捣刺法与提插法针刺治疗慢性紧张型头痛的疗效比较

目的比较捣刺法与提插法针刺治疗慢性紧张型头痛的临床疗效差异。方法将56例慢性紧张型头痛患者随机分为治疗组和对照组,每组28例。治疗组头部穴位采用捣刺法针刺,对照组头部穴位采用提插法针刺。观察两组治疗前后头痛强度评分、头痛指数变化,并比较两组临床疗效。结果两组治疗后头痛强度评分、头痛指数显著降低(P<0.05),治疗组下降幅度大于对照组(P<0.05);治疗组愈显率为78.6%(22/28),优于对照组的50.0%(14/28)(P<0.05)。结论捣刺法能明显减轻患者的头痛程度,缩短头痛持续时间,改善头痛症状,疗效优于提插法。     

紧张型头痛患者中医心理紊乱状态与中医证候的相关性研究

目的探讨中医心理紊乱状态与紧张型头痛（TTH）中医证侯的相关性。方法临床观察236例紧张型头痛伴中医心理紊乱状态患者,采用结构式问卷收集资料,建立数据库,探讨TTH中医心理紊乱状态与中医证候的相关性。结果存在思虑过度状态的患者,中医证候以风痰候和风瘀候为主;存在郁闷不舒状态的患者,中医证候以风痰候和风瘀候为主;存在烦躁焦虑状态的患者,中医证候以风火候为主;存在郁闷不舒＋思虑过度的患者,中医证候以风痰候和风瘀候为主;存在郁闷不舒＋烦躁焦虑的患者,中医证候以风痰候、风火候、风瘀候为主;存在精神萎靡状态的患者,中医证候以气血两虚候和阳虚寒凝候为主;存在惊悸不安状态的患者,中医证候以气血两虚候为主。结论紧张型头痛患者伴中医心理紊乱状态与中医证候之间存在相关性。     

Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache

The tricyclic anti-depressant amitriptyline is widely used in the treatment of chronic tension-type headache. The aim of the present study was to investigate whether the analgesic effect is caused by a reduction of muscle pain or by a general reduction of pain sensitivity. Thirty-three non-depressed patients with chronic tension-type headache were treated with amitriptyline 75 mg/day and with the highly selective serotonin reuptake inhibitor citalopram 20 mg/day in a 32-week, double-blind, placebo-controlled, three-way crossover study. At the end of each treatment period, actual headache intensity and pericranial myofascial tenderness were recorded, pressure pain detection and tolerance thresholds were measured in the finger and in the temporal region and the electrical pain threshold was measured at the labial commissure. Amitriptyline reduced tenderness and headache intensity significantly more than placebo (P=0.01 and P=0.04, respectively). The reduction in tenderness could be ascribed solely to the group of patients who responded to amitriptyline treatment by at least 30% reduction in headache while tenderness was unchanged in non-responders. Amitriptyline did not affect pressure or electrical pain thresholds at any of the examined locations. Citalopram had no significant effect on any of the examined parameters. These findings indicate that amitriptyline elicits its analgesic effect in chronic myofascial pain by reducing the transmission of painful stimuli from myofascial tissues rather than by reducing overall pain sensitivity. We suggest that this effect is caused by a segmental reduction of central sensitization in combination with a peripheral anti-nociceptive action.     

Headache-related work disability in young men

Based on the knowledge that migraine and tension-type headache (TTH) are associated with reduced effectiveness at work and impairment of function in social roles, we studied the different influences that these primary headaches have on work in a specialized and homogeneous population. We studied 140 consecutive male patients, aged 18–35 years, attending an outpatient headache clinic at the Neurology Department of an Army General Hospital. Using International Headache Society (IHS) criteria, 60 patients were diagnosed with migraine and 80 patients with TTH. The impact of headache on work during the preceding 2 months was assessed using a selfadministered questionnaire, based on MIDAS. Two parameters of work disability were derived: the lost work days (LWD) and the days with reduced effectiveness while being at work (REWD). Of 142 LWD due to headaches, 95 (66.9%) were attributable to migraine and 47 (33.1%) to TTH (plt;0.001). Of 490 REWD, 120 (24.4%) were reported by migraineurs and 370 (75.5%) by TTH patients (p<0.001). The number of LWD in migraine was significantly higher (p<0.001) than in TTH group; the number of REWD in TTH group was significantly higher (p<0.001) than in migraine group. Pain intensity was the main factor contributing to disability at work in migraine group (plt;0.001), in contrast with TTH group in which there was no statistical difference (p>0.05) between pain intensity and duration of pain. Patients with migraine were much more likely to report actual lost workdays because of headache whereas TTH was responsible for the largest proportion of decreased work effectiveness. Assessing headache severity with an objective method (i.e. questionnaire) may improve headache care and lead to proper treatment decisions. Special attention must be given to particular populations. Received: 14 January 2002, Accepted in revised form: 22 April 2002 Correspondence to I. Heliopoulos     

Predictors of treatment outcome in headache patients with the Millon Clinical Multiaxial Inventory III (MCMI-III)

