星状神经节阻滞与颈椎旁注射治疗颈源性头痛头晕的临床观察

颈源性头痛头晕是临床常见症状,是颈椎退变、小关节增生及椎间盘突出等原因导致椎动脉血流改变或上位颈神经卡压所致。我院自2007年2月至2009年11月共收治96例该类患者,经星状神经节阻滞配合椎旁注射治疗后,疗效满意,现报道如下。     

颈椎旁神经阻滞治疗颈源性头痛的疗效评价

目的:对比观察两种神经阻滞疗法治疗颈源性头痛(CHE)的临床效果。方法:按国际头痛委员会诊断标准选取CHE患者94例,随机分为2,3横突阻滞组(A组,n=48)和星状神经节阻滞(SGB)组(B组,n=46)。观察两组患者治疗前后头痛频率、头痛时间和视觉模拟量表(VAS)评分的变化。结果:两组患者治疗后头痛频率、头痛时间均较治疗前减少,A组更少于B组,差异有统计学意义(P<0.05);A组治疗后VAS评分分值较B组低,即A组治疗效果较B组更好(P<0.05)。结论:两种方法对治疗CHE均有良好效果,颈2、3横突阻滞更优于SGB。     

超声引导下C2神经根阻滞联合冲击波治疗颈源性头痛的临床研究

目的 观察超声引导下C2神经根阻滞联合冲击波治疗颈源性头痛(CEH)的临床疗效.方法 选择60例CEH患者,其中男性27例,女性33例;年龄35～ 60岁,平均年龄47.82岁;病程4～ 15年,平均病程10.03年;疼痛视觉模拟(VAS)评分4～9分,平均VAS评分7.62分.随机分为2组,30例予以单纯超声引导下C...     

痛性及非痛性糖尿病神经病变的临床研究进展

13%～35%的糖尿病患者存在痛性神经病变,而痛性及非痛性糖尿病神经病变(diabetic neuropathy, DNP)在糖尿病患者中差异性临床表现的原因尚不清楚。性别、糖尿病类型、糖化血红蛋白、血脂水平等对痛性DNP有一定预测作用,临床上需关注小纤维病变引起的疼痛和感觉异常;现有的诊断方法鉴别作用有限,痛性DNP诊断明确后需积极用药治疗。后续需进一步研究痛性DNP的发病机制,以寻找新的治疗靶点。     

颈源性头痛诊断标准解读:诊断与鉴别诊断中的问题与认识

背景:颈源性头痛患病率在1.0％–4.1％,是一种常见的头痛类型,国际上多个权威组织发布了颈源性头痛诊断标准,但由于颈源性头痛与其他头痛类型存在重叠症状,这些诊断标准难以完全发挥鉴别效力.目的:解读相关诊断标准内容,梳理发展脉络,阐释颈源性头痛诊断与鉴别诊断中面临的困境与挑战,为进一步临床和科研工作提供线索.方法:以...     

痛性疤痕治疗的探讨

软组织创伤的修复过程修复组织常形成疤痕。疤痕产生过多时常引起疼痛，治疗方面亦常不尽人意。作者在门诊工作中对痛性疤痕病例行局部注射强的松龙，获得比较满意的效果，可供临床参考。     

鼻内镜下中鼻甲修整治疗泡状中鼻甲致鼻源性头痛

目的：探讨泡状中鼻甲引发头痛的诊断与手术治疗。方法对29例经鼻内试验及鼻窦CT检查明确为泡状中鼻甲者行鼻内镜下中鼻甲修整术。结果头痛症状完全消失,随访6个月无复发视为痊愈。头痛明显减轻6月以上视为显著疗效,24例痊愈,5例显著疗效。结论治疗的要点是矫正鼻腔局部解剖变异,解除鼻粘膜相抵触的状态,使鼻腔接触性头痛的病因得以解除。     

孤立性蝶窦病变致鼻源性头痛39例临床分析

目的:研究孤立性蝶窦病变所致鼻源性头痛的诊断要点和鼻内镜手术治疗方法.方法:对39例孤立性蝶窦病变所致鼻源性头痛患者进行鼻窦冠状位簿层 CT或 MRI检查及鼻内镜检查明确诊断,采用全麻鼻内窥镜下经鼻腔蝶窦开放手术治疗,术中开放蝶窦口,清除蝶窦内病变组织,使其通畅引流.结果:手术均顺利,39例患者随访1a,症状完全缓解者36例,明显改善者3例,有效率100%.结论:对孤立性蝶窦病变所致的鼻源性头痛的患者,早期 CT或 MRI检查是减少误诊误治的关键,术后定期随访复查是预防复发的关键.     

