紧张型头痛飞行人员认知功能的改变

目的 探讨紧张型头痛(TTH)飞行人员认知功能的改变. 方法 自2006年1月至2007年12月期间因患TTH在我院住院的11名飞行人员作为TTH组,10名来院体检的飞行人员作为对照组,进行心理学仪器测试,包括:临界闪光融合频率、选择反应时、注意力集中能力、记忆能力、警戒性、听觉Oddball任务、视觉Sterberg任务及手控跟踪+听觉Oddball双任务. 结果 TTH组飞行人员的闪光融合频率显著低于CON(t=2.212,P<0.05);对红色、黄色和绿色灯光的选择性反应时均显著大于对照组(t=2.681、2.999、2.409,P<0.05);注意力集中能力测试的注意力集中时间显著低于对照组(t=3.718,P<0.01);而出错次数显著高于对照组(t=4.533,P<0.01).TTH飞行人员的听觉Oddball反应时、视觉Sterberg反应时均显著长于对照组(t=2.221、2.172,P<0.05).结论 紧张型头痛飞行人员的部分认知功能下降.     

Association between primary headaches and temporomandibular disorders: A systematic review and meta-analysis

BackgroundThe primary objective of this systematic review was to answer the following question systematically: Is there any association between primary headaches (PHs) and temporomandibular disorders (TMDs) in adults?Types of Studies ReviewedThe protocol was registered with the International Prospective Register of Systematic Reviews. The authors performed the search in 6 main databases and 3 gray literature sources. The included articles had to have adult samples. PHs must have been diagnosed using the International Classification of Headache Disorders, and TMDs must have been diagnosed using Research Diagnostic Criteria for Temporomandibular Disorders, Diagnostic Criteria for Temporomandibular Disorders, or International Classification of Orofacial Pain. Risk of bias was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tools. The meta-analysis was performed using Review Manager software, Version 5.4. Certainty of evidence was screened according to Grading of Recommendations Assessment, Development and Evaluation.ResultsNine of 2,574 articles reviewed met the inclusion criteria for qualitative analysis and, of these, 7 met the inclusion criteria for quantitative analysis. Odds ratios (ORs) for painful TMD and tension-type headache (OR, 1.94 [95% CI, 0.56 to 6.76] to OR, 7.61 [95% CI, 1.84 to 31.48]), migraines (OR, 4.14 [95% CI, 1.38 to 12.43] to OR, 5.44 [95% CI, 3.61 to 8.21]), and chronic headaches (OR, 40.40 [95% CI, 8.67 to 188.15] to OR, 95.93 [95% CI, 12.53 to 734.27]) were calculated. Articular TMDs without pain were evaluated in 2 articles, and both did not show positive association with tension-type headache nor migraine. Three studies were classified as moderate risk of bias and 6 as low risk of bias. The certainty of evidence varied between very low and low.Conclusions and Practical ImplicationsRecognizing the positive association between painful TMD and PHs can help dentists and physicians treat the pain and avoid it, or recommend the patient to a specialist.     

中医药治疗紧张型头痛

紧张型头痛为临床常见病、多发病,严重危害人类身心健康。中医药在治疗紧张型头痛方面有其独特的优势,在近年来的相关文献基础上,作者对紧张型头痛从辨证施治;古方及自拟方施治;针灸推拿等方面进行了综述。     

Trigger factors of migraine and tension-type headache: experience and knowledge of the patients

The objective was to examine potential trigger factors of migraine and tension-type headache (TTH) in clinic patients and in subjects from the population and to compare the patients’ personal experience with their theoretical knowledge. A cross-sectional study was carried out in a headache centre. There were 120 subjects comprising 66 patients with migraine and 22 with TTH from a headache outpatient clinic and 32 persons with headache (migraine or TTH) from the population. A semistructured interview covering biographic data, lifestyle, medical history, headache characteristics and 25 potential trigger factors differentiating between the patients’ personal experience and their theoretical knowledge was used. The most common trigger factors experienced by the patients were weather (82.5%), stress (66.7%), menstruation (51.4%) and relaxation after stress (50%). The vast majority of triggers occurred occasionally and not consistently. The patients experienced 8.9±4.3 trigger factors (range 0–20) and they knew 13.2±6.0 (range 1–27). The number of experienced triggers was smallest in the population group (p=0.002), whereas the number of triggers known did not differ in the three study groups. Comparing theoretical knowledge with personal experience showed the largest differences for oral contraceptives (65.0 vs. 14.7%, p<0.001), chocolate (61.7 vs. 14.3%, p>0.001) and cheese (52.5 vs. 8.4%, p<0.001). In conclusion, almost all trigger factors are experienced occasionally and not consistently by the majority of patients. Subjects from the population experience trigger factors less often than clinic patients. The difference between theoretical knowledge and personal experience is largest for oral contraceptives, chocolate and cheese.     

