Polymorphism in apolipoprotein E among migraineurs and tension-type headache subjects

Nitric oxide plays an important role in the pathogenesis of migraine as well as tension-type headache. Studies suggest that the expression of molecules involved in the pathogenesis of headache, i.e., nitric oxide and interleukin, is influenced by apolipoprotein E (APOE) and is gene specific. Hence, we hypothesized that APOE polymorphism may be associated with migraine as well as tension-type headache.The study sample comprised of three groups: migraineurs, tension-type headache subjects as well as a healthy control group. A total of 50 subjects in each group were included after screening for the inclusion and exclusion criteria. None of the subjects was a blood relative of any other subject included in the present study. Their venous blood was drawn and stored at −20°C. Genomic DNA extraction was performed with a commercial kit and simple sequence-specific primer PCR was performed to assess the APOE polymorphism. Data were analyzed with the help of SPSS V11.0 for Windows. χ² test and logistic regression analysis were run. The results of the study showed that APOE ε2 gene increases the risk of migraine as compared to the control group and the tension-type headache group (OR = 4.85; 95% CI = 1.92–12.72; P < 0.001 and OR = 2.31; 95% CI = 1.08–4.94; P = 0.01, respectively). Interestingly, APOE ε4 gene was protective against migraine as well as tension-type headache. This study shows that APOE ε2 gene increases the risk of migraine, while APOE ε4 gene is protective against migraine and tension-type headache. Further research is required to confirm the findings of the present study in a larger sample and to elucidate the role of APOE polymorphism in headache.     

The prevalence of headache may be related with the latitude: a possible role of Vitamin D insufficiency?

According to recent observations, there is worldwide vitamin D insufficiency (VDI) in various populations. A number of observations suggest a link between low serum levels of vitamin D and higher incidence of chronic pain. A few case reports have shown a beneficial effect of vitamin D therapy in patients with headache disorders. Serum vitamin D level shows a strong correlation with the latitude. Here, we review the literature to delineate a relation of prevalence rate of headaches with the latitude. We noted a significant relation between the prevalence of both tension-type headache and migraine with the latitude. There was a tendency for headache prevalence to increase with increasing latitude. The relation was more obvious for the lifetime prevalence for both migraine and tension-type headache. One year prevalence for migraine was also higher at higher latitude. There were limited studies on the seasonal variation of headache disorders. However, available data indicate increased frequency of headache attacks in autumn–winter and least attacks in summer. This profile of headache matches with the seasonal variations of serum vitamin D levels. The presence of vitamin D receptor, 1α-hydroxylase and vitamin D-binding protein in the hypothalamus further suggest a role of vitamin D deficiency in the generation of head pain.     

紧张型头痛患者事件相关诱发电位的特点

目的 通过测定紧张型头痛患者早期认知功能障碍的指标听觉事件相关诱发电位,探讨对紧张型头痛进行评价的有效方法.方法 选择32例紧张型头痛患者,同时选取30名健康人作为正常对照组,均自愿参加观察.采用肌电诱发电位仪检测以上两组观察对象的听觉事件相关诱发电位,记录波型中潜伏期和波幅,紧张型头痛组患者均行头颅MR检查,除外颅内病变,分析以上指标与听觉事件相关诱发电位潜伏期和波幅的相关性.结果 紧张型头痛组听觉事件相关电位N1、P2、N2、P300的潜伏期与对照组比较有延长,但差异无统计学意义,P300波幅与对照组相比较明显减弱（P＜0.01）.结论 P300听觉事件相关诱发电位可能有助于对紧张型头痛患者的临床评价.     

The burden of headache in China: validation of diagnostic questionnaire for a population-based survey

The objective of this study was to test the validity, in the Chinese population, of the Lifting The Burden diagnostic questionnaire for the purpose of a population-based survey of the burden of headache in China. From all regions of China, a population-based sample of 417 respondents had completed the structured questionnaire in a door-to-door survey conducted by neurologists from local hospitals calling unannounced. They were contacted for re-interview by telephone by headache specialists who were unaware of the questionnaire diagnoses. A screening question ascertained whether headache had occurred in the last year. If they had, the specialists applied their expertise and ICHD-II diagnostic criteria to make independent diagnoses which, as the gold standard, were later compared with the questionnaire diagnoses. There were 18 refusals; 399 interviews were conducted in 202 women and 197 men aged 18-65 years (mean age 44.4±12.6 years). In comparison to the specialists' diagnoses, the sensitivity, specificity, positive predictive value, negative predictive value and Cohen's kappa (95% CI) of the questionnaire for the diagnosis of migraine were 0.83, 0.99, 0.83, 0.99 and 0.82 (0.71-0.93), respectively; for the diagnosis of tension-type headache (TTH), they were 0.51, 0.99, 0.86, 0.92 and 0.59 (0.46-0.72), respectively. In conclusion, the questionnaire was accurate and reliable in diagnosing migraine (agreement level excellent), less so, but adequate, for TTH (sensitivity relatively low, false negative rate relatively high and agreement level fair to good). The non-specific features of TTH do not lend themselves well to diagnosis by questionnaire.     

