Clinical presentation of cerebral aneurysms

Presentation of a cerebral aneurysm can be incidental, discovered at imaging obtained for unrelated causes, can occur in the occasion of imaging obtained for symptoms possibly or likely related to the presence of an unruptured aneurysm, or can occur with signs and symptoms at the time of aneurismal rupture.     

头痛粉所致药物滥用性头痛1例

在中国头痛粉是最便宜的止痛药,尤其针对偏头痛,效果甚好。但是,由于头痛粉的滥用,常常导致药物滥用性头痛,头痛粉的剂量逐渐增加,药物治疗效果差。本研究举例分析头痛粉所致药物滥用性头痛的个案,同时总结药物滥用性头痛的定义、流行病学、产生药物滥用性头痛的危险因素以及药物滥用性头痛的治疗。     

Whites and African-Americans in headache specialty clinics respond equally well to treatment

This study sought to determine if Whites and African-Americans respond similarly to headache treatment administered in 'real-world' headache specialty treatment clinics. Using a naturalistic, longitudinal design, 284 patients receiving treatment for headache disorders completed 30-day daily diaries that assessed headache frequency and severity at pretreatment and 6-month follow-up and also provided data on their headache disability and quality of life at pretreatment and 1-, 2- and 6-month follow-up. Controlling for socioeconomic status and psychiatric comorbidity, hierarchical linear models found that African-Americans and Whites reported significant reductions in headache frequency and disability and improvements in life quality over the 6-month treatment period. African-Americans, unlike Whites, also reported significant decreases in headache severity. Nevertheless, Africans-Americans had significantly more frequent and disabling headaches and lower quality of life after treatment relative to Whites. Although Whites and African Americans responded favourably to headache treatments, more efficacious treatments are needed given the elevated level of headache frequency that remained in both racial groups following treatment.     

Opiate-induced persistent pronociceptive trigeminal neural adaptations: potential relevance to opiate-induced medication overuse headache

Medication overuse headache (MOH) is a challenging, debilitating disorder that develops from the frequent use of medications taken for the treatment of migraine headache pain. MOH affects an estimated 3–5% of the general population. The mechanisms underlying the development of MOH remain unknown. Opiates are one of the major classes of medications used for the treatment of migraine at least in some countries, including the USA. Although the effects of repeated opiate use for headache are unknown, it is possible that opiate use may contribute to increased frequency and occurrence of such headaches. Recent preclinical studies exploring the neuroadaptive changes following sustained exposure to morphine may give some insights into possible causes of MOH. Peripherally, these changes include increased expression of calcitonin gene-related peptide (CGRP) in trigeminal primary afferent neurons. Centrally, they include increased excitatory neurotransmission at the level of the dorsal horn and nucleus caudalis. Critically, these neuroadaptive changes persist for long periods of time and the evoked release of CGRP is enhanced following morphine pretreatment. Stimuli known to elicit migraine, such as nitric oxide donors or stress, produce hyperalgesia in morphine- but not in saline-pretreated rats even long after the discontinuation of the opiate. CGRP plays a prominent role in initiating vasodilation of the intracranial blood vessels and subsequent headache. Furthermore, studies have demonstrated increased excitability of the nociceptive pathway in migraine sufferers, and CGRP receptor antagonists have been shown to be efficacious in migraine pain. Thus, such persistent neuroadaptive changes may be relevant to the processes that promote MOH.     

孤立性蝶窦病变31例临床分析

目的探讨孤立性蝶窦病变的诊断与治疗,以提高其诊治水平。方法回顾分析孤立性蝶窦病变患者31例的临床资料。结果31例患者临床症状无特征性,以头痛和眼部症状多见。一次性确诊5例,其他被误诊、漏诊。全部病例经CT或MRI确诊,并经鼻内镜手术及病理检查证实。全部病例行鼻内镜下蝶窦开放术,症状完全缓解26例,改善4例,无效1例。全部病例随访1年以上,4例分别于术后3、4、6及7个月症状复发,经鼻内镜下清理后缓解。超过一年以上者无复发病例。结论孤立性蝶窦病变易被漏诊、误诊,CT或MRI是确诊的标准。早诊断,早治疗非常重要,鼻内窥镜手术是首选安全、有效的治疗方法。     

