氟桂利嗪与心得安防治偏头痛对照观察

近几年来应用盐酸氟桂利嗪胶囊(西比灵)防治偏头痛,报告如下。1对象与方法病例选择:300例偏头患者均符合HIS犤1犦偏头痛诊断标准。且病程在3个月以上,每月至少发作2次。其中先兆型偏头痛80例,无先兆型偏头痛220例。排除高血压病、癫痫及其他器质性疾病引起的头痛。入组病例按发作性头痛的程度、伴随的植物神经反应及对日常活动的影响,参考国际通用分级方法,将头痛分为3级(Ⅰ级为头痛及植物神经反应较轻;Ⅱ级为头痛及植物神经反应较重;Ⅲ级为头痛及植物神经反应严重,必须卧床)。头痛诱因:遗传因素125例,内分泌因素68例,精神因素75例,原因不…     

灵通胶囊治疗紧张型头痛随机双盲对照临床研究

<正>紧张型头痛(tension-type headache,TTH)指双侧颈枕部或全头部的紧缩性或压迫性头痛。随着生活节奏加快,社会压力增大,其在普通人群终生发病率高达30%⁷8%[1]。因其反复发作,迁延难愈,疼痛剧烈,给患者带来极大痛苦,严重影响其日常生活与工作。前期研究已证实灵通胶囊对于多种疼痛具有良好的即时止痛效果,且无明显不良反应[2,3]。本研究通过随机双盲安慰剂对照研究,以进一步客观评价灵通胶囊对紧张型头痛的即时止痛疗效。     

托吡酯治疗偏头痛的近期疗效

目的:观察托吡酯治疗偏头痛的近期疗效。方法:选取偏头痛病人72例,随机分为托吡酯组和对照组,每组36例。比较两组治疗后偏头痛疼痛强度、持续时间及治疗总有效率。结果:两组病人治疗后偏头痛均有改善,疼痛强度减轻,头痛持续时间缩短(P<0.01);与对照组比较,托吡酯组疼痛强度减轻明显,头痛持续时间更短(P<0.05),治疗后1个月止痛显效病例明显增加(χ2=8.02,P<0.01),总有效率显著提高(χ2=7.41,P<0.05)。结论:托吡酯治疗偏头痛,可以缩短病程,改善头痛症状,近期效果满意。     

儿童和青春期偏头痛临床特点

目的:通过与成年偏头痛患者临床特点比较,探讨儿童和青春期偏头痛的临床特点.方法:解放军总医院神经内科门诊2005年1月～2006年12月收集的45例儿童和青春期偏头痛及224例成年偏头痛患者,分析其一般资料及临床特点,包括头痛的发作频率、持续时间、程度、部位、性质和伴随症状.结果:(1)儿童和青春期以及成年偏头痛患者男女比例分别为1∶1.05和1:3.48(x2=13.493,P＜0.001);有先兆偏头痛占儿童和青春期以及成年偏头痛患者的比例分别为53.3%和21.9%(x2=18.754,P＜0.001).(2)儿童和青春期以及成年偏头痛患者的头痛发作频率分别为1(1～2)次/月和2(1～3)次/月(P=0.032),持续时间分别为6(2.5～24)h和24(7.25～36)h(P=0.001),头痛程度VAS分别为7.5(6～8)和8(7～9)(P=0.002).(3)儿童和青春期以及成年偏头痛患者单侧头痛所占各自比例分别为57.8%和65.2%(P=0.345),搏动性头痛占头痛性质比例分别为55.6%和67.9%(P=0.112).(4)儿童和青春期以及成年偏头痛患者出现伴随症状的比例分别为:恶心呕吐88.9%和92.0%(P=0.501),畏光怕声60.0%和70.5%(P=0.164),不愿活动86.7%和74.1%(P=0.071).结论:与成年偏头痛相比,儿童及青春期偏头痛患者的临床特点包括:男女比例接近,易出现先兆症状,持续时间更短、疼痛程度较轻、发作频率更少;二者的头痛部位、头痛性质以及伴随症状相近.     

