足窍阴放血治疗高颅压头痛40例临床观察

目的：利用足窍阴穴放血缩短高颅压头痛时间以减少患者焦躁情绪，利于原发病的治疗。方法：治疗组在使用降颅压药物的基础上加用穴位治疗， 每日1次，3次为一疗程。结果：治疗组中患者的头痛时间缩短，3日之内疼痛缓解95．0％，对照组15．0％。结论：足窍阴放血可有效缓解高颅压引起的头痛。     

血管神经性头痛的中医治疗

血管神经性头痛属中医内伤头痛范畴,系因脏腑阴阳的虚损,精神情志的侵扰,精气营血的亏耗,饮食起居的失常,逐渐形成脏虚痰盛,阴虚火旺,阳虚寒凝,气虚血瘀及阳亢风动等病理现象。随着病理的不断发展,风火痰瘀相互交织,最终导致本虚标实之症。临床诊治本病,多从风火痰瘀入手,以"急则治其标,缓则治其本"为治疗原则。     

Application of the ICHD-II criteria to the diagnosis of primary chronic headaches via a computerized structured record

BACKGROUND: The authors recently developed a software program designed to analyze clinical data from patients affected by primary headache. The program is based exclusively on the International Classification of Headache Disorders 2nd edition (ICHD-II) criteria. This software examines all the diagnoses of primary headaches on the basis of the variables needed to fulfill these mandatory criteria. METHODS: We tested the software, Primary Headaches Analyser 1.0 INT (PHA), by entering and analyzing clinical data from 200 consecutive patients affected by primary chronic headaches and evaluating the corresponding output diagnoses. RESULTS: The diagnosis of chronic migraine (1.5.1) was obtained in 68 cases (34 %) and that of probable chronic migraine (1.6.5) plus probable medication-overuse headache (8.2.8) in 46 (23%). Chronic tension-type headache (2.3) and probable chronic tension-type headache (2.4.3) plus probable medication-overuse headache (8.2.8) were diagnosed in 24 (12%) and 2 (1%) patients, respectively. Moreover, 4 and 12 patients, respectively, received both the diagnosis of chronic migraine (1.5.1) plus chronic tension-type headache (2.3) and of probable migraine (1.6.1) without aura plus chronic tension-type headache (2.3). In the remaining 44 cases (22%), none of the chronic primary headaches disorders defined by ICHD-II received an output diagnosis from the program. This was due mainly to the fact that the criteria fulfilled were insufficient for the diagnoses of migraine without (1.1) aura plus chronic migraine or, more infrequently, chronic tension-type headache. CONCLUSIONS: Our software program permitted diagnoses of chronic migraine, chronic tension-type or their probable forms (with or without MOH) in 78% of 200 patients with headache 15 or more days per month. In the remaining cases the inability to provide a specific diagnosis may be explained in part by the fact that the criteria for both diagnoses are too stringent and do not accurately reflect variations of the headache pattern in these chronic forms.     

Osmophobia in primary headaches

This study evaluates osmophobia (defined as an unpleasant perception, during a headache attack, of odours that are non–aversive or even pleasurable outside the attacks) in connection with the diagnosis of primary headaches. We recruited 775 patients from our Headache Centre (566 females, 209 males; age 38±12 years), of whom 477 were migraineurs without aura (MO), 92 with aura (MA), 135 had episodic tension–type headache (ETTH), 44 episodic cluster headache (ECH), 2 chronic paroxysmal hemicrania (CPH) and 25 other primary headaches (OPHs: 12 primary stabbing headaches, 2 primary cough headaches, 3 primary exertional headaches, 2 primary headaches associated with sexual activity, 3 hypnic headaches, 2 primary thunderclap headaches and 1 hemicrania continua). Among them, 43% with MO (205/477), 39% with MA (36/92), and 7% with CH (3/44) reported osmophobia during the attacks; none of the 135 ETTH and 25 OPH patients suffered this symptom. We conclude that osmophobia is a very specific marker to discriminate adequately between migraine (MO and MA) and ETTH; moreover, from this limited series it seems to be a good discriminant also for OPHs, and for CH patients not sharing neurovegetative symptoms with migraine. Therefore, osmophobia should be considered a good candidate as a new criterion for the diagnosis of migraine.     

腰/硬联合麻醉术中体位对麻醉后头痛的影响

目的探讨腰/硬联合麻醉术中体位对麻醉后头痛的影响.方法1000例剖宫产病人被随机分为实验组和对照组各500例,实验组在麻醉后平卧时给病人垫1个小枕头,对照组按传统护理常规去枕平卧,术后1～3天对病人术后头痛进行评估.结果2组病人术后头痛发生率及头痛程度差异无显著性,但对麻醉中体位的感受,实验组优于对照组.结论腰麻术中垫枕与否对术后头痛没影响.     

