整脊结合热敏灸治疗颈源性头痛的疗效观察

目的：观察整脊结合热敏灸治疗颈源性头痛的疗效。方法：颈源性头痛患者80例,随机分为2组各40例,观察组采用整脊结合热敏灸治疗,对照组给予塞来昔布胶囊加盐酸乙哌立松片口服治疗。治疗前后进行视觉模拟量表（VAS）评分及疼痛发作次数比较。结果：2组患者治疗1个月后,VAS评分、头痛发作频率均较治疗前明显下降（P〈0．05）,且观察组更低于对照组（P〈0．05）。结论：整脊结合热敏灸治疗颈源性头痛临床疗效优于非甾体抗炎药加肌松药,操作安全,患者易接受,值得进一步临床推广。     

丹红注射液联合步长脑心通治疗急性脑梗死临床观察

目的：观察丹红注射液联合步长脑心通治疗脑梗死的临床疗效。方法：治疗组30例，用丹红注射液联合步长脑心通治疗；对照组30例，用川芎嗪注射液治疗。观察并比较两组患者神经功能缺损评分、临床疗效及用药期间的不良反应。结果：丹红注射液联合步长脑心通治疗组总有效率为93．3％，对照组总有效率为70．0％，两组比较差异有统计学意义（P〈0．05）。结论：丹红注射液联合步长脑心通治疗急性脑梗死有效、安全，且疗效优于川芎嗪注射液。     

综合康复治疗颈源性头痛

目的：观察综合康复治疗颈源性头痛的疗效。方法：颈源性头痛患者116例，随机分为观察组和对照组各58例，观察组采用手法、牵引和中药热敷等综合康复治疗；对照组口服双氯芬酸钠肠溶片治疗。结果：治疗2周后，2组VAS评分均较治疗前明显下降，观察组更显著；临床疗效比较，观察组治愈率和有效率均高于对照组（81．0％、98．3％与12．0％、77．5％，P〈0．05）。结论：综合康复疗法能显著提高颈源性头痛患者的痛阌值及临床疗效。     

低浓度大容量利多卡因混合镇痛液用于颈源性头痛神经阻滞的临床观察

目的观察低浓度大容量与常规浓度剂量的利多卡因混合镇痛液在颈源性头痛神经阻滞治疗上的临床疗效和安全性。方法选用符合颈源性头痛诊断标准的108例患者,分为2组各54例。治疗组以0．1％利多卡因60～80mL加得宝松0．5rnL、甲钴胺1mg。对照组以0．5％利多卡因40mL加得宝松0．5mL、甲钴胺1mg分别行枕神经、Q横突、颈部竖棘痛点阻滞,注射镇痛液3～5mL。每周1次,4次为一个疗程。评价2组临床疗效、疼痛视觉模拟评分（vAs评分）、不良反应。结果2组临床疗效无显著差异。与治疗前比较,2组治疗后1周、治疗后1个月、治疗后3个月、治疗后6个月时的头痛VAS评分均明显低于治疗前。治疗组治疗后各时间点VAS评分均明显低于对照组。治疗组不良反应总发生率明显低于对照组。结论低浓度大容量利多卡因用于颈源性头痛的神经阻滞是一种不良反应少,疗效确切的方法,尤其适用于老年患者的治疗。     

普瑞巴林联合布洛芬治疗偏头痛的临床疗效观察

目的：分析普瑞巴林联合布洛芬治疗偏头痛的临床疗效。方法：选取2017年3月~2020年3月收治的80例偏头痛患者,随机分为研究组和对照组各40例。对照组给予普瑞巴林治疗,研究组给予普瑞巴林联合布洛芬治疗。比较两组临床疗效、头痛频率、视觉模拟评分法（VAS）评分、不良反应发生情况、头痛持续时间以及血清内皮素-1（ET-1）、5-羟色胺（5-HT）、降钙素基因相关肽（CGRP）指标水平变化情况。结果：研究组VAS评分低于对照组,头痛频率、头痛持续时间均少于对照组（P＜0.05）;研究组临床疗效高于对照组（P＜0.05）;两组不良反应总发生率比较无显著性差异（P＞0.05）;研究组ET-1、5-HT及CGRP水平均低于对照组（P＜0.05）。结论：对偏头痛患者应用普瑞巴林联合布洛芬治疗可有效增强疗效,进一步降低头痛频率,有效缓解头痛程度,使头痛持续时间明显缩短,并改善患者多项血清因子水平。     