舒马普坦与散利痛治疗偏头痛急性发作疗效比较

目的比较舒马普坦与散利痛治疗偏头痛急性发作的疗效。方法57例偏头痛患者随机单盲分为舒马普坦与散利痛组,头痛开始发作时分别服用舒马普坦50 mg及散利痛1片,分别观察患者服药后起效的时间,服药后4小时的治疗有效率,各组服药后0.5、1、2、4小时头痛消失的比例及VAS评分,服药后24小时内完全止痛维持的时间,药物不良反应。结果起效时间散利痛组(1.02±0.67)小时,舒马普坦组(0.79±0.49)小时;服药后4小时治疗有效率分别为89.29%、93.10%;不良反应发生率分别为14.29%、10.34%;舒马普坦组服药后1小时头痛消失率(62.09%)高于散利痛组(32.14%),P=0.024。结论舒马普坦与散利痛均能有效治疗偏头痛急性发作,舒马普坦1小时头痛消失率高于散利痛。     

速效救心丸临床新用途

速效救心丸具有镇静止痛，改善循环，降低外周血管阻力，减轻心脏负荷，改善心肌缺血的作用，主治冠心病、胸闷弊气、心前区疼痛。近年来的临床资料表明，速效救心丸还具有以下新的治疗作用和用途。1血管神经性头痛15例偏头痛患者于头痛发作前30min口服15～20粒，60min后再服6粒，头痛缓解期每天早饭后服8粒，连续10次为一疗程。结果：近期治愈4例（25.67％），显效8例（53.33％），有效2例（13.33％），无效1例，总有效率为93.3％。一般眼药前后5～10min疼痛缓解，30min左右疼痛消失。有头痛先兆时服药6～10粒可预防头痛发作。2急腹痛含服…     

羟考酮控释片单药或联合加巴喷丁治疗癌性神经病理性疼痛的临床研究

目的:观察羟考酮控释片单药或联合加巴喷丁治疗癌性神经病理性疼痛的镇痛效果.方法:入组患者第一周先予羟考酮控释片单药止痛;第8日轻度疼痛以下者入A组,继续单药治疗2周,中至重度疼痛者入B组,联合加巴喷丁止痛2周.结果:共入组63例,58例(92.06%)完成第一周治疗;第8日22例(37.93%)入A组,36例(62.07%)入B组,两组患者第15日疼痛程度均明显减轻,但第22日都无显著改善.A组第15、22日羟考酮控释片的平均剂量分别为71.43mg及81.90mg(P=0.004);B组第15、22日加巴喷丁的平均剂量为(862.50mg,993.75mg,P<0.001).便秘为最常见副反应,A、B两组的发生率分别为13.64%及14.26%.结论:羟考酮控释片单药对部分神经病理性疼痛有效;单药疗效不满意时,联合加巴喷丁可能有效;两药的副作用可防治.     

松龄血脉康胶囊联合维生素B1片及谷维素片治疗偏头痛

目的观察松龄血脉康胶囊联合维生素B1片及谷维素片治疗偏头痛的疗效。方法将72例偏头痛患者分为治疗组(松龄血脉康胶囊联合维生素B1片及谷维素片)与对照组(单用氟桂利嗪胶囊),每组36例。治疗2个月后统计总有效率并对比治疗前后患者头痛发作频率、持续时间及头痛感受等。结果治疗30 d后,治疗组总有效率为83.3%,对照组为75.0%,差异有统计学意义(P0.05);治疗60 d后,治疗组总有效率为91.6%,对照组为88.6%,差异有统计学意义(P0.05)。治疗后患者头痛发作频率、持续时间及头痛感受均有下降,与治疗前比较差异有统计学意义(P0.05)。结论松龄血脉康胶囊联合维生素B1片及谷维素片可有效治疗偏头痛。     

