Urodynamic characteristics might be variable in bladder pain syndrome/interstitial cystitis patients with different non-bladder co-morbid conditions

Background

The aim of the study was to identify the impact of non-bladder co-morbid conditions on the urodynamic characteristics of patients with bladder pain syndrome/interstitial cystitis.

基于中医传承辅助平台系统紧张型头痛的组方用药规律分析

目的：基于中医传承辅助平台系统软件,分析中国期刊全文数据库（CNKI）中以中医药治疗紧张型头痛的组方用药规律。方法：筛选Cnki上中医药治疗紧张性头痛的文献并建立方剂数据库,方剂逐一录入中医传承辅助平台,采用软件集成的数据挖掘方法,对筛选出的方剂进行组方规律分析。结果：筛选出治疗紧张型头痛的方剂140首,涉及中药170味。确定了处方中药物出现的频次,常用药对及组合,演化得到新处方12首。结论：中国期刊全文数据库中收录治疗紧张型头痛的方剂以理气活血、平肝潜阳、疏肝解郁、祛风解肌止痛、燥湿化痰、补血益气为主,为中医药临床靶向治疗紧张型头痛提供依据。     

Prevalence of primary headaches in Germany: results of the German Headache Consortium Study

We investigated the prevalence of migraine (MIG), tension-type headache (TTH), and chronic headache in a population-based sample in Germany. A total of 18,000 subjects aged between 18 and 65 years were screened from 2003 until 2005 using a validated questionnaire. Overall 9,944 participants (55.2%) responded (mean age 43 ± 13.1 years, 52.7% women). Headache frequency <15 days/month was reported by 5,350 (55.5%) subjects of whom 1,601 (16.6%, [95% confidence interval (95% CI): 15.9–17.4]) reported episodic MIG, 1,202 (12.5%, 95% CI 11.8–13.1) episodic TTH, and 1,150 (11.9%, [11.3–12.6]) episodic MIG + episodic TTH, 1,396 (14.5%, [13.8–15.2]) unclassifiable headache. In women, episodic MIG peaked between 36 and 40 years, episodic MIG + TTH between 18 and 35 years and episodic TTH between 56 and 66 years. In men, episodic MIG was predominant between 36 and 45 years, episodic MIG + TTH between 26 and 35 years and episodic TTH showed comparable frequency between 36 and 66 years. Headache ≥15 days/month was reported by 2.6% (n = 255, [95% CI 2.3–3]). Chronic MIG was reported by 1.1% (n = 108, [0.91–1.33]), chronic TTH (n = 50, [95% CI 0.4–0.7]), chronic MIG + TTH 0.8% (n = 74, 95% CI 0.6–0.9) and unclassifiable headache 0.2% (n = 23, [95% CI 0.1–0.3]). Chronic headache was more frequent in women compared to men with the highest prevalence between 46 and 65 years. It is of note that the number of subjects with chronic headache is small in all age groups. The results of our large, population-based study provide reliable, age- and sex-specific estimates of the prevalence of primary headache disorders in Germany. The prevalence with respect to episodic and chronic primary headache disorders in Germany is comparable to other European countries and the USA.     

One-year prevalence and the impact of migraine and tension-type headache in Turkey: a nationwide home-based study in adults

