正天丸与氟桂利嗪联合治疗偏头痛疗效观察

目的 观察正天丸与氟桂利嗪联合治疗偏头痛的临床疗效.方法 将80例偏头痛患者,随机分为2组,治疗组40例,服用正天丸6 g,3次/d,氟桂利嗪10 mg,每晚睡前服;对照组40例,服用氟桂利嗪10 mg,每晚睡前服;2组均连续治疗4周,观察2组疗效,比较有效率.结果 治疗组总有效率92.5% ,其中治愈12例(30.0%),显效15例(37.5%),好转20例(25.0%);对照组总有效率72.5%,其中治愈7例(17.5%),显效13例(32.5%),好转9例(22.5%);治疗组总有效率明显优于对照组(P＜0.05).结论 正天丸与氟桂利嗪联合治疗偏头痛疗效好且不良反应小,值得临床推广.     

高压氧联合氟桂利嗪治疗偏头痛疗效分析

目的探讨高压氧联合氟桂利嗪治疗偏头痛的疗效。方法将120例偏头痛患者随机分为氟桂利嗪组、高压氧组和联合治疗组,对比分析各组间的有效率和1周治愈率。结果有效率:联合组(97.5%)高于高压氧组(82.5%)和氟桂利嗪组(80.0%),差异有统计学意义(P<0.05);1周治愈率:联合组(60.0%)、高压氧组(52.5%)高于氟桂利嗪组(22.5%),差异有统计学意义(P<0.01)。结论高压氧联合氟桂利嗪是治疗偏头痛的理想方法。     

氟桂利嗪联合血塞通治疗偏头痛的临床疗效

目的探讨氟桂利嗪与血塞通联合治疗偏头痛的临床疗效。方法 108例偏头痛患者随机分为观察组(n=54)与对照组(n=54),对照组给予氟桂利嗪治疗,观察组在对照组基础上加用血塞通治疗,对比2组治疗效果。结果 2组偏头痛发作频率及VAS评分较治疗前均显著降低(P0.01),疼痛持续时间显著缩短(P0.01),且治疗后观察组显著优于对照组(P0.01);观察组治愈率33.3%,显著高于对照组的16.7%;观察组有效率94.4%,显著高于对照组的75.9%。结论氟桂利嗪与血塞通联合治疗偏头痛,有较好的治愈率与有效率,值得临床推广。     

盐酸氟桂利嗪胶囊治疗月经期偏头痛的临床疗效观察

目的探讨盐酸氟桂利嗪胶囊治疗月经期偏头痛的临床疗效及最佳治疗方案。方法将68例月经期偏头痛患者随机分为两组,A组为常规治疗组(每周服用盐酸氟桂利嗪胶囊5天,停用2天),B组为按生物节律周期治疗组(在月经来临前十天服用盐酸氟桂利嗪胶囊,连续服用20天)。所有患者均于睡前服用5mg盐酸氟桂利嗪胶囊,并记录头痛日记和药物不良反应;根据头痛程度、发作频率、持续时间和伴随症状的变化情况,经量化记分,于用药1个月、3个月、6个月进行疗效判定,同时比较药物不良反应的发生率。结果 1个月和3个月两组间盐酸氟桂利嗪胶囊疗效无明显差异(P>0.05),但6个月时,B组患者头痛程度、发作频率、持续时间、伴随症状与A组相比,明显减轻/减少(P<0.001);两组间药物不良发应发生率无差异(P>0.05)。结论盐酸氟桂利嗪胶囊能够有效的防治月经期偏头痛;根据生物节律周期即女性雌激素分泌水平变化给予盐酸氟桂利嗪胶囊防治月经期偏头痛疗效更佳。     