The objective was to discover possible psychological factors influencing treatment outcome for headache patients referred to psychological treatment in a tertiary headache centre by initial assessment using the Millon Clinical Multiaxial Inventory III (MCMI-III). The MCMI-III was administered to 136 referred patients. Patients with valid protocols who had completed their treatment by October 2003 were included. Multidisciplinary treatment was offered including psychological treatment, mainly pain and stress management, pharmacological treatment and physiotherapy. Medians of MCMI-III scales for patients with and without reduction in headache frequency were compared. All of the eligible 58 patients were included in the study. Patients with reduction in headache frequency after treatment had lower scores on the MCMI-III Somatoform, Major depression and Avoidant personality pattern scales and higher scores on the Alcohol Dependence, Self-Defeating personality pattern, Depressive personality pattern, Drug Dependence, Aggressive personality pattern and Bipolar: Manic scales before treatment compared to patients without effect. Patients with a positive treatment effect reported less symptoms of depression and seemed less inclined to somatisation than non-responders. Responders also appeared more likely to experience increased social or occupational distress and report difficulties with handling emotions and an enduring tendency to focus on negative aspects of the self-image. The results can give valuable information regarding treatment planning and development.     

The burden of headache disorders in India: methodology and questionnaire validation for a community-based survey in Karnataka State

Primary headache disorders are a major public-health problem globally and, possibly more so, in low- and middle-income countries. No methodologically sound studies of prevalence and burden of headache in the adult Indian population have been published previously. The present study was a door-to-door cold-calling survey in urban and rural areas in and around Bangalore, Karnataka State. From 2,714 households contacted, 2,514 biologically unrelated individuals were eligible for the survey and 2,329 (92.9 %) participated (1,103 [48 %] rural; 1,226 [52 %] urban; 1,141 [49 %] male; 1,188 [51 %] female; mean age 38.0 years). The focus was on primary headache (migraine and tension-type headache [TTH]) and medication-overuse headache. A structured questionnaire administered by trained lay interviewers was the instrument both for diagnosis (algorithmically determined from responses) and burden estimation. The screening question enquired into headache in the last year. The validation study compared questionnaire-based diagnoses with those obtained soon after through personal interview by a neurologist in a random sub-sample of participants (n = 381; 16 %). It showed high values (>80 %) for sensitivity, specificity and predictive values for any headache, and for specificity and negative predictive value for migraine and TTH. Kappa values for diagnostic agreement were good for any headache (0.69 [95 % CI 0.61–0.76]), moderate (0.46 [0.35–0.56]) for migraine and fair (0.39 [0.29–0.49]) for TTH.The survey methodology, including identification of and access to participants, proved feasible. The questionnaire proved effective in the survey population. The study will give reliable estimates of the prevalence and burden of headache, and of migraine and TTH specifically, in urban and rural Karnataka.     

Memantine for prophylaxis of chronic tension-type headache—a double-blind, randomized, crossover clinical trial

Treatment for chronic tension-type headache (CTTH) is unsatisfactory. Our aim was to investigate the efficacy of the N-methyl D-aspartate (NMDA) antagonist memantine in the prophylactic treatment of CTTH. We included 40 patients in a randomized, double-blind, placebo-controlled, crossover trial. Memantine 20–40 mg/day or placebo was each given for 10 weeks separated by a 2-week wash-out period; 29 patients completed the study. The primary efficacy variable, area-under-the-headache curve (duration × intensity), did not differ between memantine (1352 ± 927) and placebo (1449 ± 976; P  = 0.10). Headache intensity in both sexes was significantly lower on a 0–10 verbal rating scale with memantine (3.8) than with placebo (4.1; P  = 0.03). In women, area-under-the-headache curve was significantly lower with memantine (1343 ± 919) than with placebo (1555 ± 1019; P  = 0.01). The most common side-effects were dizziness and nausea. In conclusion, although no statistically significant effect was seen in the primary end-point, some beneficial effects of memantine were observed in women. Memantine was shown to reduce pain intensity in CTTH patients, albeit to a limited extent. Future NMDA antagonists with higher efficacy could be of major interest as regards the pathophysiology and future treatment of CTTH and other chronic pain disorders.     

A comparative analysis of personality profile and muscle tenderness between chronic migraine and chronic tension-type headache

Abstract This study was aimed at comparing the personality profile, the psychiatric comorbidity (depression and anxiety) and the tenderness of the pericranial and cervical muscles in women with chronic migraine (CM) and chronic tension-type headache (CTTH). Forty-one CM and 34 CTTH women were enrolled. A clinical evaluation (according to SCID-I) and a psychometric assessment (MMPI-2, STAI-1 and STAI-2) were performed. After palpation, a Pericranial muscle Tenderness Score (PTS) and a Cervical Muscle Tenderness Score (CTS) were calculated. No significant difference was detected in MMPI-2, STAI-1, STAI-2, PTS and CTS scores between the two groups. Anxiety and depression were present in 80% of CM and in 63% of CTTH women. We did not find any significant difference either in the personality profile or in the muscle tenderness between CM and CTTH patients. This similarity points to a role of these factors, in association with psychiatric comorbidity, in the chronicisation of headache.     

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。