二十五味珊瑚丸联合西比灵对偏头痛患者血浆内皮素的影响及疗效观察

目的观察二十五味珊瑚丸联合西比灵治疗偏头痛的疗效和不良反应。方法将158例偏头痛患者随机分为两组,观察组(84例)给予二十五味珊瑚丸联合西比灵治疗,对照组(74例)单用西比灵治疗,两组疗程均为4周。对两组患者治疗前后头痛的改善情况进行疗效评定,并用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)对患者进行评分。采用放射免疫分析技术测定血浆内皮素含量。结果与单用西比灵治疗的对照组比较,二十五味珊瑚丸和西比灵联合治疗的观察组临床疗效好,总有效率高,可以更有效地减轻头痛的程度,缓解伴随的非头痛症状如焦虑、抑郁,不仅如此,联合治疗的观察组中血浆内皮素水平在治疗后下降更明显。在治疗过程中两组均未出现明显不良反应。结论二十五味珊瑚丸和西比灵联合治疗偏头痛临床疗效好,值得推广使用。     

Migraine vestibulaire : critères diagnostiques. Document consensuel de la Société Bárány et de la Société internationale des céphalées

This paper presents diagnostic criteria for vestibular migraine, jointly formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (IHS). The classification includes vestibular migraine and probable vestibular migraine. Vestibular migraine will appear in an appendix of the third edition of the International Classification of Headache Disorders (ICHD) as a first step for new entities, in accordance with the usual IHS procedures. Probable vestibular migraine may be included in a later version of the ICHD, when further evidence has been accumulated. The diagnosis of vestibular migraine is based on recurrent vestibular symptoms, a history of migraine, a temporal association between vestibular symptoms and migraine symptoms and exclusion of other causes of vestibular symptoms. Symptoms that qualify for a diagnosis of vestibular migraine include various types of vertigo as well as head motion-induced dizziness with nausea. Symptoms must be of moderate or severe intensity. Duration of acute episodes is limited to a window of between 5 minutes and 72 hours.     

犬尿氨酸代谢通路与偏头痛

色氨酸犬尿氨酸代谢通路涉及一系列酶促反应,生成多种具有生物活性的化合物,参与一些复杂的病理生理学过程.近年来的研究显示,犬尿氨酸代谢通路可能与偏头痛的发病机制和治疗有关.文章就色氨酸犬尿氨酸代谢通路与偏头痛关系的研究进展进行了综述.     

Migraine in Assiut Governorate,Egypt: epidemiology,risk factors,comorbid conditions and predictors of change from episodic to chronic migraine

Abstract

Objectives: Headache is one of the most common complaints in medicine. Epidemiological and population-based studies reported that migraine has a variable prevalence worldwide. This study was done to estimate the prevalence of migraine across various age groups in Assiut district, Egypt.

Methods: This is a door-to-door study. It included 4700 randomly selected individuals.

Results: Headache was reported in 1668 subjects (35.49%), of them, 87.65% (n = 1462) had primary headaches. Migraine prevalence was 10.51% with female-to-male ratio of 2.4:1 particularly in ages of 20–40 years. The mean age of patients was 31.46 ± 13.39 years and age at onset was 24.16 ± 12.10 years. Nearly, 63.5% had frequent attacks, 65.2% of the attacks were severe enough to stop daily activities and lasted for >1 day in 32.5% of females compared to 40.7% and 14.5% for males. Chronic or daily migraine was more in females (35.3% versus 20.7% for males). Approximately, 5.6% had chronic migraine and 1.2% had daily migraine from the start, while 24.2% had transformation from episodic to chronic migraine within 6.1 ± 4.4 years. Migraine was prevalent among those with middle educational levels and labor workers. The duration of migraine attacks was found to reduce with age but the chronic/daily migraine increased with age. Hypertension, anxiety, irritable bowel syndrome, and depression were common comorbidities with migraine.

Conclusions: We believe that the work done in this study is informative as it determined the actual prevalence of migraine across various age groups and the important predictors of change in the severity, duration, and frequency of migraine in our locality.     

Brain white matter hyperintensities in migraine: Clinical and radiological correlates

Objective

Migraine is a recognised cause of brain white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI). However radiological characteristics of those in migraine are not well defined. We sought to study the radiological characteristics and factors associated with WMH in migraine.

Methods

Migraine patients who were investigated with MRI of the brain in the outpatient clinic were studied retrospectively. Two groups were delineated based on the presence or absence of WMH in MRI scans. The clinical and demographic characteristics between the two groups were compared to delineate the associations of WMH.

Results

Forty four patients were studied, out of which 19 demonstrated WMH on MRI. Frontal lobe was involved in all subjects with WMH. Infratentorial hyperintensities were not seen in any. Subcortical and deep white matter was the commonest distribution while callosal and subcallosal lesions were very rare. Family history of migraine, increasing age, and increasing headache frequency emerged as significant associations of WMH in multivariable analysis.

Conclusions

There are characteristic radiological features and clinical associations of WMH in migraine.     

Relations between epileptic seizures and headaches

PurposeTo describe headaches in patients with epilepsy and try to identify relations between epileptic seizures and headaches.MethodsCross-sectional study, with 304 patients from the epilepsy out-patient section of University Hospital of Federal University of Alagoas (Brazil) between February 2007 and February 2008. The presence of headaches and their relationships with the epileptic seizures were analyzed.ResultsFrequent seizures were associated with a greater tendency of occurrence of headaches (odds ratio = 1.6 times, p = 0.077). Headaches occurred in 66.1% of the cases. The highest occurrence was of migraine (32.9% of the patients), followed by tension-type headaches (9.2%). Two syndromes with a continuum epilepsy–migraine in the same seizure are worth mentioning: migralepsy in 6.6% and epilepgraine in 10.2% of the patients with epilepsy.ConclusionsA high prevalence of headaches in patients with epilepsy was observed, with emphasis on hybrid crises of epilepsy and migraine.     

CGRP en migraña: de la fisiopatología a la terapéutica

IntroductionIt has been observed in recent years that levels of such molecules as calcitonin gene–related peptide (CGRP) and, to a lesser extent, the pituitary adenylate cyclase–activating peptide are elevated during migraine attacks and in chronic migraine, both in the cerebrospinal fluid and in the serum. Pharmacological reduction of these proteins is clinically significant, with an improvement in patients’ migraines. It therefore seems logical that one of the main lines of migraine research should be based on the role of CGRP in the pathophysiology of this entity.DevelopmentThe Spanish Society of Neurology's Headache Study Group decided to draft this document in order to address the evidence on such important issues as the role of CGRP in the pathophysiology of migraine and the mechanism of action of monoclonal antibodies and gepants; and to critically analyse the results of different studies and the profile of patients eligible for treatment with monoclonal antibodies, and the impact in terms of pharmacoeconomics.ConclusionsThe clinical development of gepants, which are CGRP antagonists, for the acute treatment of migraine attacks, and CGRP ligand and receptor monoclonal antibodies offer promising results for these patients.     

癫痫及偏头痛相关诊断标准解读

国际头痛学会相继提出“偏头痛癫痫”和“发作性癫痫性头痛”等概念和诊断标准,并在临床上广泛应用。笔者认为上述诊断标准均有值得商榷之处。头痛可以作为癫痫发作的症状,也常见于癫痫发作后,偏头痛和癫痫可以共病。从癫痫专业角度来看,偏头痛癫痫也许是一种局灶性癫痫。医学观点百家争鸣,癫痫和头痛亚专业组应加强对话,科学地制订癫痫和偏头痛相关诊断标准。