手法加电针治疗颈源性头痛的疗效观察

目的 观察手法加电针治疗颈源性头痛疗效。方法 共选取50例 颈源性头痛患者,随机将其分为治疗组和对照组。治疗组在手法基础上采用电针治疗,对照组给予单纯电针治疗。于治疗前、后采用VAS评分对2组患者进行疗效评定。结果 2组患者分别经二个疗程治疗后,发现其VAS评分结果均较治疗前好转,并且均以治疗组的改善幅度较显著,与对照组差异具有统计学意义（P〈0.05）,同时治疗组临床疗效亦显著优于对照组。结论 手法加电针治疗颈源性头痛疗效显著,是临床上比较确切的治疗方法。     

综合护理对颈椎综合征患者疼痛敏感的临床效果

目的：探讨综合护理对颈椎综合征患者疼痛敏感的临床疗效。方法选取确诊为颈椎综合征的患者100例,随机分为实验组和对照组,每组50例。两组患者均给予患者药物、物理疗法、针灸、手法推拿等治疗,同时观察组实施综合护理。对比两组患者治疗前后的临床症状及功能评分、VAS评分、FS－CSA评分和SF－36评分及临床疗效。结果两组患者治疗后的眩晕、头痛、颈肩痛、心理及社会适应、日常生活及工作评分均显著高于治疗前（均P＜0.05）,实验组患者治疗后的眩晕、头痛、颈肩痛、心理及社会适应、日常生活及工作评分均显著高于对照组（均P＜0.05）。两组患者治疗后VAS评分、FS－CSA评分显著低于治疗前（均P＜0.05）,SF－36评分显著高于治疗前（P＜0.05）;实验组患者治疗后的VAS评分、FS－CSA评分显著低于对照组（均P＜0.05）,SF－36评分显著高于对照组（P＜0.05）。实验组患者临床疗效显著优于对照组（P＜0.05）。结论采用综合护理干预结合传统治疗可以有效地改善颈椎综合征患者的疼痛症状和生活质量。     

超声引导下枕神经阻滞治疗颈源性头痛的临床疗效

目的探讨超声引导下枕神经阻滞在颈源性头痛治疗中的临床疗效。方法将48例颈源性头痛患者随机分成对照组和超声组,每组24例。对照组采用传统盲探操作行患侧枕神经阻滞,超声组采用超声引导下行患侧枕神经阻滞：两组均每周治疗1次,持续2周。比较两组患者穿刺成功率、穿刺次数、穿刺时间、治疗1周和1个月后的视觉模拟（VAS）评分及总有效率的差异。结果与对照组比较,超声组入路的实际穿刺深度和穿刺时间缩短,感觉阻滞增高,穿刺成功率增高,患者满意率增高,差异均有统计学意义（P〈0．05）。两组治疗后1周和1个月的VAS评分均较治疗前下降,治疗后1个月VAS评分较治疗后1周亦下降,但超声组较对照组下降更明显,差异均有统计学意义（P〈0．05）。两组患者均未发生严重并发症。结论超声引导下枕神经阻滞治疗颈源性头痛的方法明显优于传统盲探的治疗方法。     

度洛西汀联合乙哌立松对紧张性头痛伴焦虑障碍患者的疗效观察

目的探讨度洛西汀联合乙哌立松对紧张性头痛伴焦虑障碍患者的疗效。方法选取在门诊治疗的50例紧张性头痛伴焦虑障碍患者作为研究对象,将其随机分为实验组与对照组,各25例。实验组患者采用盐酸乙哌立松片联合盐酸度洛西汀肠溶胶囊治疗,对照组仅采用盐酸乙哌立松片治疗。所有患者观察4周,实验过程中采用副反应量表(TESS)评定副反应,实验开始及结束时采用视觉模拟评分法(VAS)判断患者头痛程度,并采用汉密尔顿焦虑量表(HAMA)评估焦虑程度。结果治疗后,2组患者的VAS评分均较治疗前显著下降(P 0. 05),且实验组VAS评分显著低于对照组(P 0. 05);治疗后,2组患者的HAMA评分均较治疗前显著下降(P 0. 05),且实验组HAMA评分显著低于对照组(P 0. 05); 2组的副反应发生率比较,差异无统计学意义(P0. 05)。结论度洛西汀联合乙哌立松可有效且安全地缓解紧张性头痛伴焦虑障碍患者的症状。     

