. Metabolic syndrome has been recently associated mainly with migraine with aura and is now considered a risk factor also for medication overuse headache. Finally, a bidirectional association between migraine and hypothyroidism has been recently demonstrated, suggesting that common genetic or autoimmune mechanisms underlie both diseases.

Summary

Recent studies showed that insulin receptor signaling and the related physiological responses are altered in migraine and may have a relevant pathogenic role in the disease. Further studies are warranted in order to better elucidate mechanisms underlying insulin resistance in migraine in order to develop new therapeutic strategies for this debilitating disease.

     

Are Menstrual and Nonmenstrual Migraine Attacks Different?

Migraine is the second most common headache condition next to tension-type headache. Up to one fourth of all women have migraine, and 20% of them experience migraine without aura attack in at least two thirds of their menstrual cycles. The current literature is analyzed in response to the question of whether menstrual and nonmenstrual migraine attacks are different. The different studies provide conflicting results, so it is not possible to answer the question firmly. Future studies should be based on the general population. Collection of both prospective and retrospective data is warranted, and headache diagnosis base on interviews by physicians with interest in headache are more precise than lay interviews or questionnaires.     

Lifetime Basilar Migraine: A Pontine Syndrome?

We describe the clinical and radiological findings of an 82-year-old woman patient with basilar type migraine attacks occurring over 70 years with a similar pattern of intensity and symptoms. We provide some evidence to suggest that gradual development of calcifications in the pontine tegmental nuclei can trigger attacks of basilar type migraine.     

Migraine and adiponectin: is there a connection?

Migraine is a common disorder, characterized by recurrent episodes of headache and associated symptoms. The full pathophysiology of migraine is incompletely delineated. Current theories suggest that it is a neurovascular disorder involving cortical depression, neurogenic inflammation and vasodilation. Various neuropeptides and cytokines have been implicated in the pathophysiology of migraine including calcitonin gene-related peptide, interleukin (IL)-1, IL-6 and tumour necrosis factor (TNF)-alpha. There is evidence demonstrating an association between migraine and processes associated with inflammation, atherosclerosis, immunity and insulin sensitivity. Similarly, adiponectin, an adipocytokine secreted by adipose tissue, has protective roles against the development of insulin resistance, dyslipidaemia and atherosclerosis and exhibits anti-inflammatory properties. The anti-inflammatory activities of adiponectin include inhibition of IL-6 and TNF-induced IL-8 formation, as well as induction of the anti-inflammatory cytokines IL-10 and IL-1 receptor antagonist. Adiponectin levels are also inversely correlated with C-reactive protein (CRP), TNF-alpha and IL-6 levels. Likewise, recent studies have shown a possible correlation between CRP, TNF-alpha and IL-6 and migraine attacks. In addition, insulin sensitivity is impaired in migraine and obesity is a risk factor for the transformation from episodic to chronic migraine. In this review we discuss the basic science of adiponectin and its potential connection to the pathophysiology of migraine. Future research may focus on how adiponectin levels are potentially altered during migraine attacks, and how that information can be potentially translated into migraine therapy.     

a Clinical Observation of Stellate Ganglion Block Used for Migraine

Stellate ganglion block (SGB) is an efficient way to treat many kinds of pain in the head, as well as the disorder of automatic nerve function. From the beginning of 1992 to the end of 1998, 80 patients with migraine in our pain－treatment department received different drug combinations and achieved satisfied result. 1 Materials and Methods 80 patients presented in this paper (52 men, 28 women), with an age from 18 to 60 years, mainly 30 to 39 years (67％ of the total). Their ASA wereⅠ to…     

Alcohol and Migraine: What Should We Tell Patients?

Alcoholic drinks are a migraine trigger in about one third of patients with migraine in retrospective studies on trigger factors. Many population studies show that patients with migraine consume alcohol in a smaller percentage than the general population. Moreover, research has shown a decreased prevalence of headache with increasing number of alcohol units consumed. The classification criteria of alcohol-related headaches remain problematic. We discuss the role and mechanism of action of alcohol or other components of alcoholic drinks in relation to alcohol-induced headache. In accordance with data from a recent prospective study, we believe that reports overestimate the role of alcohol, as well as other foods, in the triggering of migraine. If a relationship between the intake of alcohol and the migraine attack is not clear, a small dose of alcohol is not contraindicated either for enjoyment or its protective effect on cardiovascular disease.     

Migraine de l’enfant et de l’adolescent

Migraine is the most frequent recurrent headache syndrome in children. It is characterized by attacks of intense, throbbing, mostly bilateral head pain, often accompanied by nausea, vomiting, photophobia and phonophobia. Efficacy of drugs for the acute treatment of migraine has not been studied in well-controlled trials. Ibuprofen and nasal spray sumatriptan may effectively alleviate migraine in children and adolescents.