鼻内镜下重建鼻内结构治疗鼻源性头痛

目的探讨鼻内镜下重建鼻内结构治疗鼻源性头痛的疗效。方法对82例鼻源性头痛患者采用鼻内镜下鼻内结构重建治疗,比较治疗前和治疗后6个月的VAS评分,统计有效率。结果 82例患者治愈69例(84.1%),显效8例(9.8%),无效5例(6.1%),总有效率为93.9%;黏膜接触性头痛组治疗前VAS评分大于鼻窦性头痛组(P0.05),治疗后2组患者VAS评分均低于治疗前(P0.05),但治疗后2组之间VAS评分比较差异无统计学意义(P0.05)。结论鼻内镜手术解除了鼻腔和鼻窦的挤压以重建鼻腔正常的解剖结构,恢复了鼻腔和鼻窦正常的功能,对鼻源性头痛有良好的治疗效果。     

发作后头痛及头痛性发作1例报告

一个多世纪以前已发现头痛和癫(癎)关系密切,为高度共病[1].2004头痛国际分类第二版(ICHD-Ⅱ)中将癫(癎)合并头痛分为前驱性发作前头痛、发作前头痛、发作后头痛及发作间头痛.发作后头痛的诊断标准:①紧张性头痛;②病人曾有全面或部分性发作;③头痛在发作后3h内出现;④头痛在72 h内消失[2].但头痛为癫(癎)发作的唯一症状者罕见,称之为发作性癫(癎)性头痛(ictal epileptic headache)[3].     

Clinical efficacy of radiofrequency cervical zygapophyseal neurotomy in patients with chronic cervicogenic headache

The purpose of the present study was to assess the clinical efficacy of radiofrequency (RF) cervical zygapophyseal joint neurotomy in patients with cervicogenic headache. A total of thirty consecutive patients suffering from chronic cervicogenic headaches for longer than 6 months and showing a pain relief by greater than 50% from diagnostic/prognostic blocks were included in the study. These patients were treated with RF neurotomy of the cervical zygapophyseal joints and were subsequently assessed at 1 week, 1 month, 6 months, and at 12 months following the treatment. The results of this study showed that RF neurotomy of the cervical zygapophyseal joints significantly reduced the headache severity in 22 patients (73.3%) at 12 months after the treatment. In conclusion, RF cervical zygapophyseal joint neurotomy has shown to provide substantial pain relief in patients with chronic cervicogenic headache when carefully selected.     

Comparison of generalized and localized hyperalgesia in patients with recurrent headache and fibromyalgia

OBJECTIVES: Research suggests that dysregulated pain modulation may play an important role in recurrent headaches and fibromyalgia syndrome (FMS). The primary objective of this study was to investigate algesic responses in localized cervical and pericranial regions (ie, headache-specific areas) and distal locations (ie, trochanter and gluteal) in patients with primary headaches (tension-type and migraine). The headache patients' algesic responses were compared with those of a sample of patients with musculoskeletal pain who report generalized hyperalgesia, or FMS. METHODS: Seventy patients with mixed headache diagnoses and 66 patients with FMS underwent a standardized examination of generalized hyperalgesia based on American College of Rheumatology criteria. RESULTS: Twenty-eight of the 70 headache patients reported the presence of widespread TP pain, suggesting generalized hyperalgesia. Headache diagnosis was unrelated to the presence or absence of generalized hyperalgesia. The subset of headache patients with generalized hyperalgesia did not differ from the FMS patients in pain sensitivity in the cervical and pericranial areas. Regression analyses revealed that pressure pain sensitivity was significantly related to self-reported pain only in the headache patients with generalized hyperalgesia. CONCLUSIONS: These results suggest that extensive dysregulation in pain modulation is important for a substantial minority of recurrent headache patients, who seem to be quite similar to FMS patients. Differential treatment planning targeting generalized hyperalgesia may be useful in treating headache patients exhibiting generalized hyperalgesia more effectively.     

Composition of cervical smears in patients with and without a cervical ectropion.

AIMS--To test the hypothesis that absence of squamous cells in cervical smears obtained by an endocervical sampling technique is more prominent in patients with a cervical ectropion. METHODS--Prospective study exploring the relation between the composition of cervical smears obtained using an endocervical cotton swab in patients with (n = 188) and without (n = 341) a cervical ectropion. Subjects were 529 consecutive patients from whom a cervical smear was prepared at a university gynaecological clinic. RESULTS--In 7% of the endocervical samples no squamous cells were found. There was no correlation, however, between the presence or the size of an ectropion and the absence of squamous cells in those samples. CONCLUSIONS--It was confirmed that endocervical sampling alone is insufficient to obtain good quality cervical smears. The presence of an ectropion proved to be an unreliable predictor of the absence of squamous cells.     

Evaluation of Helicobacter pylori infection in patients with common migraine headache

Introduction

Migraine can cause headache in different communities so that 12-15% are suffering worldwide. Recently the relationship between infectious diseases such as Helicobacter pylori infection and migraine headache has been the focus of many studies. The current study was designed to evaluate IgG and IgM antibodies to H. pylori in patients suffering from migraine headaches.