航天工作者偏头痛患病率及相关因素分析

目的:调查航天工作者的偏头痛患病率及临床特征,探讨航天工作者偏头痛的危险因素,并为偏头痛的防治提供有效策略。方法:采取分层随机整群抽样的方法,对1 200名航天工作者进行头痛问卷调查,问卷内容包括人口统计学资料、头痛诊断问题、睡眠质量。结果:136例符合偏头痛诊断标准,患病率为12.3%;先兆偏头痛52例(38.2%),无先兆偏头痛84例(61.8%);平均年龄(33±10.72)岁;男性46例(33.8%),女性90例(66.2%);大学以上学历占比最高(92.6%);疼痛部位为单侧86例(63.2%),搏动性62例(45.6%);发作时间为4～72 h 88例(64.7%);中重度112例(72.3%);伴随症状出现畏声64例(47.1%),恶心59例(43.3%);活动加重头痛86例(63.2%);诱发因素中睡眠缺乏99例(72.8%)。单因素分析显示,不同性别、职业类型、睡眠质量组间偏头痛的分布存在统计学差异(P<0.05)。多因素Logistic回归分析显示,女性、睡眠质量差者患偏头痛的风险较高(P<0.05)。结论:航天工作者偏头痛患病率较高,性别(女)和睡眠障碍是其主要危险因素。     

A型肉毒毒素治疗偏头痛的临床观察

1 资料与方法 选取2005年9月-2007年9月我院神经内科门诊偏头痛患者(间歇期)94例,随机分为治疗组和对照组.治疗组47例,男性17例,女性30例;年龄29.2±8.2岁;小脑萎缩1例,有先兆偏头痛1例;双侧疼痛3例,有偏头痛家族史2例,头痛评分[1]:20.32±9.3.对照组47例,男性19例,女性28例:年龄31.2±9.2岁;有先兆偏头痛2例;双侧疼痛2例,有偏头痛家族史3例,头痛评分19.23±8.9.偏头痛的诊断依据国际头痛协会1988年的诊断标准[2].     

Intravenous magnesium sulphate in the acute treatment of migraine without aura and migraine with aura. A randomized,double-blind,placebo-controlled study

Magnesium sulphate has been used in the acute treatment of migraines; some studies found it to be a highly effective medication in the acute control of migraine pain and associated symptoms. This randomized, double-blind, placebo-controlled study assesses the effect of magnesium sulphate on the pain and associated symptoms in patients with migraine without aura and migraine with aura. Sixty patients in each group were assigned at random to receive magnesium sulphate, 1000 mg intravenously, or 0.9% physiological saline, 10 ml. We used seven parameters of analgesic evaluation and an analogue scale to assess nausea, photophobia and phonophobia. In the migraine without aura group there was no statistically significant difference in the patients who received magnesium sulphate vs. placebo in pain relief. The analgesic therapeutic gain was 17% and number needed to treat was 5.98 at 1 h. There was also no statistical difference in relief of nausea. We did observe a significant lower intensity of photophobia and phonophobia in patients who received magnesium sulphate. In the migraine with aura group patients receiving magnesium sulphate presented a statistically significant improvement of pain and of all associated symptoms compared with controls. The analgesic therapeutic gain was 36.7% at 1 h. A smaller number of patients continued to have aura in the magnesium sulphate group compared with placebo 1 h after the administration of medication. Our data support the idea that magnesium sulphate can be used for the treatment of all symptoms in migraine with aura, or as an adjuvant therapy for associated symptoms in patients with migraine without aura.     

Intravenous dipyrone in the acute treatment of migraine without aura and migraine with aura: a randomized,double blind,placebo controlled study

BACKGROUND: Dipyrone (Metamizol) has been used in the acute treatment of migraines in Brazil. Some investigators have found it to be a highly effective medication for migraine pain and associated symptoms. OBJECTIVE: To conduct a randomized, placebo controlled, double blind study to assess the effect of dipyrone on the pain and symptoms associated with migraine without aura or with aura and the adverse effect profile of this medication. METHODS: For the migraine without aura group, 44 patients were assigned at random to receive 1 g intravenous dipyrone, and 30 patients received 10 mL 0.9% physiological saline. For the migraine with aura group, 30 patients received both dipyrone or placebo. We used seven parameters of analgesic evaluation and an analog scale to assess nausea, photophobia, and phonophobia. RESULTS: Patients receiving dipyrone demonstrated a statistically superior improvement (P<.05 and P<.01) in pain and all associated symptoms compared with control subjects. CONCLUSIONS: Dipyrone is an effective drug for the relief of acute migraine pain and associated symptoms.     