帕罗西汀联合氟桂利嗪防治更年期偏头痛的疗效观察

目的 观察帕罗西汀联合氟桂利嗪防治更年期偏头痛的疗效.方法 将120例更年期偏头痛患者随机分成两组,帕罗西汀联合氟桂利嗪为研究组,单用氟桂利嗪为对照组,观察治疗前后偏头痛发作次数、持续时间的变化,同时采用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)进行评定.共观察8周.结果 治疗8周末,研究组每周偏头痛发作次数(0.5±0.3)比治疗前减少(1.1±0.5),差异有统计学意义(t=8.0,P<0.01);偏头痛持续时间(h/次)比治疗前短(2.7±0.7,7.6±3.1,t=11.9,P<0.01).治疗8周末,对照组发作次数也比治疗前减少,差异有统计学意义(0.7±0.3,2.7±0.7,t=8.0,P<0.01),偏头痛持续时间(h/次)比治疗前短(2.7±0.7,7.4±3.1,t=11.5,P<0.01);治疗8周末,研究组的发作次数少于对照组(t=3.7,P<0.05),两组偏头痛持续时间差异无统计学意义(t=0,P>0.05).治疗8周末研究组HAMD和 HAMA低于对照组(HAMD:5.9±1.8,8.7±2.3,t=7.3,P<0.01;HAMA:4.9±1.7,8.8±2.1,t=11.2,P<0.01).结论 帕罗西汀联合氟桂利嗪对预防更年期偏头痛发作优于单用氟桂利嗪.     

头痛宁胶囊联合氟桂利嗪治疗偏头痛疗效观察

2008—06-2009～07我院对55例偏头痛患者采用头痛宁胶囊与氟桂利嗪联合用药的治疗方法，取得较好临床疗效，现报道如下。     

多虑平治疗偏头痛32例疗效观察

自1999—01～2003—12，笔者采用多虑平治疗偏头痛32例，疗效满意，报道如下。     

氟桂利嗪单用及联用血塞通治疗偏头痛的疗效对比

目的观察氟桂利嗪单用及联用血塞通治疗偏头痛的效果。方法选择我院2010-01—2013-01收治的116例偏头痛患者为对象,随机分为单用组和联用组各58例。单用组采用氟桂利嗪治疗,联用组加用血塞通。对2组疗效及病情发作情况进行观察和比较。结果联用组总有效率明显高于单用组,病情发作次数、发作持续时间及疼痛程度评分均明显优于单用组,差异有统计学意义（P〈0.05）。结论氟桂利嗪联合血塞通治疗偏头痛效果显著,能够有效改善患者病情,减少发病次数及持续时间,改善患者头痛程度,具有临床应用价值。     

托吡酯治疗儿童偏头痛的疗效观察

目的 观察托吡酯治疗儿童偏头痛的临床效果。方法 选取我院门诊收治的偏头痛患儿作为研究对象,分别采用托吡酯和氟桂利嗪治疗,2组患儿均治疗3个月,观察治疗效果。结果 观察组治疗后每月偏头痛发作次数及发作持续时间分别为(0.89±0.43)次、(0.76±0.41)d,均少于对照组,差异具有统计学意义(P<0.05);观察组总有效率显著性高于对照组(χ2=4.24,P<0.05)。结论 托吡酯治疗儿童偏头痛效果显著,头痛发作次数和发作持续时间均有所减少,值得临床推广应用。     

Rizatriptan benzoate influences the endogenous pain modulatory system in a rat model of migraine

The present study utilized a nitroglycerin-induced rat model of migraine to detect the effects of rizatriptan benzoate on proenkephalin and substance P gene expression in the midbrain using real-time quantitative polymerase chain reaction and investigate whether rizatriptan benzoate can regulate the endogenous pain modulatory system. The results showed that rizatriptan benzoate significantly reduced expression of the mRNAs for proenkephalin and substance P. Rizatriptan benzoate may inhibit the analgesic effect of the endogenous pain modulatory system.     

Rizatriptan in the treatment of migraine

Migraine is a common, disabling disorder associated with considerable personal and societal burden. Current guidelines recommend triptans for the acute treatment of migraine unlikely to respond to less effective therapies. Rizatriptan is a second-generation triptan available in tablet or orally disintegrating tablet (wafer) formulations that offers several advantages over other members of its class. Rizatriptan is rapidly absorbed from the gastrointestinal tract and achieves maximum plasma concentrations more quickly than other triptans, providing rapid pain relief. Clinical trials have shown that rizatriptan is at least as effective or superior to other oral migraine-specific agents in the acute treatment of migraine, and has more consistent long-term efficacy across multiple migraine attacks. Rizatriptan has a favorable tolerability profile, and patients have reported greater satisfaction and a preference for rizatriptan over other migraine-specific agents. Improvements in quality of life reported with rizatriptan are consistent with its favorable efficacy and tolerability profiles. Notably, multi-attribute decision models that combine clinical data with patient- and physician-reported treatment preferences have identified rizatriptan as one of three triptans closest to a hypothetical “ideal”. The efficacy and tolerability of rizatriptan for the acute treatment of migraine have thus been well established.     