针刺联合中药热透治疗颈源性头痛疗效观察

目的:分析研讨针刺联合中药热透治疗颈源性头痛的临床疗效。方法:随机从我院2014年2月~2017年8月期间收治的颈源性头痛患者中抽取66例进行讨论,回顾分析其病历资料,依据其治疗方式分研究组与对照组,对照组33例接受针刺治疗,研究组33例接受针刺联合中药热透治疗,观察比较两组患者治疗疗效。结果:研究组治疗总疗效(93.94%)高于对照组(78.79%),组间数据差异明显(P0.05)。比较两组患者ROM评分、VAS评分,组内比较治疗后低于治疗前,数据差异明显(P0.05);组间比较,治疗前数据差异不明显(P0.05),治疗后研究组ROM评分、VAS评分低于对照组,数据差异明显(P0.05)。结论:临床治疗颈源性头痛采用针刺联合中药热透方式,颈部活动度得到明显改善,能有效缓解疼痛,提升疗效,值得推广。     

Occipital Nerve Blockade for Cervicogenic Headache: A Double-Blind Randomized Controlled Clinical Trial

Abstract:   Cervicogenic headache is a chronic hemicranial pain, usually occurring daily. This randomized, double-blind, placebo-controlled trial evaluated the effectiveness of nerve stimulator-guided occipital nerve blockade in the treatment of cervicogenic headache. The reduction in analgesic consumption was the primary outcome measure. Fifty adult patients diagnosed with cervicogenic headache were randomly divided into two equal groups of 25 patients each. All patients in both groups received greater and lesser occipital blocks, whereas only 16 patients in each group received facial nerve blockade in association with the occipital blocks. The control group received injections of an equivalent volume of preservative-free normal saline. Pain was assessed using the visual analog scale (VAS) and the Total Pain Index (TPI). Forty-seven patients entered into the final analysis as three patients were lost to follow-up. Anesthetic block was effective in reducing the VAS and the TPI by approximately 50% from baseline values ( P  = 0.0001). Analgesic consumption, duration of headache and its frequency, nausea, vomiting, photophobia, phonophobia, decreased appetite, and limitations in functional activities were significantly less in block group compared to control group ( P  < 0.05). The nerve stimulator-guided occipital nerve blockade significantly relieved cervicogenic headache and associated symptoms at two weeks following injection.     

悬吊运动训练对颈源性头痛的疗效

目的观察悬吊运动训练治疗颈源性头痛的临床疗效。方法颈源性头痛患者60 例,按就诊顺序分为两组。Ⅰ组(n=30)行C2椎旁阻滞,每周1 次;Ⅱ组(n=30)在颈椎旁阻滞基础上配合悬吊运动训练,悬吊运动训练每周3 次。均治疗4 周。观察治疗前与治疗后1 个月、3 个月、6 个月的疼痛视觉模拟评分(VAS)、每月疼痛发作次数及临床疗效。结果治疗后VAS评分,Ⅰ组治疗后1 个月、3 个月,Ⅱ组治疗后1 个月、3 个月、6 个月均较治疗前显著改善(P<0.001);治疗后3 个月、6 个月,Ⅱ组较Ⅰ组改善更显著(P<0.001)。治疗后疼痛发作次数,Ⅰ组治疗后1 个月、3 个月,Ⅱ组治疗后1 个月、3 个月、6 个月均较治疗前减少(P<0.05);治疗后3 个月、6 个月,Ⅱ组较Ⅰ组减少更明显(P<0.05)。治疗后Ⅰ组优良率33.3%,Ⅱ组73.3% (P<0.01)。结论配合悬吊运动训练治疗颈源性头痛优于单一采用颈椎旁阻滞,远期效果更佳。     

