偏头痛患者外周血一氧化氮、血管内皮素含量的变化

目的 观察偏头痛患者外周血一氧化氮(NO)、血管内皮素1(ET-1)含量的变化,探讨其在偏头痛发病机制中的作用.方法 分别测定40例偏头痛患者发作期、间歇期颈静脉血NO和ET-1含量,并以38例健康体检者作为对照.结果 偏头痛患者NO和ET-1在发作期的含量分别为(138.96±19.23)μmol/L、(136.13±8.05)ng/L,间歇期为(110.38±22.20)Umol/L,(108.23±9.25)ng/L;对照组NO和ET-1分别为(105.36±24.21)Umol/L,(93.52±8.89)ng/L.结论 偏头痛患者颈静脉血NO、ET-1在发作期、间歇期含量明显不同,这种变化可能是偏头痛发作的一种因素.     

无先兆偏头痛患者血浆及血小板5-HT、5-HIAA含量的变化

目的　了解 5 -羟色胺 (5 - HT)、5 -羟吲哚乙酸 (5 - HIAA)在无先兆偏头痛发病中的作用。方法　用荧光分光光度法检测 2 0例无先兆偏头痛患者 (病例组 )和 2 3名正常人 (对照组 )血浆及血小板 5 - HT、5 - HI-AA的含量。结果　病例组发作期血浆 5 - HT含量低于对照组 (P<0 .0 5 ) ,而 5 - HIAA高于对照组 (P<0 .0 5 ) ;间歇期血浆 5 - HT高于发作期 (P<0 .0 5 ) ,而 5 - HIAA含量低于发作期 (P<0 .0 5 )。发作期血小板 5 - HT含量显著高于间歇期和对照组 (P<0 .0 1) ,而 5 - HIAA含量显著低于间歇期和对照组 (P<0 .0 1)。病例组 (含发作期和间歇期 )血小板 5 - HT含量高于对照组 (P<0 .0 5 ) ,而 5 - HIAA含量显著低于对照组 (P<0 .0 5 )。结论　无先兆偏头痛患者不同时期其血浆和血小板 5 - HT、5 - HIAA含量发生不同变化     

P物质与偏头痛及其天容穴治疗的关系

研究了21例无先兆型偏头痛(MWO)患者血浆P物质(SP)的变化,发现MWO发作期血浆SP含量显著高于对照组(P<0.01),而经天容穴治疗后,有效者血浆SP含量下降至正常范围(P<0.01)。提示SP参与了MWO的发病过程。天容穴治疗通过调节SP系统达到镇痛效果。与应用解热镇痛剂比较,天容穴治疗见效迅速,近、远期疗效均好(P<0.01),不失为治疗偏头痛的良好方法。     

不同类型偏头痛局部脑血流量变化的研究

目的检测有先兆及无先兆的偏头痛脑局部血流量(rCBF)的变化。方法研究对象共分4组:分别为无先兆的偏头痛组40例(M组)、有先兆的偏头痛25例(MA组)、肌紧张型头痛25型(TH组)以及对照组(C组)40名,用133Xe吸入法测定三组头痛及正常对照组的脑局部血流量。结果无先兆偏头痛组(M)平均脑局部血流量(71.04±12.01)ml/100 g脑组织/分,而有先兆偏头痛MA组平均脑局部血流量(55.27±10.13)ml/100 g脑组织/分,肌紧张头痛(TH)组平均脑局部血流量(60.82±7.64)ml/100 g脑组织/分,正常对照(C)组平均脑局部区域血流(59.96±7.63)ml/100 g脑组织/分,经统计学处理,F=12.01,P<0.001,M组平均rCBF明显高于正常对照组及肌紧张头痛组,而MA组的rCBF明显低于常对照组及肌紧张头痛组。TH组rCBF与正常对照组相比无明显差异(P>0.05)。结论无先兆偏头痛组平均脑局部血流量呈弥漫性高血流量状态,而有先兆偏头痛组明显低于正常对照组(P<0.001),尤以后枕部血流量降低更为明显。肌紧张头痛组rCBF与正常对照组相比无明显差异(P>0.05)。     