Rizatriptan does not change cerebral blood flow velocity during migraine attacks

Rizatriptan represents a major advance in the treatment of migraine attack: inhibition of peripheral trigeminal nerve and constriction of intracranial extracerebral blood vessels have been proposed as its main antimigraine mechanisms of action. Although many studies may suggest that rizatriptan causes highly selective vasoconstriction within intracranial extracerebral vessels (i.e., meningeal arteries), no literature data are available to date on possible cerebral hemodynamic changes in humans after treatment with rizatriptan. The aim of this study was to evaluate the effect of rizatriptan on cerebral blood flow velocity performing transcranial Doppler during spontaneous attacks of migraine without aura. Fourteen patients suffering from migraine without aura were monitored to evaluate mean flow velocity changes on both middle cerebral arteries during migraine attack 30 min before and 120 min after oral administration of rizatriptan 10mg. Monitoring was repeated for 30 min during the pain-free period. All patients turned out to be drug responders and no significant mean flow velocity changes were observed between the pain-free period and pre-treatment phase; besides no significant difference in mean flow velocity value have been detected between the periods after the drug administration during the attack versus both pre-treatment period and pain-free phase. These findings indicate that the antimigraine action of rizatriptan is not associated with clear intracranial cerebral hemodynamic changes and may support its cerebrovascular safety.     

Cognitive and psychiatric effects of topiramate monotherapy in migraine treatment: an open study

Few data are available on cognitive and psychiatric effects of topiramate (TPM) monotherapy in migraine. Twenty patients affected by migraine were treated with TPM monotherapy. At the same time, twenty control subjects were selected. A comprehensive neuropsychological and behavioural battery of tests were performed at baseline (T0), at titration (T1) and in maintenance period (T2). Topiramate serum levels were also investigated at T1 and T2. On comparison with the control group, no cognitive and psychiatric differences were detected at baseline. A significant reduction of word fluency score ( P  < 0.05) was evident after TPM treatment, both at T1 and T2. No patient developed psychiatric adverse events. TPM induced an impairment of verbal fluency and no psychiatric adverse events, demonstrating selective negative cognitive profile in migraine therapy. Slow titration, low doses, lack of previous psychiatric disorders and/or familial history may explain our data.     

波立维与阿司匹林联合治疗进展型脑梗死的疗效观察

目的探讨波立维与阿司匹林联合治疗进展型脑梗死的临床疗效。方法92例进展型脑梗死患者随机分为联合治疗组和对照组(各46例),两组在常规治疗的基础上,联合治疗组患者用波立维75mg和阿司匹林150mg每天1次,对照组单用阿司匹林150mg每天1次。在治疗前及治疗30d时进行神经功能缺损程度评分,以及凝血功能和血液流变学检测。结果联合冶疗组总有效率(93%)明显高于对照组(74%)(P<0.05)。联合治疗组和对照组治疗后红细胞比容、血小板聚集率及联合治疗组全血高切、低切黏度、血浆比黏度及全血黏度均较治疗前显著降低(均P<0.05),联合治疗组治疗后的血小板聚集率明显低于对照组(P<0.05)。而凝血指标两组治疗前后对比均无统计学意义。联合治疗组治疗期间出现脑出血2例,无其他不良反应。结论波立维与阿司匹林联合治疗进展型脑梗死疗效较好,但有出血不良反应。     

Increased risk of migraine with typical aura in probands with familial hemiplegic migraine and their relatives

We investigated the occurrence of migraine without aura (MO) and migraine with typical aura (MA) amongst probands with familial hemiplegic migraine (FHM) and their first degree relatives in order to evaluate the relations between these syndromes. A total of 44 FHM probands and 240 first degree relatives were identified in the Danish population. The pattern of familial aggregation was assessed by population relative risk (PRR) calculations. Amongst FHM probands the PRR of MO was 1.5 (95% CI: 0.8-2.2), whereas the PRR of MA was 7.1 (95% CI: 5.0-9.2). Thus, compared with the general population, FHM probands had no increased risk of MO but a significantly increased risk of MA. A similar pattern was seen amongst their first degree relatives, who had no increased risk of MO, whereas the risk of MA was significantly increased; 7.6 times in FHM-affected first degree relatives and 2.4-times in non-FHM-affected first degree relatives. These results are contrary to a sharing of genetic mechanisms between FHM and MO. Furthermore, they suggest that the genetic abnormality causing FHM may also cause attacks with the symptomatology of MA.     