柔筋方对紧张型头痛大鼠张颌反射的影响及机制研究

目的探索柔筋方对紧张型头痛大鼠张颌反射的影响及作用机制。方法采用颈部双侧半棘肌局部注射三磷酸腺苷二钠注射液（ATP）制造紧张型头痛的动物实验模型。体重（254±28）g的SPF级Wistar大鼠40只,分为假手术组、模型组、柔筋方组和一氧化氮合成酶（NOS）抑制剂组,通过张颌反射定量分析紧张型头痛模型大鼠头区皮肤肌肉筋膜疼痛阈值及敏感性的变化。结果柔筋方组和NOS抑制剂组潜伏期延长（P〈0.05或P〈0.01）,模型组疼痛阈值降低（P〈0.01）,柔筋方组和NOS抑制剂组疼痛阈值有下降趋势,但差异无统计学意义（P〉0.05）。结论柔筋方可显著延长潜伏期,并减低疼痛阈值,降低头颈部肌筋膜敏感性,疗效机制与降低一氧化氮浓度有关。     

试论精神分裂症紧张型及其治疗

文章就其家对精神分裂症紧张型独到的病因病机认识、临床表现与辨证做了论述;同时,还提出了其家临床治疗的经验方药与针灸疗法。文章指出,紧张型病久,其致病因子痰多继生瘀,痰瘀互结,致病情增重,愈加难治;且使原典型的紧张型症状变得模糊混乱。文末,就紧张型之防复问题,笔者提出了其家之认识与巩固治疗方法。     

The ''dry-needle technique'': intramuscular stimulation in tension-type headache

The 'dry-needle technique', an intramuscular stimulation technique carried out by using a fine solid, 1-inch long, 30-gauge needle, was investigated in the treatment of tension-type headache (TTH) in a randomized, placebo-controlled trial. Fifteen patients with TTH received intramuscular needle insertions into six designated trigger points, while 15 controls received subcutaneous insertions. Headache indices, muscle tenderness and neck ROMs were evaluated before and after treatment. Mean headache indices improved significantly after treatment, both in the treatment group and in the placebo group, but the difference between the two groups was insignificant. In the treatment group the tenderness score and the neck ROM limitation score were significantly improved after treatment, while there was no significant improvement in the placebo group. We conclude that more and larger controlled, comparative trials are needed to show whether the dry-needle technique is an effective non-pharmacological alternative for the treatment of TTH.     

帕罗西汀和多虑平联合氯唑沙宗治疗伴有焦虑抑郁情绪的紧张型头痛的临床对照研究

目的比较帕罗西汀和多虑平联合氯唑沙宗治疗伴有焦虑抑郁情绪的紧张型头痛的临床疗效及安全性。方法选择在我科门诊治疗伴有焦虑抑郁情绪的紧张型头痛患者56例为研究对象,采用随机数字表法分为帕罗西汀组和多虑平组,每组28例,帕罗西汀组在常规服用氯唑沙宗的基础上加服帕罗西汀治疗,多虑平组加服多虑平治疗,另外回顾以往常规应用氯唑沙宗治疗的伴有焦虑抑郁情绪的紧张型头痛患者30例的临床资料,并作为对照组。分别对治疗12周后三组患者头痛、焦虑抑郁情绪改善情况及药物不良反应发生情况进行评价,并进行对比分析。结果所有患者均顺利完成12周的治疗,治疗后帕罗西汀组显效率和总有效率均明显高于对照组,差异均有统计学意义(P<0.05或P<0.01);帕罗西汀组患者总有效率略高于多虑平组,但差异无统计学意义(P>0.05),而帕罗西汀组显效率明显高于多虑平组,差异有统计学意义(P<0.05);多虑平组显效率与对照组相当,总有效率高于对照组,但差异无统计学意义(P>0.05)。帕罗西汀组和多虑平组患者HAMA评分和HAMD评分均较治疗前明显改善(P<0.01),且改善程度明显优于对照组(P<0.05);与多虑平组相比,帕罗西汀组HAMA和HAMD评分改善更为明显,差异均有统计学意义(P<0.05)。帕罗西汀组和对照组不良反应发生率和不良反应严重程度评分均明显低于多虑平组(P<0.05或P<0.01);而帕罗西汀组和对照组间差异无统计学意义(P>0.05)。结论帕罗西汀联合氯唑沙宗治疗伴有焦虑抑郁的紧张型头痛的临床疗效满意,不良反应少,且较轻微,值得临床推广应用。     

Risk factors for migraine and tension-type headache in 11?year old children

Background

Though migraine and tension type headache are both commonly diagnosed in childhood, little is known about their determinants when diagnosed prior to puberty onset. Our aim was to determine psychosocial- and health-related risk factors of migraine and tension-type headache in 11 year old children.

Methods

871 New Zealand European children were enrolled in a longitudinal study at birth and data were collected at birth, 1, 3.5, 7, and 11 years of age. Primary headache was determined at age 11 years based on the International Headache Society. Perinatal factors assessed were small for gestational age status, sex, maternal smoking during pregnancy, maternal perceived stress, and maternal school leaving age. Childhood factors assessed were sleep duration, percent body fat, television watching, parent and self-reported total problem behaviour, being bullied, and depression.

Results

Prevalence of migraine and tension-type headache was 10.5% and 18.6%, respectively. Both migraine and TTH were significantly associated with self-reported problem behaviour in univariable logistic regression analyses. Additionally, migraine was associated with reduced sleep duration, and both sleep and behaviour problems remained significant after multivariable analyses. TTH was also significantly associated with antenatal maternal smoking, higher body fat, and being bullied. For TTH, problem behaviour measured at ages 3.5 and 11 years both remained significant after multivariable analysis. Being born small for gestational age was not associated with either headache group.

Conclusions

Although they share some commonality, migraine and tension-type headache are separate entities in childhood with different developmental characteristics. The association between primary headache and problem behaviour requires further investigation.