Interaction between anxiety, depression, quality of life and clinical parameters in chronic tension-type headache

Our aim was to investigate the mediating or moderating role of anxiety and depression in the relationship between headache clinical parameters and quality of life in Chronic Tension-Type Headache (CTTH). Twenty-five patients diagnosed with CTTH according to the criteria of the International Headache Society were studied. A headache diary was kept for 4 weeks in order to substantiate the diagnosis and record the pain history. Quality of life was assessed by means of the Medical Outcome Study (MOS) 36-Item Short-Form (SF-36) questionnaire. The Beck Depression Inventory (BDI-II) was used to assess depression, and the Trait Anxiety Scale (TA) from the State-Trait Anxiety Inventory was administered in order to assess anxiety. Moderating and mediating analyses were conducted with ordinary least squares multiple regression analysis using the SPSS General Linear Model procedure. Anxiety mediated the effect between headache frequency and quality of life, but not the effect of either headache intensity or duration. Anxiety totally mediated the effects of headache frequency on vitality, social functioning and mental health. On the other hand, depression modulated the effect in the mental health domain. The effect in the mental health domain was a function of the interaction between headache duration and depression (β = −0.34, p < 0.05), after controlling for age, gender, the main effects of headache duration, and depression. We did not find anxiety to be a moderating factor between intensity, frequency or duration of headache and perceived quality of life. Anxiety exerts a mediating effect, conditioning the relationship between headache frequency and some quality of life domains; depression seems to play an inherent role in the reduced quality of life of these patients, that is, it has a moderating effect.     

Treatment of migraine and tension-type headache in Croatia

The aim of this study was to assess the treatment patterns of migraine and tension-type headache in the Croatian population. Analysis included the proportion of patients who were taking specific antimigraine therapy and the number of tablets per attack per month, the proportion of patients who were taking prophylactic therapy or using alternative treatment methods and their satisfaction with the treatment. The design of the study was a cross-sectional survey. Self-completed questionnaires were randomly distributed to adults >18 years of age in the Croatian population. A total of 616 questionnaires were analyzed: 115 patients with migraine (M), 327 patients with tension-type headache (TTH), and 174 patients with probable migraine (PM) and TTH. Specific antimigraine therapy was taken by half of patients with migraine: 35.7% of patients used triptans and 21.7% ergotamines. Prophylactic treatment had been used by 13.9% of M, 1.2% of TTH, and 6.9% of PM patients. Alternative methods of treatment were tried by 27% of M and TTH patients. Only 16.8% of patients with M pay regular visits to physicians, while 36.3% never visited a physician. More than half of TTH patients have never visited a physician. The majority of patients are only partially satisfied with their current treatment, and almost one-third are not satisfied. Results of this study indicate that the treatment of primary headaches in Croatia should be improved.     

The efficacy of goshuyuto,a typical Kampo (Japanese herbal medicine) formula,in preventing episodes of headache

ABSTRACT

Objective: The purpose of this clinical trial was to assess the efficacy of goshuyuto, a typical Kampo formula, in preventing episodes of headache in chronic headache patients.

Research design and methods: Because the treatment target of a Kampo formula is decided on a basis different to that of Western medicine, we first selected patients belonging to a subgroup that responded to goshuyuto before conducting the usual randomized controlled trial. During stage 1, the subjects were instructed to orally consume goshuyuto for 4 weeks. Only those subjects judged as responders advanced to stage 2, during which a double-blind, randomized, placebo-controlled study was conducted. The subjects consumed the same dose of goshuyuto or placebo for 12 weeks.

Results: Of the 91 subjects enrolled in stage 1, 60 were judged as responders. Of these, 53 advanced to stage 2; 28 were assigned to the goshuyuto group and 25 to the placebo group. The decrease in the number of days on which headache episodes occurred was greater in the goshuyuto group than in the placebo group (2.6 ± 3.7 vs. 0.3 ± 4.0 days, p = 0.034); no difference was observed with regard to the reduction in the frequency of consuming reliever medications (2.2 ± 4.0 vs. 1.4 ± 8.2, p = 0.672). Improvement in the associated symptoms was observed in more than 50% of the subjects in the goshuyuto group.

Conclusion: Goshuyuto is useful in preventing episodes of headache in chronic headache patients. Responder-limited design is a candidate for evaluating Kampo medicine.     

紧张型头痛患者的生活事件、心身症状及其相关关系

目的探讨紧张型头痛(TTH)住院患者的生活事件、心身症状及其相关关系。方法将35例诊断为TTH的住院军人作为患者组,以35名正常军人作为对照组,分别用生活事件量表及症状自评量表(SCL—90)对他们的生活事件及心身症状进行评定,并对二者进行相关分析。结果TTH患者所经历的正性生活事件分值低于对照组(P<0.01)、而负性生活事件分值高于对照组(P<0.01),两组间生活事件总值无差异(P>0.05)。TTH患者SCL—90的躯体化、人际敏感、抑郁、焦虑、恐怖、偏执及精神病性因子分均高于对照组(P<0.05),强迫、敌对因子分与对照组无差别(P>0.05)。SCL-90总分及阳性项目数与正性生活事件之间呈负相关关系(P<0.01),与负性生活事件之间呈正相关关系(P<0.01),与生活事件总值之间无明显相关关系(P>0.05)。结论TTH住院军人经历了较多的不良生活事件,也出现较多的心身症状,这些心身症状与生活事件之间有相关关系