偏头痛与卵圆孔未闭关系的研究

目的：探讨先兆性偏头痛、无先兆性偏头痛患者和正常人卵圆孔未闭（ PFO）发生率的差异。方法采用经颅多普勒超声（TCD）检测先兆性偏头痛组（29例）、无先兆偏头痛组（31例）和正常对照组（26名） PFO的发生率,比较各组差异。记录治疗前偏头痛患者的头痛频率、头痛发作日数和头痛程度等,并分析其与PFD分流量大小的相关性。结果先兆性偏头痛组、无先兆偏头痛组和正常对照组PFO发生率分别为72％、45％和31％,先兆偏头痛组PFO发生率较正常对照组高（ P＝0.008）,无先兆偏头痛组较正常对照组高,但比较差异尚无统计学意义（ P＝0.491）;PFO大小与头痛频率、头痛发作日数呈正相关（P均＜0.05）。结论先兆偏头痛患者的PFO发生率较高,提示此两种疾病可能有共同的病理学发病机制。     

偏头痛伴发枕大神经痛的临床意义

目的:观察偏头痛伴发枕大神经痛的临床意义。方法:对1998~2010年我院神经内科专科门诊382例偏头痛患者按照性别、发作类型、病程进行亚组分型,分别统计伴发枕大神经痛的发生率。将偏头痛患者按治疗方式分为封闭+药物组(发作性偏头痛30例、慢性偏头痛50例)和药物组(发作性偏头痛20例、慢性偏头痛50例),比较枕大神经封闭对总疗效影响。结果:男性、女性偏头痛并发枕大神经痛比例分别为36%和37%;先兆性和无先兆性偏头痛合并枕大神经痛比例分别为42%和36%;发作性和慢性偏头痛合并枕大神经痛比例分别为25%和56%(P<0.001)。发作性偏头痛总疗效86%,慢性偏头痛总疗效71%(P<0.05);慢性偏头痛亚组中,封闭+药物组有效率84%,药物组有效率58%(P<0.05)。结论:偏头痛并发枕大神经痛与否与其病程有关,枕大神经痛可能是偏头痛慢性化临床指标之一。合并治疗枕大神经痛可有效提高偏头痛的治愈率。     

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.     

Improved description of the migraine aura by a diagnostic aura diary

We present a diagnostic aura diary for prospective recordings of migraine with aura. Three questionnaires are supplemented with sheets for drawings and plottings of visual and sensory auras. Twenty patients recorded 54 attacks of migraine with aura and 2 attacks of migraine aura without headache. The visual and sensory aura were usually gradually progressive, reaching maximum development in 15 and 25 min (median) respectively and had a total duration of 20 and 55 min (median) respectively. Approximately 13% of the attacks had acute onset of visual aura associated with other features more typical of migraine. The visual and sensory auras always preceded typical migraine headache, and headache occurring before aura symptoms was always of the tension type, The migraine headache was milder than in attacks of migraine without aura and often did not have migraine characteristics. In attacks with unilateral head pain, headache and aura symptoms were contralateral in 90% and ipsilateral in 10%.     

调神针刺法预防性治疗偏头痛的临床效果

目的观察调神针刺法预防性治疗偏头痛的临床疗效。方法将90例先兆型及无先兆型偏头痛患者随机分为三组。治疗组(脱落4例)26例,针刺+口服安慰剂;对照组(脱落3例)27例,口服盐酸氟桂利嗪胶囊;安慰剂组(脱落1例)29例,口服安慰剂。比较三组的VAS评分及抑郁情况。结果治疗后及随访1个月,治疗组和对照组的VAS评分均低于治疗前,且治疗组低于对照组(P<0.05)。三组间治疗后和随访1个月的抑郁程度无显著差异(P>0.05)。结论调神针刺法可有效缓解偏头痛患者的疼痛程度,具有较好的临床疗效,但对患者的抑郁程度无明显的改善作用。     

Migraine aura without headache compared to migraine with aura in patients with affective disorders