Several studies have shown that the prevalence of migraine and tension-type headache (TTH) varied between different geographical regions. Therefore, there is a need of a nationwide prevalence study for headache in our country, located between Asia and Europe. This nationwide study was designed to estimate the 1-year prevalence of migraine and TTH and analyse the clinical features, the impact as well as the demographic and socio-economic characteristics of the participant households in Turkey. We planned to investigate 6,000 representative households in 21 cities of Turkey; and a total of 5,323 households (response rate of 89%) aged between 18 and 65 years were examined for headache by 33 trained physicians at home on the basis of the diagnostic criteria of the second edition of the International Classification of Headache Disorders (ICHD-II). The electronically registered questionnaire was based on the headache features, the associated symptoms, demographic and socio-economic situation and history. Of 5,323 participants (48.8% women; mean age 35.9 ± 12 years) 44.6% reported recurrent headaches during the last 1 year and 871 were diagnosed with migraine at a prevalence rate of 16.4% (8.5% in men and 24.6% in women), whereas only 270 were diagnosed with TTH at a prevalence rate of 5.1% (5.7% in men and 4.5% in women). The 1-year prevalence of probable migraine was 12.4% and probable TTH was 9.5% additionally. The rate of migraine with aura among migraineurs was 21.5%. The prevalence of migraine was highest among 35–40-year-old women while there were no differences in age groups among men and in TTH overall. More than 2/3 of migraineurs had ever consulted a physician whereas only 1/3 of patients with TTH had ever consulted a physician. For women, the migraine prevalence was higher among the ones with a lower income, while among men, it did not show any change by income. Migraine prevalence was lower in those with a lower educational status compared to those with a high educational status. Chronic daily headache was present in 3.3% and the prevalence of medication overuse headache was 2.1% in our population. There was an important impact of migraine with a monthly frequency of 5.9 ± 6, and an attack duration of 35.1 ± 72 h, but only 4.9% were on prophylactic treatment. The one-year prevalence of migraine estimated as 16.4% was similar or even higher than world-wide reported migraine prevalence figures and identical to a previous nation-wide study conducted in 1998, whereas the TTH prevalence was much lower using the same methodology with the ICHD-II criteria.     

Interactions between migraine and tension-type headache and alcohol drinking, alcohol flushing, and hangover in Japanese

The aim of the study was to investigate associations between headache types and alcohol drinking, alcohol flushing, and hangover. Alcohol consumption is inhibited by the presence of inactive aldehyde dehydrogenase-2 (ALDH2) whose carriers are susceptible to alcohol flushing and hangovers. We conducted a cross-sectional study of the 2,577 subjects (men/women: 1,018/1,559) who reported having ever experienced headaches unrelated to common colds and alcohol hangovers among 5,408 (2,778/2,630) Tokyo health checkup examinees. We used a questionnaire inquiring about current and past facial flushing after drinking a glass of beer which identifies the presence of inactive ALDH2 with a sensitivity and specificity of approximately 90%. Based on ICHD-II criteria migraine was diagnosed in 419 (75/344) subjects, and tension-type headache (TTH) in 613 (249/364). We classified the headaches of the remaining 1,545 (694/851) of headaches sufferers into the category “other headaches (OH)”. The migraineurs drank alcohol less frequently than the subjects with TTH among current/past alcohol flushers and than the subjects with OH regardless of flushing category. No such difference in drinking frequency was observed between TTH and OH. Current/past flushers drank alcohol less frequently than never flushers, and the likelihood that male migraineurs would avoid alcohol drinking than men with TTH or OH was stronger among current/past flushers than among never flushers. Flushers and women were more susceptible to hangover than never flushers and men, respectively, regardless of headache type. Among never flushers, women with migraine were more susceptible to hangover than women with OH. The difference in alcohol sensitivity may partly explain less alcohol consumption by migraineurs.     

Nitric oxide: emerging implications for headache mechanics

The involvement of nitric oxide (NO) in the pathophysiology of primary headaches was suggested by several authors during the last decade. Migraine, cluster headache, tension headache, and cervicogenic headache have been extensively studied on the basis of NO donor headache pain. Different mechanisms seem to be involved in the generation of pain in these clearly different clinical head pain disorders. NO could control all the mechanisms leading to head pain. In migraine NO is correlated with endothelial activation, in cluster headache with a brainstem unravelling of the on/off regulatory clocks, in cervicogenic headache with a cytokine-dependent pain, and in tension-type headache with a sensitization of pain pathways at the spinal/trigeminal level. The next natural frontier in the study of pain in primary headaches seems to be the functional study of the relationship between NO and the immune regulatory system. Received: 30 Devember 2000 / Accepted in revised form: 9 April 2001     

