盐酸乙哌立松治疗伴有颈椎异常的紧张型头痛的疗效及安全性

目的：观察盐酸乙哌立松治疗伴有颈椎异常的紧张型头痛的治疗效果及安全性。方法：采用开放性研究，患者226例，每日口服盐酸乙哌立松150mg，治疗时间为4周。在疗程开始前用药后第2周、4周分别记录头痛的强度、持续时间、频率、部位、性质和不良事件，并测定颈肌的痛阈。结果：治疗前与治疗第二周和第四周相比，盐酸乙哌立松明显减轻头痛程度和减少头痛频率，对于缓解颈肌张力和颈肌压痛明显有效。约有7％的病人在服药期间有轻度肢体无力、嗜睡、头晕及胃肠道反应等不适。结论：盐酸乙哌立松是治疗伴有颈椎异常的紧张型头痛安全有效的药物。     

中西医结合治疗慢性紧张性头痛62例

目的:观察中西医结合治疗紧张性头痛的临床疗效.方法:选择122例紧张性头痛患者,随机分为治疗组和对照组.治疗组62例,西医治疗的基础上加天麻钩藤饮、半夏白术天麻汤;对照组60例,单纯用西医治疗,观察临床疗效.结果:治疗组显效率80.6%,对照组显效率63.3%.结论:中西医结合治疗紧张性头痛效果明显优于单纯西医组.     

养血清脑颗粒治疗紧张型头痛的临床观察

目的观察养血清脑颗粒治疗紧张型头痛的疗效及安全性。方法将120例紧张型头痛患者随机分为治疗组和安慰剂组各60例。治疗组给予养血清脑颗粒治疗;对照组给予安慰剂。结果治疗组和安慰剂组头痛发作次数分别为1.21±1.38次和2.65±3.24次,P〈0.05;头痛持续时间分别为6.55±12.63h和22.72±40.88h,P〈0.01;治疗组的总有效率为93.3%,而安慰剂组为36.7%,P〈0.01;治疗组和安慰剂组的不良反应发生率分别为5.0%和3.3%,P〉0.05。结论养血清脑颗粒治疗紧张型头痛可减少头痛的发作次数、持续时间,是一种治疗紧张型头痛安全有效的药物。     

紧张型头痛与中医心理紊乱状态的相关性研究

目的 探讨紧张型头痛与中医心理紊乱状态的相关性.方法 临床观察300例紧张型头痛患者,采用结构式问卷收集资料,建立数据库.经单因素方差分析、x2检验等统计学方法,探讨紧张型头痛与中医心理紊乱状态的相关性.结果 300例紧张型头痛患者中,有236例存在不同程度的中医心理紊乱状态,占紧张型头痛患者总数的78.7％.患者以思虑过度和郁闷不舒状态所占比例较大,各占30.08％和20.76％,两者共占50.84％;其次为烦躁焦虑、郁闷不舒+思虑过度、郁闷不舒+烦躁焦虑,分别占15.26％、13.14％、11.86％;惊悸不安和精神萎靡所占比例较少,共占8.9％.经单个样本多个构成的拟和优度的x2检验,P＜ 0.05,说明紧张型头痛中医心理紊乱状态整体构成不同.不同中医心理紊乱状态下的头痛指数差异有高度统计学意义(P＜0.01).结论 紧张型头痛与中医心理紊乱状态有相关性.中医心理紊乱状态整体构成不同.     

Brain-derived neurotrophic factor in primary headaches

Brain derived neurotrophic factor (BDNF) is associated with pain modulation and central sensitization. Recently, a role of BDNF in migraine and cluster headache pathophysiology has been suspected due to its known interaction with calcitonin gene-related peptide. Bi-center prospective study was done enrolling four diagnostic groups: episodic migraine with and without aura, episodic cluster headache, frequent episodic tension-type headache, and healthy individuals. In migraineurs, venous blood samples were collected twice: outside and during migraine attacks prior to pain medication. In cluster headache patients serum samples were collected in and outside cluster bout. Analysis of BDNF was performed using enzyme-linked immunosorbent assay technique. Migraine patients revealed significantly higher BDNF serum levels during migraine attacks (n = 25) compared with headache-free intervals (n = 53, P < 0.01), patients with tension-type headache (n = 6, P < 0.05), and healthy controls (n = 22, P < 0.001). There was no significant difference between patients with migraine with aura compared with those without aura, neither during migraine attacks nor during headache-free periods. Cluster headache patients showed significantly higher BDNF concentrations inside (n = 42) and outside cluster bouts (n = 24) compared with healthy controls (P < 0.01, P < 0.05). BDNF is increased during migraine attacks, and in cluster headache, further supporting the involvement of BDNF in the pathophysiology of these primary headaches.     

Serum levels of N-acetyl-aspartate in migraine and tension-type headache

Serum levels of N-acetyl-aspartate (NAA) may be considered a useful marker of neuronal functioning. We aimed to measure serum NAA in cohorts of migraine and tension-type headache patients versus controls, performing correlations with main clinical features. A total of 147 migraine patients (including migraine without aura, with aura and chronic migraine), 65 tension-type headache (including chronic and frequent episodic tension-type headache) and 34 sex- and age-matched controls were selected. Serum was stored at −80 °C. Quantification of NAA was achieved by the standard addition approach and analysis was performed with liquid-chromatography–mass-spectrometry (LC/MS) technique. The NAA levels were significantly decreased in migraine group (0.065 ± 0.019 mol/L), compared with both tension-type headache patients (0.078 ± 0.016 mol/L) and controls (0.085 ± 0.013 mol/L). Control subjects were significantly different from migraine with and without aura and chronic migraine, who differed significantly from episodic and chronic tension-type headache. Migraine with aura patients showed lower NAA levels when compared to all the other headache subtypes, including migraine without aura and chronic migraine. In the migraine group, no significant correlation was found between NAA serum levels, and headache frequency, allodynia and interval from the last and the next attack. The low NAA in the serum may be a sign of neuronal dysfunction predisposing to migraine, probably based on reduced mitochondria function.     