The characteristics of psychiatric comorbidity in migraine have been studied in migraine with aura (MA) and migraine without aura (MO). Little information is available concerning patients with migraine aura without headache. In a study of 201 patients with major affective disorders (DSM–IV) we have described the clinical characteristics of patients with these three sub–types of migraine (IHS criteria) and compared the MA and migraine aura without headache groups. Compared to patients having MA (n=57), the group with migraine aura without headache (n=18) had a higher age of onset of migraine (28.5 vs. 19.2, p=0.001), significantly lower prevalences of affective temperaments (28% vs. 56%, p=0.036), suicide attempts (17% vs. 53%, p=0.013) and Raynaud’s syndrome (0% vs. 25%, p=0.017). These results indicate that there seem to be differences in the clinical characteristics found in patients with migraine with aura when compared to those having the migraine subtype without a headache phase. This may convey new information concerning the comorbid expression of migraine and affective disorders or concerning the processes that differentiates the migraine types with and without a subsequent pain attack.     

穴位热痛刺激治疗无先兆偏头痛的近期镇痛疗效观察

目的 观察穴位热痛刺激治疗无先兆偏头痛患者的近期镇痛疗效。 方法 采用随机数字表法将120例无先兆偏头痛患者分为观察组及对照组，每组60例。对照组患者给予西比灵口服，每晚1次，每次5 mg，治疗4周为1个疗程。观察组患者在对照组干预基础上辅以穴位热痛刺激，取穴风池、率谷、阳陵泉、外关、太阳、印堂，选用Pathway疼痛及感觉评估系统配置的圆形刺激器，当刺激器加热至54.5 ℃时发放可调节脉冲热刺激，单个脉冲热刺激其脉宽为0.3 s，刺激间隔10 s，每个穴位连续刺激5次后换下一穴位，各穴位循环交替刺激，共治疗20 min，每日治疗1次，治疗4周为1个疗程。记录治疗前、后2组患者头痛发作频率、持续时间、疼痛视觉模拟评分(VAS)、头痛伴随症状评分、偏头痛特异生活质量问卷量表（MSQ）评分，并对比2组患者近期疗效差异。 结果 治疗后观察组患者头痛发作频率［（1.27±0.13）次/月］、头痛持续时间［（2.51±0.22）分钟/次］、疼痛VAS评分［（0.43±0.08）分］、头痛伴随症状评分［（0.21±0.20）分］、MSQ功能受限评分［（79.0±10.2）分］、功能障碍评分［（82.6±10.3）分］及情感评分［（85.2±10.5）分］均较治疗前及对照组明显改善（均P<0.05）；另外治疗后观察组患者总有效率（95.0%）亦显著优于对照组水平（80.0%），组间差异具有统计学意义（P<0.05）。所有患者在治疗期间其心率、血压均未出现不良反应，热痛刺激部位无感染、红肿等异常表现。 结论 穴位热痛刺激治疗无先兆偏头痛患者近期疗效显著，并且治疗过程安全可靠、副反应少，为偏头痛患者提供了一种新的治疗方法，值得临床推广、应用。     

Biofeedback-assisted relaxation in migraine headache: relationship to cerebral blood flow velocity in the middle cerebral artery

OBJECTIVE: To determine if migraineurs with aura respond differently to biofeedback/relaxation than those without aura and, if so, whether the variability in outcome can be explained by blood flow velocity. Background.-The relationship between cerebral blood flow velocity and treatment response to biofeedback/relaxation in migraine with and without aura is uncertain. METHOD: Twenty migraineurs underwent 12 sessions of biofeedback/relaxation therapy, while 20 controls simply were told to relax on their own. Cerebral blood flow velocity was measured bilaterally in the middle cerebral artery with transcranial Doppler. RESULTS: The biofeedback group showed significant (P <.05) reductions in pain, depression, and anxiety compared to the control group. Patients with and without aura did equally well. There were significant (P <.05) left to right blood flow velocity differences only in the migraine with aura group. Maximum blood flow velocities were significantly higher (P <.05) in the migraine with aura group than in the cohort without aura. There was an inverse correlation between indicators of anxiety and blood flow velocity, perhaps related to hyperventilation-induced constriction in the small vessels distal to the middle cerebral artery. CONCLUSION: The positive treatment response to biofeedback/relaxation in migraine headache is not related to presence of aura, nor to changes in blood flow velocity, but may be associated with reduction in anxiety and depression.