A comparison of preference for and efficacy of tablet formulations of sumatriptan (50 mg and 100 mg), naratriptan (2.5 mg), rizatriptan (10 mg), and zolmitriptan (2.5 mg) in the acute treatment of migraine

Abstract This randomized, multicenter, open-label, five-way crossover study was conducted to assess patients preference for tablet formulations of sumatriptan (50 mg and 100 mg), naratriptan (2.5 mg), rizatriptan (10 mg), and zolmitriptan (2.5 mg) in the acute treatment of migraine and to identify determinants of preference. Patients treated one mild, moderate, or severe migraine with each triptan. The results show that sumatriptan 100 mg was significantly preferred over the random preference rate of 20% (p<0.001) whereas sumatriptan 50 mg, naratriptan, rizatriptan, and zolmitriptan were not. Patients primary reason for preferring a medication was best relief of migraine pain, and the treatment that patients preferred corresponded to the medication that was most likely to confer for them a pain-free response 2 hours postdose. Across all patients, efficacy 2 hours postdose was comparable among triptans with the exception of naratriptan, which was slightly less effective than the other medications (pain-free response 2 hours postdose: 40% sumatriptan 100 mg, 37% sumatriptan 50 mg, 28% naratriptan 2.5 mg, 38% rizatriptan 10 mg, 36% zolmitriptan 2.5 mg). The medications were also similarly well-tolerated. These data demonstrate that information on patients medication preference supplements and does not duplicate data from traditional efficacy measures. Patient preference data are useful in tailoring migraine therapy to the needs of the individual patient.     

Development of a ICHD–II based computerised system for the general practitioner

We present a computerised programme designed for use in the office of a general practitioner. The system provides an assisted diagnosis according to the ICHD–II criteria for the principal forms of primary headaches (migraine, tension–type headache, cluster headache) and highlights the red flags of a possible secondary headache. A relevant feature is that explanations for the selection of a particular diagnosis are given at the end of the process; furthermore, the characteristics of the patient’s headache, which were previously inserted in the programme by the physician, are summarised, allowing critical evaluation of the suggested diagnosis. The software can also be used as a clinical file, in that it is possible to create for each patient a clinical chart in which to record the selected diagnosis, the recommended therapy and any eventual comments. Our programme aims for educational growth, promoting the learning of the basic ICHD–II criteria.     

Migraine-like headache as the presenting symptom of basilar artery occlusion

If migraine or a migrainelike headache and stroke occur together, it is difficult to determine whether migraine is the cause of the stroke or stroke is the cause of symptomatic migraine. We report the case of a 19-year-old woman without a history of migraine who presented with a migraine-like headache, nausea and desire for tranquility and dimmed lighting. Initial neurological examination, computed tomography and cerebrospinal fluid analysis were normal, leading to the presumptive diagnosis of first manifestation of migraine. Persistence of dizziness and transient diplopia, however, prompted a magnetic resonance imaging examination, which revealed major stroke in the posterior circulation due to occlusion of the basilar artery. The symptoms resolved spontaneously and treatment with antiplatelet inhibitor was prescribed. Smoking and use of oral contraceptives were identified as vascular risk factors. Stroke in the posterior circulation due to occlusion of the basilar artery may show rather inconspicuous symptoms and provoke migrainous headache. Received: 19 August 2002, Accepted in revised form: 2 December 2002 Correspondence to J.G. Heckmann     

www.cefalea.it: the first five years

The Italian headache disorders website (www.cefalea.it) was launched in 1999 by the CIRNA foundation in partnership with Al.Ce, which is a lay association and member of the World Headache Alliance. In 2004, the website registered almost 130 000 hits (+200% on the 1999 figure). The most visited parts were the sections devoted to topical issues relating to headache, the list of headache specialists, the headache glossary and the support group. This article summarises the website’s first five years of activity and highlights the Internet’s potential to improve headache–related decision–making, behaviour and outcomes.     

Efficacy of multidisciplinary treatment in a tertiary referral headache centre

Despite the high prevalence of headaches, multidisciplinary headache clinics are few and their efficacy still needs validation. We set out to describe the procedures, characterize the patients and evaluate the treatment results in Danish Headache Centre. All clinical records for patients discharged in 2002 were systematically reviewed. Diagnoses were classified in accordance with ICHD-II. Outcome results were analysed with respect to headache diagnoses, frequency, intensity, absence from work and medication use. Five hundred and five patients were included and 336 were eligible for the study. Mean age was 46 years and male/female ratio 1:2.4. For patients without medication overuse headache (MOH) a reduction in headache frequency (P<0.01) and intensity (P<0.05) was seen for frequent episodic and chronic tension-type headache (TTH), migraine, cluster and other headaches. No reduction was seen in post-traumatic headache. Absence from work decreased significantly for migraine (P<0.001) and frequent episodic TTH (P<0.05). For patients with MOH a reduction in headache frequency was seen for TTH and migraine (P<0.001). A specialized headache centre is valuable in treatment of patients with complex headache disorders.