星状神经节阻滞与颈横突局部注射疗法对颈源性头痛的疗效评价

目的:探讨星状神经节阻滞疗法和C2横突旁注射疗法对颈源性头痛的疗效.方法:颈源性头痛患者96例分别采用C2横突局部注射36例(A组)、星状神经节阻滞36例(B组)及单纯口服对乙酰氨基酚胶囊24例(C组).治疗前后采用McGill疼痛评分量表评定患者疼痛程度.结果:治疗3周后,A、B组疼痛评分差异无显著性意义,但均优于C组(P＜0.05).结论:C2横突旁局部注射与星状神经节阻滞疗法治疗作用相近,对颈源性头痛均有较好疗效.     

McKenzie技术治疗椎间盘源性下腰痛的临床效果

目的观察中医推拿配合McKenzie 技术对椎间盘源性下腰痛的临床影响。方法80 例入选者随机分为对照组和观察组各40 例(对照组脱失1 例),对照组采用中医推拿治疗,观察组采用中医推拿结合McKenzie 技术治疗,并于治疗前和治疗3 周后采用Oswestry 功能障碍指数(ODI)、视觉模拟评分(VAS)和Zung 抑郁自评量表(SDS)进行评价。结果治疗后,两组患者的ODI、VAS评分和SDS评分较治疗前显著降低(P<0.001),观察组患者ODI和VAS评分低于对照组(P<0.05),两组SDS评分无显著性差异(P>0.05)。结论中医推拿结合McKenzie技术对椎间盘源性下腰痛有较好的疗效。     

Headache after whiplash: a historical cohort study outside the medico-legal context

Headache is frequently reported as a chronic complaint after whiplash traumas. Criteria have been presented, but it has not been validated whether any specific headache type emerges after a trauma with whiplash mechanism. In a questionnaire-based historical cohort design, 202 adult Lithuanian individuals were interviewed 1–3 years after experiencing a rear-end car collision. The questionnaire was designed so that a diagnosis of migraine and tension-type headache in accordance with the International Headache Society criteria could be made. "Possible cervicogenic headache" was diagnosed according to Sjaastad et al.'s minimal criteria. The diagnostic panorama in those with traumas was compared with that of an age- and sex-matched control group. The introductory questions did not reveal differences in headache frequencies between the traumatized and control groups ( p =0.60). The prevalence of migraine and tension-type headache (both episodic and chronic) was also similar. A higher frequency of possible cervicogenic headache was observed in the traumatized group (10 vs 5), but the difference was not statistically significant ( p =0.28). Sixteen patients in the accident group had headache >15 days per month, 11 of the 16 had similar complaints before the trauma, while 5 had worsened headache as compared to (the recollected headache) before the trauma. None of the patients with possible cervicogenic headache reported increased headache after the accident. Accordingly, the present results obtained outside the medico-legal context do not confirm that a specific headache pattern emerges 1–3 years after a rear-end car collision.     

颅脑手术后头痛的综合治疗效果

目的观察疼痛科协助下综合治疗颅脑手术后头痛的效果。方法将30例颅脑手术后颅内情况稳定但出现严重头痛的患者随机分为治疗组(n=15,疼痛科协助下行神经阻滞为主的综合治疗)和对照组(n=15,继续神经外科药物治疗)。对两组患者治疗前后疼痛的视觉模拟评分(VAS)、手术后至出院的住院天数以及医疗费用进行比较。结果与对照组比较,治疗组患者治疗后的VAS评分明显降低(P<0.01),手术后至出院的平均住院天数明显减少(P<0.01),检查费和药费明显降低(PP<0.01),床位费亦降低(P<0.05)。结论疼痛科协助下对颅脑手术后头痛患者行神经阻滞为主的综合治疗可明显提高治疗效果,缩短住院时间,降低医疗费用。     

Upper Cervical Facet Joint and Spinal Rami Blocks for the Treatment of Cervicogenic Headache