针刺风府穴对紧张型头痛大鼠张颌反射的影响

目的：探索针刺风府穴对紧张型头痛大鼠张颌反射波幅和潜伏期的影响。方法采用大鼠双侧半棘肌注射三磷酸腺苷二钠注射液（ATP）的方法制备紧张型头痛大鼠模型。体重220~260 g的SPF级Wistar大鼠40只,雌雄各半,分为空白组、模型组、风府穴组和假穴组四组,通过定量分析紧张型头痛模型大鼠张颌反射波幅及潜伏期,反映头颈部皮肤肌肉筋膜痛阈及敏感性变化。结果空白组半棘肌注射生理盐水不引起张颌反射波幅及潜伏期变化（P〉0.05）;模型组半棘肌注射ATP导致张颌反射波幅下降（P〈0.05）,潜伏期见缩短趋势,但差异无统计学意义（P〉0.05）;针刺风府穴可见风府穴组JOR波幅升高（P〈0.05）,潜伏期延长（P〈0.05）;针刺假穴见张颌反射波幅升高（P〈0.05）,潜伏期延长,但差异无统计学意义（P〉0.05）。与模型组相比,风府穴组波幅明显升高（P〈0.01）,假穴组差异无统计学意义（P〉0.05）;风府穴组波幅较假穴组升高明显（P〈0.01）。与模型组相比,风府穴组潜伏期明显延长（P〈0.01）,假穴组差异无统计学意义（P〉0.05）;风府穴组潜伏期与假穴组相比差异无统计学意义（P〉0.05）。结论针刺风府穴可提高张颌反射波幅,延长潜伏期,即提高痛阈,降低头颈部肌筋膜敏感性。     

失眠与紧张性头痛及其诱因间关系的研究进展

紧张性头痛是最普遍的神经系统疾病。传统的紧张性头痛的诱因包括焦虑、抑郁、5-羟色胺（5-HT）、疼痛等，失眠是近年来才被确认的紧张性头痛的诱因。越来越多的流行病学调查显示，失眠和紧张性头痛存在关联。本文旨在对失眠与紧张性头痛及其诱因之间关系的研究进展进行综述，以提高基层医生对失眠和紧张性头痛的认识，为紧张性头痛高危人群的预防及治疗提供参考。     

La chirurgia decompressiva neurovascolare della rino-base cranica nelle cefalee primarie con trigger rinogeno

Sommario I risultati terapeutici di guarigioni o miglioramenti sostanziali ottenuti su 2124 casi di cefalee primarie (emicrania con aura, emicrania senza aura, cefalea a grappolo, emicrania cronica parossistica, cefalee di tipo tensivo) con la chirurgia funzionale morfocorrettiva e decompressiva neurovascolare della rino-base cranica (Bonaccorsi, Novak, Blondiau, Bisschop, Hoover, Clerico) impongono ormai una revisione del classico capitolo delle “cefalee rinogene”. Vi devono infatti essere comprese tutte quelle cefalee “apparentemente primarie” che invece hanno un'etiopatogenesi centro-periferica per una documentata (TC) ridotta volumetria delle “camere etmoidosfenoidali sottocribrose” ai fini emoangiocinetici della circolazione anastomotica endo-esocranica di questo distretto. Circolazione che costituisce “un'unità funzionale” per la continuità dei circuiti vascolari e trigemino-vegetativi rino-oftalmo-encefalici (Hannerz, Hardebo, Moskowitz). Tali anomalie morfologiche delle strutture osteo-vasculo-mucose della rino-base cranica acquistano significato fisiopatologico di “trigger neuroangioematochimico” solo nei pazienti con “bassa soglia dolorifica ed elevata capacità integrativa centrale” modulata e temporizzata dai bioritmi neurogeni. Viene descritta la chirurgia della rino-base cranica mediante l'intervento di “setto-etmoidosfenectomia decompressiva neurovascolare”, sia conservativo che radicale sino al III grado monolaterale con deafferentazione trigemino-vegetativa selettiva che permette di salvare l'olfatto e di risolvere anche il dolore controlaterale decomprimendo il circolo ed eliminando la stasi anche dal lato opposto. Inoltre, viene sottolineato che la sintomatologia neurologica deficitaria od irritativa centrale (aura visiva, paresi sensitivo-motoria, epilessia) scompare dopo l'eliminazione chirurgica del “trigger rinogeno periferico”. Ciò evidenzia un nesso di causa-effetto che è l'interdipendenza funzionale centro-periferica, se pur inserita nel terreno costituzionale biochimico, neuroendocrino, neuro-trasmettitoriale emicranico controllato dai bioritmi vegetativi, disnocicettivi e psichici. I risultati chirurgici sono dell'88% di guarigioni o sostanziali miglioramenti con un follow up annuale dal 1964 al 1994 su un campione di 1000 pazienti su un totale di pazienti operati di 2124.