Alzheimer病病人血清与脑脊液白细胞介素-1及肿瘤坏死因子水平检测的研究

目的　为探讨炎性细胞因子 (CK)在Alzheimer病 (AD)慢性炎性病理过程中的作用。方法　本研究采用ELISA法对AD病人 (1 1例 )、血管性痴呆 (VD)病人 (1 3例 )与正常对照 (1 3名 )的血清与脑脊液 (CSF)、白细胞介素 1 β(IL 1 β)和肿瘤坏死因子 (TNF α)的水平进行了测定。 结果　与VD(38 51± 1 4 39)pg/ml、正常对照 (33 98± 1 6 31 )pg/ml相比 ,AD病人血清IL 1 β水平 (60 1 3± 1 7 81 )pg/ml明显升高 ,P <0 0 1。AD病人血清TNF α水平 (81 2 0± 2 3 99)pg/ml虽较VD(71 77± 2 8 86)pg/ml和正常对照 (73 91± 1 7 69)pg/ml轻度升高 ,但并无统计学意义。AD病人CSFIL 1 β水平 (38 2 5±1 8 42 )pg/ml明显高于对照组 (2 0 2 5± 1 5 86 )pg/ml和VD病人 (32 1 8± 1 9 81 )pg/ml,P <0 0 5。AD病人CSFTNF α水平 (1 4 2 58± 1 1 46)pg/ml也明显高于VD病人 (1 1 5 46± 1 9 52 )pg/ml,P <0 0 5 )和对照组 (1 0 6 2 3± 2 6 1 3)pg/ml,P <0 0 1。结论　上述结果表明 ,炎性细胞因子IL 1 β和TNF α在AD的神经变性过程起着重要的作用 ,炎症可参与AD的发病机制。开发针对AD细胞因子网络的特异性治疗有着相当意义     

通心络胶囊对急性脑梗死患者血浆内皮素水平的影响及其疗效观察

目的观察通心络胶囊对急性脑梗死(AC I)患者的血浆内皮素(ET)含量的影响及其疗效。方法将60例发病72 h内的AC I患者,随机分为治疗组及对照组(各30例)。对照组给予脑复康、阿司匹林等基础治疗;治疗组在此基础上加用通心络胶囊,4粒1日3次,连续治疗30 d。在治疗前和治疗第30 d进行欧洲卒中评分(ESS)及日常生活能力量表(ADL)评分,同时检测血浆ET-1含量,以治疗第30 d的ESS和ADL评分增分率判断疗效。结果治疗第30 d治疗组和对照组血浆ET-1含量较治疗前分别降低(40.3±20.5)pg/m l及(31.5±14.7)pg/m l,差异有显著性(P<0.01);治疗组和对照组ADL增分率分别为(51.9±20.7)%、(35.9±25.8)%,差异有显著性(P<0.05);而两组ESS增分率比较差异无显著性(P>0.05)。治疗前两组AC I患者血浆ET-1含量与其ESS和ADL评分均呈极显著性负相关(r=-0.437、r=-0.449,均P<0.001)。治疗组有2例空腹服通心络胶囊后出现胃部不适,改饭后服用即消失。结论通心络胶囊治疗AC I有效,不良反应少;并能明显降低AC I患者血浆ET含量。     

天容穴治疗偏头痛前后脑动脉血流速度和脑电地形图对称性变化的研究

目的 :探讨天容穴治疗无先兆偏头痛 (MWO)的神经生理机制。方法 :36例 MWO病人发作期和天容穴注射 12 .5 mg强地松龙后 30分钟 ,观察脑动脉平均血流速度 (MFV)和脑电地形图 (BEAM)对称性的变化。结果 :MFV下降占 5 2 .77%(19/36 ) ,增加占 2 5 %(9/36 ) ,不对称改变占 6 9.44 %(2 5 /36 )。不对称的脑血流速度天容穴治疗 30分钟后转化为正常 (P<0 .0 1) ,但不能影响脑电地形图的不对称性。平均血流速度和脑电地形图的不对称性没有一致对应关系 (P>0 .0 5 )。结论 :天容穴治疗 MWO可以双相调节脑动脉血流速度和脑功能。     

偏头痛患者β-内啡肽含量测定及其意义的探讨

本文用放射免疫分析法测定了42例偏头痛患者和18例年龄相应的健康对照者血浆β-内啡肽(β-EP)含量变化。测定于发作期16例,间歇期16例,发作期后仍有慢性头痛者(CDH)10例。结果表明:发作期血浆β-EP含量下降明显(P<0.01),间歇期和CDH组下降不明显(P>0.05)。探讨了β-EP与偏头痛发作的关系。     

