小脑顶核刺激联合药物治疗紧张型头痛效果评价

目的探讨小脑顶核刺激治疗在肌紧张型头痛急性发作期治疗的效果。方法按照ICHD-II诊断标准选取87例肌紧张型头痛患者,随机分为药物治疗组、小脑顶核刺激治疗组和联合治疗组。药物治疗组：妙钠（（盐酸乙哌立松）25~50mg,tid,连服2周;阿米替林12.5~25mg,tid,连服2周;泰诺林（对乙酰氨基酚）0.65g,bid,头痛缓解3d后停服。小脑顶核刺激治疗组通过CVFT-010M脑循环治疗仪给予电刺激,每日1次,每次30min,10d为1疗程;联合治疗组在电刺激治疗的同时,根据具体情况选用药物治疗组3种药物中的1种、2种或3种,分别给予相应治疗2周。2周后根据患者头痛自评问卷和经颅多普勒（TCD）检查比较各组头痛强度下降级数、头痛指数降低程度、头痛复发系数、疼痛缓解率以及椎动脉、基底动脉血流动力学指标的变化。结果小脑顶核刺激治疗组较单纯传统药物治疗组有更高的头痛强度下降级数（1.59±0.57vs1.42±0.23,P〈0.05）;但头痛指数下降程度〔（109.91±36.73）%vs（152.58±0.02）%,P〈0.05〕和头痛缓解率（42.3%vs68.1%,P〈0.05）不如药物治疗组,头痛复发率较高〔（48.9±28.1）%vs（33.7±12.5）%,P〈0.05〕;联合治疗组显示出最高的头痛强度减轻、头痛指数下降和头痛缓解率及最低的头痛复发系数（P均〈0.01）。TCD检查结果显示,小脑顶核刺激治疗组双侧椎动脉平均流速快于药物治疗组〔（66±12）vs（54±10）cm/s,P〈0.05〕。结论小脑顶核刺激可作为肌紧张型头痛急性发作期传统药物治疗基础上的有效辅助治疗,适宜在基层神经科门诊推广。

The therapeutic effect of combined stimulation of cerebellar fastigial nucleus and drugs on tension-type headache

Objective To investigate the therapeutic effect of extracranial electric stimulation of cerebellar fastigial nucleus in acute attack period of tension-type headache （TTH）.Methods According to the standard of international classification of headache disorders （ICHD-Ⅱ） 87 patients with TTH were selected and randomly designed to three groups：drug-treatment group,stimulating cerebellar fastigial nucleus treatment group （SFN group） and combined treatment group.In the drug-treatment group,used drugs included：myonal （eperisone hydrochloride）25-50 mg three times a day for two weeks,amitriptyline 12.5-25 mg three times a day for two weeks and tylenol（paracetamol） 0.65 g twice a day till three days after hea-dache remission.In SFN group,electric stimulation was given for 30 minutes each time（once a day,a course of treatment was 10 days） through cerebral circulation apparatus（CVFT-010M type）.In combined treatment group,the electric stimulation treatment of cerebellar fastigial nucleus was persisted, and one,two or three of above three drugs were selected in the meanwhile according to particular condition. Based on the headache self-rating questionnaires and the results of transcranial Doppler（TCD）,the descended grade of headache intensity,the declined degree of headache index,the coefficient of headache recurrence,the rate of headache remission and the changes ofhemodynamic indexes of vertebrobasilar artery and basic artery were compared among three groups after two weeks treatment.Results The descended grade of headache intensity in SFN group was more than that in drug-treatment group （1.59±0.57 vs 1.42±0.23,P0.05）,while its declined degree of headache index 〔（109.91±36.73）% vs （152.58±0.02）%,P0.05〕 and the rate of headache remission （42.3% vs 68.1%,P0.05） were less than those in drug-treatment group,and coefficient of headache recurrence was higher than that in drug-treatment group〔（48.9±28.1）% vs （33.7±12.5）%,P0.05〕.The combined treatment group showed obvious advantages with the highest descended grade of headache intensity （1.98±0.32）,the highest declined degree of headache index （180.63±34.88）,the highest rate of headache remission （83.9%）and the lowest coefficient of headache recurrence 〔（23.4±17.2）%,all P0.05）〕.TCD results showed that the mean flow velocity of bilateral vertebral artery in SFN group was rapider than that in drug-treatment group〔（66±12） vs （54±10） cm/s,P0.05〕.Conclusions The treatment of stimulation of cerebellar fastigial nucleus can be served as a supplementary therapy based on traditional drug-treatment in the acute attack period of TTH and should be spreaded in outpatient service of department of neurology for primary hospital.