天舒胶囊治疗偏头痛疗效的Meta分析

目的评价天舒胶囊治疗偏头痛的疗效和安全性。方法检索公开发表关于天舒胶囊治疗偏头痛的随机对照试验的文献,通过Cochrane系统评价方法对所纳入文献进行质量评价,采用Revman 5.2软件进行统计分析。结果将对照组仅为氟桂利嗪、结局指标为总有效率的7篇文献进行Meta分析显示,天舒胶囊组疗效显著优于氟桂利嗪组(OR=2.92,95%CI:1.89~4.49,Z=4.87,P0.00001);选取其中3个剂量及疗程相同的研究做亚组分析发现,治疗组与对照组疗效差异有统计学意义(OR=4.21,95%CI:2.21~8.02,Z=4.37,P0.0001),与整体分析结果一致。对另4篇因对照组药物不同及结局指标无法合并的文献进行描述性分析发现,天舒胶囊治疗偏头痛的疗效优于奥卡西平(P=0.007),且奥卡西平更易发生肝功能异常;治疗前后头痛发作频率、头痛持续时间差异均有统计学意义(均P0.05)。8篇文献以胃部不适、女性月经过多为主要不良反应,未见严重不良反应。结论天舒胶囊治疗偏头痛的疗效优于氟桂利嗪、奥卡西平、传统中成药元胡止痛胶囊、丹参胶囊,且不良反应少。     

Neurostimulation for the treatment of chronic migraine and cluster headache

Small subsets of patients who fail to respond to pharmacological treatment may benefit from alternative treatment methods. In the last decade, neurostimulation is being explored as a potential treatment option for the patients with chronic, severely disabling refractory primary headaches. To alleviate pain, specific nerves and brain areas have been stimulated, and various methods have been explored: deep brain stimulation, occipital nerve stimulation, and sphenopalatine ganglion stimulation are among the more invasive ones, whereas transcranial magnetic stimulation and supraorbital nerve stimulation are noninvasive. Vagal nerve stimulation can be invasive or noninvasive, though this review included only data for noninvasive VNS. Most of these methods have been tested in small open‐label patient series; recently, more data from randomized, controlled, and blinded studies are available. Although neurostimulation treatments have demonstrated good efficacy in many studies, it still has not been established as a standard treatment in refractory patients. This review analyzes the available evidence regarding efficacy and safety of different neurostimulation modalities for the treatment of chronic migraine and cluster headache.     

偏头痛慢性转化的临床危险因素分析

目的 比较慢性偏头痛（CM）与发作性偏头痛（EM）的病史特征、临床特点等,探究偏头痛慢性转化的危险因素,为其防治提供依据和策略。方法 共纳入在中南大学湘雅医院神经内科就诊的CM患者72例及EM患者109例进行回顾性分析。采集患者基本信息,先进行单因素分析,筛选有统计学意义的指标进行相关分析和非条件性多因素logistic回归分析。结果 单因素分析发现两组的BMI（P=0.000）、病程（P=0.000）、基线头痛发作频率（P=0.000）、基线头痛持续时间（P=0.037）、匹兹堡睡眠质量指数量表（PSQI,P=0.000）、焦虑自评量表（SAS,P=0.000）及抑郁自评量表（SDS,P=0.001）差异有统计学意义。logistic回归分析显示BMI（OR=1.468,95%CI：1.148~1.876）、病程（OR=1.102,95%CI：1.022~1.188）、基线头痛发作频率（OR=1.461,95%CI：1.247~1.711）、睡眠质量（OR=1.494,95%CI：1.198~1.864）、焦虑状态（OR=1.201,95%CI：1.048~1.376）是偏头痛慢性转化的危险因素。结论 控制体重、减少头痛发作频率、缩短病程、改善心境状态与睡眠质量,有可能延缓偏头痛的慢性进展。