偏头痛患者发作期血浆中过氧化物酶体增殖物激活受体β/δ水平的研究

目的观察偏头痛患者血浆中过氧化物酶体增殖物激活受体(peroxisome proliferator-activated receptorβ/δ,PPARβ/δ)水平,探究其与偏头痛的关系及临床意义。方法收集偏头痛发作期患者共59例作为病例组,再根据患者有无先兆症状分成有先兆组和无先兆组两个亚组,同时选取27例健康者作为对照组。采用酶联免疫法(ELISA)检测受试者血浆PPARβ/δ水平,采用SPSS系统软件进行统计分析。结果偏头痛患者血浆中PPARβ/δ水平明显高于健康对照者,差异有统计学意义(P<0.01);有先兆和无先兆偏头痛患者发作期血浆中PPARβ/δ水平比较无明显差异(P>0.05)。结论 PARβ/δ可能参与了偏头痛的发病过程;与有无先兆无关。     

偏头痛的血镁水平变化观察

偏头痛的病因及发病机理十分复杂,近年来研究发现体内镁水平降低在偏头痛的发病中起重要作用。本文根据1962年美国NIH Ad Hoc委员会制定的头痛分类标准,收集偏头痛24例,其中典型偏头痛7例,普通偏头痛17例;男性10例,女性14例;年龄11～51岁(平均32.1岁);病史为1～12年;有家族史者9例。和年龄配比的健康成人男性8例,女性9例为对照组。应用Spectru-Spom-V三极直流等离子体原子发射光电直读光谱仪(DCP-AES)检测病人和对照组血清镁浓度(mmol/L)。结果发现,偏头痛间歇期(19例)血镁浓度为1.08±0.79,发作期(24例)为0.88±0.51,均低于健康对照组1.34±0.53,P分别<0.05,0.01。     

Structural abnormalities in the thalamus of migraineurs with aura: A multiparametric study at 3 T

Background and objectives: The thalamus exerts a pivotal role in pain processing and cortical excitability control, and migraine is characterized by repeated pain attacks and abnormal cortical habituation to excitatory stimuli. This work aimed at studying the microstructure of the thalamus in migraine patients using an innovative multiparametric approach at high‐field magnetic resonance imaging (MRI). Design: We examined 37 migraineurs (22 without aura, MWoA, and 15 with aura, MWA) as well as 20 healthy controls (HC) in a 3‐T MRI equipped with a 32‐channel coil. We acquired whole‐brain T1 relaxation maps and computed magnetization transfer ratio (MTR), generalized fractional anisotropy, and T2* maps to probe microstructural and connectivity integrity and to assess iron deposition. We also correlated the obtained parametric values with the average monthly frequency of migraine attacks and disease duration. Results: T1 relaxation time was significantly shorter in the thalamus of MWA patients compared with MWoA (P < 0.001) and HC (P ≤ 0.01); in addition, MTR was higher and T2* relaxation time was shorter in MWA than in MWoA patients (P < 0.05, respectively). These data reveal broad microstructural alterations in the thalamus of MWA patients compared with MWoA and HC, suggesting increased iron deposition and myelin content/cellularity. However, MWA and MWoA patients did not show any differences in the thalamic nucleus involved in pain processing in migraine. Conclusions: There are broad microstructural alterations in the thalamus of MWA patients that may underlie abnormal cortical excitability control leading to cortical spreading depression and visual aura. Hum Brain Mapp 35:1461–1468, 2014. © 2013 Wiley Periodicals, Inc.     

Interictal levels of calcitonin gene related peptide in gingival crevicular fluid of chronic migraine patients

Calcitonin gene related peptide (CGRP) is a mediator of neurogenic inflammation playing a major role in the pathogenesis of migraine. Increases in serum CGRP have been detected previously in migraineurs and a return to baseline values regarded as successful treatment. As gingival crevicular fluid is known to originate from the serum, the aim of this study is to measure the CGRP content of gingival crevicular fluid (GCF) in chronic migraine patients and to determine whether there is a correlation between serum and GCF values of CGRP. For this study, 24 female individuals suffering from chronic migraine with aura were age-matched with 15 healthy individuals. Serum and GCF samples were obtained from both groups and enzyme linked immunosorbent assay performed to measure CGRP concentration. The level of CGRP in the serum and GCF of chronic migraine patients was 41?±?16 pg/mL and 0.25?±?0.09 pg/μg respectively while in healthy individuals CGRP levels were 29?±?8 pg/mL and 0.19?±?0.07 pg/μg. The correlation between CGRP levels of the GCF and serum was 0.88 for migraineurs and 0.81 in the controls. Only a weak positive relationship was observed between age and CGRP levels in both groups. CGRP levels were higher in migraineurs compared with controls both in serum and GCF. Furthermore there is a strong correlation between CGRP levels of the serum and GCF. The results of this study suggest that CGRP levels of GCF have potential diagnostic purposes in patients with chronic migraine.     