河车路颈针治疗椎-基底动脉供血不足患者84例疗效观察

目的观察河车路颈针疗法治疗椎-基底动脉供血不足的临床疗效。方法选择128例椎-基底动脉供血不足患者,随机分为两组,治疗组84例,对照组44例。治疗组接受河车路颈针疗法治疗,对照组接受传统针刺治疗。观察治疗前后临床症状及经颅多普勒超声检测基底动脉、左椎动脉、右椎动脉平均血流速度的变化情况。结果治疗两个疗程后,治疗组不仅在改善头痛、眩晕等临床症状方面,而且在提高椎-基底动脉平均血流速度方面优于对照组。结论河车路颈针对椎-基底动脉供血不足具有肯定的疗效。     

TREATING 100 CASES OF HEADACHE BY MAINLY NEEDLING FENGCHI AND TAICHONG

This article introduces the writers' experience in treating 100 cases of headache bymainly needling Fengchi (GB 20) and Taichong (LR 3). It is considered in TCM that headache ismostly caused by pathogenic wind, and there is a saying of "no wind, no headache". The combinationof the two points can expel both endogenous and exogenous wind. So we treat headache mainly withneedling Fengchi and Taichong. The result is good, especially for cluster headache and psychicheadache.'     

Efficacy of the non-peptide CGRP receptor antagonist BIBN4096BS in blocking CGRP-induced dilations in human and bovine cerebral arteries: potential implications in acute migraine treatment

Calcitonin gene-related peptide (CGRP) is a potent vasodilator in brain vessels and it has been implicated in the pathogenesis of migraine headache. Blocking post-junctional CGRP receptors, mediators of trigeminal-induced vasodilation, has been suggested as a potential antimigraine strategy. In this study, we tested the ability of a new non-peptide CGRP receptor antagonist, BIBN4096BS, to inhibit the CGRP-induced dilation in human and/or bovine brain vessels and compared it to that of the antagonist alpha-CGRP(8-37). BIBN4096BS and alpha-CGRP(8-37) both blocked the alpha-CGRP-induced dilation in bovine middle artery segments with respective potency (pK(B) values) of 6.3 and 7.8. In human pial vessels, BIBN4096BS was particularly potent. When tested at 10(-14)-10(-9) M concentrations, it induced a rightward shift in the alpha-CGRP concentration-response curve and yielded a biphasic Schild plot suggesting interaction with more than one receptor population, as was also indicated by the significant best fit of the alpha-CGRP-induced dilation in human brain vessels with a two receptor site interaction. Schild plot analysis in the linear portion of the BIBN4096BS inhibition curve revealed interaction with one high affinity site (pA(2) value approximately 14). In bovine vessels, both alpha-CGRP(8-37) and BIBN4096BS concentration-dependently reversed a pre-established CGRP-induced dilation ( approximately 59 and 85%, respectively), BIBN4096BS being approximately tenfold more potent than alpha-CGRP(8-37) (respective pIC(50) values of 7.5 and 6.75). In human middle cerebral and middle meningeal arteries, BIBN4096BS reversed the alpha-CGRP-induced dilation (> or =70%) by interaction with two different receptor populations: it exhibited a high affinity for one population (pIC(50) value approximately 13) and a lower affinity for the other (pIC(50) value approximately 8). The present data demonstrate that BIBN4096BS is a very potent antagonist that could, depending on its bioavailability and in vivo affinity, be of potential benefit in the acute treatment of migraine headache by blocking and/or reversing the CGRP-mediated dilation of intracranial vessels induced by activation of trigeminovascular afferents.     

自行足反射法治疗功能性头痛疗效观察

目的观察自行足部按摩防治功能性头痛的效果。方法选择功能性头痛患者56例，进行调查、施教、督导、评价。结果头痛好转率为96．30％，头昏缓解率44．12％，颈儇缓解率62．50％，恶心、呕吐缓解率61．54％，失眠缓解率53．85％，视觉症状缓解率90．91％。结论自行足部按摩防治功能性头痛有一定的效果。     

Observation of therapeutic effect of cervicogenic headache treated by acupuncture plus Tuina therapy

目的：观察电针配合推拿治疗颈源性头痛的疗效。方法；将200例颈源性头痛患者随机分为电针配合推拿组（针推组，n=100）、电针组（n=50）和推拿组（n=50），分别应用电针颈部夹脊穴、风池穴、阿是穴、患侧率谷、翳风、头维和外关穴和推拿治疗。结果：针推组有效率为100％；电针组总有效率为90．oH；推拿组总有效率为88．0％，差异有显著性意义（P〈0．05）。结论：电针结合推拿是治疗颈源性头痛的有效方法。