小脑顶核刺激联合药物治疗紧张型头痛效果评价

目的探讨小脑顶核刺激治疗在肌紧张型头痛急性发作期治疗的效果。方法按照ICHD-II诊断标准选取87例肌紧张型头痛患者,随机分为药物治疗组、小脑顶核刺激治疗组和联合治疗组。药物治疗组：妙钠（（盐酸乙哌立松）25~50mg,tid,连服2周;阿米替林12.5~25mg,tid,连服2周;泰诺林（对乙酰氨基酚）0.65g,bid,头痛缓解3d后停服。小脑顶核刺激治疗组通过CVFT-010M脑循环治疗仪给予电刺激,每日1次,每次30min,10d为1疗程;联合治疗组在电刺激治疗的同时,根据具体情况选用药物治疗组3种药物中的1种、2种或3种,分别给予相应治疗2周。2周后根据患者头痛自评问卷和经颅多普勒（TCD）检查比较各组头痛强度下降级数、头痛指数降低程度、头痛复发系数、疼痛缓解率以及椎动脉、基底动脉血流动力学指标的变化。结果小脑顶核刺激治疗组较单纯传统药物治疗组有更高的头痛强度下降级数（1.59±0.57vs1.42±0.23,P〈0.05）;但头痛指数下降程度〔（109.91±36.73）%vs（152.58±0.02）%,P〈0.05〕和头痛缓解率（42.3%vs68.1%,P〈0.05）不如药物治疗组,头痛复发率较高〔（48.9±28.1）%vs（33.7±12.5）%,P〈0.05〕;联合治疗组显示出最高的头痛强度减轻、头痛指数下降和头痛缓解率及最低的头痛复发系数（P均〈0.01）。TCD检查结果显示,小脑顶核刺激治疗组双侧椎动脉平均流速快于药物治疗组〔（66±12）vs（54±10）cm/s,P〈0.05〕。结论小脑顶核刺激可作为肌紧张型头痛急性发作期传统药物治疗基础上的有效辅助治疗,适宜在基层神经科门诊推广。     

针刺治疗紧张型头痛随机对照观察

[目的]观察针刺治疗紧张型头痛疗效。[方法]将66例患者随机分为治疗组和对照组。治疗组34例采用针刺治疗(取穴:百会、风池、太阳、率谷、外关),对照组口服银杏叶片,1片/次,3次/d。治疗10d随访1年判定疗效。[结果]治疗组总有效率85.30%,对照组总有效率75.00%,治疗组总有效率优于对照组。[结论]针刺治疗紧张型头痛临床疗效满意。     

Overview of diagnosis and management of paediatric headache. Part II: therapeutic management

A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment. In part 1 of this article (Özge et al. in J Headache Pain, 2010), we reviewed the diagnosis of headache in children and adolescents. In the present part, we will discuss therapeutic management of primary headaches. An appropriate management requires an individually tailored strategy giving due consideration to both non-pharmacological and pharmacological measures. Non-pharmacological treatments include relaxation training, biofeedback training, cognitive-behavioural therapy, different psychotherapeutic approaches or combinations of these treatments. The data supporting the effectiveness of these therapies are less clear-cut in children than in adults, but that is also true for the data supporting medical treatment. Management of migraine and TTH should include strategies relating to daily living activities, family relationships, school, friends and leisure time activities. In the pharmacological treatment age and gender of children, headache diagnosis, comorbidities and side effects of medication must be considered. The goal of symptomatic treatment should be a quick response with return to normal activity and without relapse. The drug should be taken as early as possible and in the appropriate dosage. Supplementary measures such as rest in a quiet, darkened room is recommended. Pharmaco-prophylaxis is only indicated if lifestyle modification and non-pharmacological prophylaxis alone are not effective. Although many prophylactic medications have been tried in paediatric migraine, there are only a few medications that have been studied in controlled trials. Multidisciplinary treatment is an effective strategy for children and adolescents with improvement of multiple outcome variants including frequency and severity of headache and school days missed because of headache. As a growing problem both children and families should be informed about medication overuse and the children’s drug-taking should be checked.     

Per-capita consumption of analgesics: a nine-country survey over 20 years

There are no reliable data at present on use of analgesics in various countries. We compared per-capita consumption in nine different countries during the period 1986-2005. The per-capita consumption was calculated on the basis of the sales figures of distributors to pharmacies and direct purchases by pharmaceutical companies in a sample of 1,000 pharmacies. The countries studied were: Australia, Austria, Belgium, Canada, France, Germany, Sweden, Switzerland, and the USA. In international comparison Austria, Switzerland, and Germany showed the lowest per-capita consumption of analgesics (approx. 40-50 Standard Units (SU) per capita per year), while in Sweden and France consumption was three times as high. The correlation analysis over the various countries and time points confirmed a significant correlation between use of single analgesics and overall use of analgesics. In Germany, where an allegedly particularly high and constantly rising analgesic use has been discussed controversially (Meiner, Pharm Ind 49:1247-1251, 1987), per-capita consumption of analgesics from 1980 to 2005 remained practically unchanged at approx. 50 SU per capita per year. The prevalence of conditions inducing analgesic use shows appropriate analgesics use on an overall population level.