Glyceryl trinitrate induced headache in migraineurs - relation to attack frequency.

Glyceryl trinitrate, a prodrug of nitric oxide, induces a mild to moderate headache in healthy subjects, whilst migraineurs develop a more severe headache, resembling spontaneous migraine attacks. In order to investigate whether this increased nitric oxide sensitivity depends upon the frequency of spontaneously occurring migraine attacks, intravenous infusion of glyceryl trinitrate (0.5 microg/kg/min) was given to 15 migraine patients with rare attacks (/=12 attacks/year) and 14 healthy subjects served as controls. No significant difference between the migraine groups for any of several parameters was detected, although the trend was always towards more headaches in frequent migraineurs. Both migraineurs with frequent and rare attacks experienced a headache that was significantly more severe, longer lasting, and fulfilled the diagnostic criteria for migraine without aura more often, compared to the healthy subjects (P = 0.0001). Conclusively, supersensitivity to glyceryl trinitrate in migraineurs seems to be related to a basic - probably genetically determined - pathophysiological mechanism involving nitric oxide, and not to the environmental influences, which to a large extent determine the expression of migraine.     

Neuroexcitatory plasma amino acids are elevated in migraine

To investigate the role of glutamic (Glu) and aspartic acid (Asp) in migraine, we measured the plasma amino acids in migraine patients with and without aura, between and during attacks, and compared the profiles with the plasma amino acid profiles of tension headache patients and healthy controls. Between attacks, migraineurs (notably with aura) had substantially higher plasma Glu and Asp levels than did controls and tension headache patients. In addition, patients with migraine without aura showed low plasma histidine levels. During migraine attacks, Glu (and to a lesser extent Asp) levels were even further increased. The results suggest a defective cellular reuptake mechanism for Glu and Asp in migraineurs, and we hypothesize a similar defect at the neuronal/glial cell level, predisposing the brain of migraineurs to develop spreading depression.     

Migraineurs Without Aura Show Microstructural Abnormalities in the Cerebellum and Frontal Lobe

The involvement of the cerebellum in migraine pathophysiology is not well understood. We used a biparametric approach at high-field MRI (3 T) to assess the structural integrity of the cerebellum in 15 migraineurs with aura (MWA), 23 migraineurs without aura (MWoA), and 20 healthy controls (HC). High-resolution T1 relaxation maps were acquired together with magnetization transfer images in order to probe microstructural and myelin integrity. Clusterwise analysis was performed on T1 and magnetization transfer ratio (MTR) maps of the cerebellum of MWA, MWoA, and HC using an ANOVA and a non-parametric clusterwise permutation F test, with age and gender as covariates and correction for familywise error rate. In addition, mean MTR and T1 in frontal regions known to be highly connected to the cerebellum were computed. Clusterwise comparison among groups showed a cluster of lower MTR in the right Crus I of MWoA patients vs. HC and MWA subjects (p?=?0.04). Univariate and bivariate analysis on T1 and MTR contrasts showed that MWoA patients had longer T1 and lower MTR in the right and left pars orbitalis compared to MWA (p?<?0.01 and 0.05, respectively), but no differences were found with HC. Lower MTR and longer T1 point at a loss of macromolecules and/or micro-edema in Crus I and pars orbitalis in MWoA patients vs. HC and vs. MWA. The pathophysiological implications of these findings are discussed in light of recent literature.     

The serum level of inflammatory markers in chronic and episodic migraine: a case-control study

The exact mechanism of the migraine pathophysiology remained unclear. Although there are some reports showing low-grade inflammation in migraineurs, further studies are needed in this field. Thus, we designed a study to evaluate the serum levels of two main proinflammatory markers in migraine patients. In this case-control research, 43 migraine patients (23 chronic and 20 episodic migraineurs) and 40 age-sex-matched headache-free controls were studied. Demographic, dietary, and anthropometric data, headache characteristics, and serum C-reactive proteins (CRP) and tumor necrosis factor-alpha (TNF-α) assessments were collected. The mean ± SD age of the case and control groups were 36.98?±?9.91 and 34.84?±?9.75 years respectively. Compared to control subjects, both episodic and chronic migraineurs had significantly higher median levels of TNF-α (0.24, 0.95, and 1.90 pg/ml, respectively; P value?<?0.001). Also, we observed a positive association between the TNF-α levels and the odds of having migraine after considering gender, age, body mass index, and dietary intakes of energy, carbohydrate, protein, fat, and mono and poly unsaturated fatty acids in the multivariable regression models (OR?=?2.15; 95% CI 1.31–3.52; P value?<?0.001). However, no significant association was demonstrated between migraine and serum CRP (OR?=?2.91; 95% CI 0.87–9.78; P value?=?0.08). These findings supported that inflammatory state could be related to the pathogenesis of migraine and it can thus be suggested that this effect might be beyond migraine progression. Further detailed studies are needed to investigate the importance of these findings in the pathogenesis of migraine headache.     