Material and methods

Patients who had diagnostic criteria for migraine were chosen as cases compared to some healthy individuals as the control group amongst which immunoglobulin G (IgG), immunoglobulin M (IgM), age, job, gastro-intestinal (GI) disorders, history of migraine, special meals, medications, sleeping disorders, stress, environmental factors etc were analysed.

Results

The prevalence of disease was 38.6%. Household women had the highest prevalence (40%). Among them menstruation was related to high prevalence of migraine. 75.6% of patients had gastrointestinal disorders of which the gastric reflux was the most important sign (47.1%). The mean optical density (OD) value of IgG and IgM antibody to H. pylori was 60.08 ±7.7 and 32.1 ±8.7 for the case group, 21.82 ±6.2 and 17.6 ±9.4 for the control group, respectively.

Conclusions

There was a significant difference in mean OD value of both antibodies to H. pylori amongst the case and control groups. As a result, active H. pylori infection is strongly related to the outbreak and severity of migraine headaches, and H. pylori treatment reduces migraine headaches significantly. Hopefully, the definite treatment and eradication of this infection can cure or reduce the severity and course of migraine headaches significantly if not totally.     

发作性头痛者动态脑电图监测的价值

目的：探讨发作性头痛者２４ ｈ 动态脑电图（ＡＥＥＧ） 监测的价值。方法：对１２０ 例发作性头痛患者进行２４ ｈ ＡＥＥＧ 监测,分析发作期和间期脑电活动特点,并与常规ＥＥＧ 作自身对照。结果：ＡＥＥＧ 非特异性异常５４ 例（４５ ％ ） ,捕捉到癎样放电１１ 例（９－２ ％ ） ,ＥＥＧ 非特异性异常３１ 例（２５－８ ％ ） ,捕捉到癎样放电仅４ 例（３－３ ％ ） ,ＡＥＥＧ 异常率（５４－２ ％ ） 明显高于ＥＥＧ（２９－２ ％ ） 。ＡＥＥＧ 癎样放电多见于觉醒期和发作期。结论：发作性头痛患者确有一小部分属于头痛型癫癎,２４ ｈ 脑电监测对其鉴别诊断有重要意义。     

Tension headache in emergency department patients

The authors report the results of a retrospective study of the charts of 181 emergency department patients with a complaint of tension headache. Although more than half the patients appeared to be suffering from anxiety and/or depression, only 14 were seen by a psychiatrist. Anxiety was reported considerably more often than depression. Additional psychiatric training of emergency room staff and active involvement of consultation-liaison psychiatrists are suggested as means of obtaining early psychiatric intervention for headache patients with associated psychiatric problems.     

Clinical follow-up: treatment and outcome of functional headache patients treated with biofeedback.

Sixteen diagnosed functional headache patients treated with biofeedback techniques of frontalis EMG feedback and/or peripheral temperature feedback, with an average headache history of 18.2 years, were evaluated at an average interval of 37 weeks posttreatment. On the average, patients showed further improvement in their headache status as measured by average daily headache pain scores in contrast with termination values. Data were obtained via structured interviews conducted by an individual not involved in patient's treatment. Patients on the average showed declines in frontalis EMG during the follow-up sessions, but not increases in temperature as had been expected. The unclear role played by increasing peripheral temperature in follow-up of migraine patients is discussed.     

The prevalence of complementary and alternative medicine use among Turkish patients with primary headache

Background/aim The use of complementary and alternative medicine (CAM) is common in patients with primary headache. However, no study has been reported in which standardized modalities were questioned in a Turkish population. The aim of the present study was to investigate the frequency of CAM use and factors related to it in these patients. Materials and methods Patients with a diagnosis of primary headache were included in this cross-sectional observational study. Demographic and disease specific characteristics were recorded. The use and effect of 15 CAM modalities were evaluated in accordance with the Traditional and Complementary Medicine Regulations. The patients were categorized into two groups according to their use of CAM procedures. Logistic regression analysis was further performed to assess the association between CAM use and related factors.Results One hundred twenty patients [101 (84.2%) female, mean age 38.20 ± 12.24 years] were included. Use of CAM was reported in 33.3% of the patients. The most frequently used CAM modalities were phytotherapy (37.5%), cupping (27.5%), and chiropractic adjustment (17.5%). Compared with nonusers, CAM users showed a longer duration of disease (respectively mean 5.68 ± 4.96 years and 10.97 ± 8.57 years, p = 0.000). There were no differences with respect to age, sex, education, presence of systemic disease, headache subtypes, number of headache days in a month, or headache severity. Patients who underwent cupping reported that they benefited more than those who tried phytotherapy and multiple CAM methods (respectively 45.5%, 33.3%, 16.6%, p = 0.039). Subsequently, the logistic regression analysis showed a significant association between only disease duration and CAM use [respectively p value, OR (95% CI), and confidence intervals = 0.002 (1.143 (1.050–1.243)]. Conclusion Our results suggest that Turkish patients with primary headache, especially those with long disease duration, use CAM modalities. Larger population-based studies are required to clarify the safety and efficacy of these methods.