(Headache 2010;50:657‐663) Objective.— To evaluate the efficacy of upper cervical facet joint injections and spinal rami blocks in the treatment of cervicogenic headache. Background.— Cervicogenic headache has been recognized as a common and often disabling disorder. The treatment of this headache type remains challenging. Methods.— We conducted a retrospective chart review of 31 patients with refractory cervicogenic headache who underwent fluoroscopically guided C_1/2, C_2/3 facet joint injections and C₂, C₃ spinal rami blocks using a mixture of 0.25% bupivacaine and 3 mg betamehtasone. The outcome measures were the change in headache severity, assessed using an 11‐point numerical pain scale, after treatment, and the duration of head pain relief. Results.— Twenty‐eight (90.3%) patients experienced >50% headache relief after treatment, with an average duration of 21.7 (1‐90) days. Mean (±SD) head pain intensity decreased from 7.5 ± 1.3 before treatment to 2.7 ± 1.9 immediately after it (P < .0001). The procedures were well tolerated. Conclusions.— C_1/2, C_2/3 facet joint injections and C₂, C₃ spinal rami blocks were effective and well tolerated for the treatment of cervicogenic headache in this study. The procedures provided significant and prolonged pain relief in the majority of patients. Larger controlled studies are needed to further evaluate the efficacy of this treatment modality in cervicogenic headache.     

Cervicogenic headache, migraine, and tension-type headache. Pressure-pain threshold measurements.

Pressure-pain threshold (PPT) measurements were performed with a pressure algometer, at 22 specified points in the head in patients with cervicogenic headache (n = 32), migraine (with and without aura) (n = 26) and tension-type headache (n = 17). Comparisons were made with a group of healthy controls (n = 20). The average PPT differed significantly between the groups (ANOVA, F = 9.5, P < 0.0005), largely caused by the low threshold in cervicogenic headache patients. There were no significant differences between controls and the 2 other headache groups. In the cervicogenic headache group, the lowest PPT was found in the occipital part of the head on the side with pain predominance. The ratio between the dominant and non-dominant sides (all 11 points on each side) was 0.85 in cervicogenic headache, whereas it was 0.99 in migraine patients with side preponderance of the pain. The present results support the view that the pathogenesis of cervicogenic headache differs from that of migraine and tension-type headache. The results may further support the theory that fibres from the C2 level (innervating the occipital part of the head) may be included in the pathogenetic mechanism in cervicogenic headache.     

氟桂利嗪联合经皮神经电刺激治疗前庭型偏头痛的效果及安全性研究

目的探讨氟桂利嗪联合经皮神经电刺激(transcutaneouselectrical nerve stimulation,TENS)治疗前庭型偏头痛(vestibular migraine,VM)的效果及安全性。方法选取我院2018年2月-2019年3月收治的VM患者124例,根据治疗方法的不同分为观察组63例和对照组61例。观察组予氟桂利嗪联合TENS治疗,对照组仅予氟桂利嗪治疗,疗程均为3个月。治疗结束后比较两组临床疗效;观察两组治疗前及治疗后随访2个月首次发作头痛、眩晕程度,头痛程度采用视觉模拟量表(visual analogue scale,VAS)评估,眩晕程度采用眩晕障碍量表(dizziness handicap inventory,DHI)评估;比较两组治疗前及治疗后随访2个月头痛、眩晕发作频率和持续时间;比较两组治疗前及治疗结束时两组生活质量评价量表(short form 36 questionnaire,SF-36)评分;观察两组治疗期间不良反应发生情况。结果治疗后观察组总有效率为92.06%高于对照组总有效率62.30%(P<0.01);治疗后随访2个月首次发作时两组VAS评分和DHI评分均较治疗前改善,且观察组VAS评分和DHI评分改善程度大于对照组,差异均有统计学意义(P<0.05或P<0.01);治疗后随访2个月两组头痛、眩晕发作频率和持续时间均较治疗前改善,且观察组头痛、眩晕发作频率和持续时间改善程度均大于对照组,差异均有统计学意义(P<0.05或P<0.01);治疗结束时两组SF-36评分均较治疗前升高,且观察组SF-36评分升高程度大于对照组,差异均有统计学意义(P<0.05或P<0.01);两组治疗期间总不良反应发生率比较差异无统计学意义(P>0.05)。结论氟桂利嗪联合TENS治疗VM可显著提高患者临床疗效,改善患者头痛及眩晕的程度、发作频率和持续时间,提高患者生活质量,且治疗安全性较好。