Short latency trigemino-sternocleidomastoid response in patients with migraine

OBJECTIVE: To investigate the central trigeminal circuits in migraine patients. MATERIALS AND METHODS: Short latency responses can be recorded in sternocleidomastoid (SCM) muscles after stimulation of the trigeminal nerve (trigemino-cervical reflex). This brainstem reflex was investigated in 20 healthy subjects, in 20 patients suffering from migraine with aura (MWA) and in 20 patients suffering from migraine without aura (MWOA) during and between the attacks. RESULTS: The trigemino-cervical responses were bilaterally abnormal in 17 patients with MWA and 15 patients with MWOA during the headache attacks, in 11 patients with MWA and in 10 patients with MWOA during the interictal period. In the patients with normal trigemino-cervical responses during the pain-free phase the triptan was significantly more effective at relieving headache. CONCLUSIONS: Our findings further support and emphasise the role of the trigeminal system in the pathogenesis of migraine. The bilateral location of the abnormalities suggests a centrally located dysfunction. Therefore, the trigemino-cervical reflex is sensitive in disclosing a disturbed brainstem activity and may be an index of neuronal activity in the human brainstem; moreover their assessment may help as valuable prognostic tool for predicting the efficacy of triptans therapy.     

Addenbrooke’s cognitive examination test for brief cognitive assessment of adolescents suffering from migraine with aura

The aim of this study was to assess the role of the Addenbrooke’s cognitive examination test (ACE-R) in the evaluation of cognitive status in migraineurs interictally. A total of 44 adolescent patients and 44 healthy controls, matched by age and gender, have undergone ACE-R testing. Migraineurs were additionally questioned about migraine aura features and presence of higher cortical dysfunctions (HCD) during an aura. According to the questionnaire results, patients were subsequently divided into HCD and Non-HCD group. ACE-R scores of migraine patients were significantly lower than in healthy controls (93.68 ± 3.64 vs 96.91 ± 2.49; t = 4.852, p < 0.001). Also, subscores of memory and verbal fluency were significantly higher in the control population. There was no correlation of HCD occurrence with cognitive examination score, although Non-HCD subgroup achieved better score (93.13 ± 3.91 vs 94.29 ± 3.30; t = 1.053, p = 0.298). Findings have shown that migraineurs get lower ACE-R test scores, with a tendency to have a poorer outcome in more complex aura. Also, our study has revealed that the ACE-R test is an easily administered test for brief assessment of cognitive status in migraineurs. Future perspectives could be further evaluation of ACE-R test in larger sample size and the impact of migraine with aura on cognitive function in adolescents.     

Clinical characteristics of menstrually related and non-menstrual migraine

Migraine attacks increase during the perimenstrual period in approximately half of female migraineurs. There are differences in the pathogenesis and clinical features of menstrually related and non-menstrual migraine attacks. The objective of this study was to compare the characteristics of migraine in patients with menstrually related and non-menstrual migraine, and to investigate the differences between premenstrual, menstrual, and late-menstrual migraine attacks. Three-hundred and thirty-two women with migraine without aura were evaluated using questionnaires and diaries to determine the characteristics of headache, preceding and accompanying symptoms, and the relation of migraine attacks and menstruation. One-hundred and sixty-three women had menstrually related migraine without aura (49.1%). Duration of disease and duration of headache were longer (p = 0.002 and p < 0.001, respectively), and nausea, vomiting, phonophobia, and aggravation of headache with physical activity were more frequent in patients with menstrually related migraine (p = 0.005, p = 0.006, p < 0.001 and p = 0.006, respectively). Premonitory symptoms and allodynia were observed more frequently in the menstrually related migraine group (p = 0.012 and p = 0.004, respectively). Perimenstrual migraine attacks occurred premenstrually (days ?2 and ?1) in 46 patients (25.3%), menstrually (days 1 to 3) in 90 patients (49.4%), and late menstrually (days 4 to 7) in 19 patients (10.4%). Our results showed that the duration of headache was longer and accompanying symptoms were more frequent and diverse in patients with menstrually related migraine without aura, suggesting that these findings may reflect the increase in excitability or susceptibility of the brain in these patients.