Association of headaches and the metals

Lack of specific markers constitutes a problem during diagnosis of headache syndromes. Recently, some metals have gained importance as biological parameters for the diagnosis and during treatment. Low-ionized Mg and high-ionized Ca/Mg in patients with daily migrainous headaches were noted. The blood Na level was shown to increase before and during headache. Headache is also a symptom of the common cold for which zinc may be an effective therapy. The existing relationship between genetic markers of the cluster headache and the efficacy of lithium salts therapy was noted. Headache was also found to be associated with toxic metals. When the health effects of mercury were investigated, the most frequently observed symptom was cephalalgia. Continuous exposure to lead was concomitant with the appearance of symptoms such as headache. In relation to some metabolic links, metals may be introduced as possible biological markers for the diagnosis and during the therapy of different headache syndromes in future clinical trials and laboratory measurements.     

Effect of intranasal arginine vasopressin on human headache

Arginine vasopressin (AVP), a nonapeptide hormone of posterior pituitary, reaches the central nervous system from systemic blood circulation with a difficulty because of the blood–brain barrier (BBB). The interest has been expressed in the use of the nasal route for delivery of AVP to the brain directly, exploiting the olfactory pathway. Our previous study has demonstrated that AVP in the brain rather than the spinal cord and blood circulation plays an important role in rat pain modulation. For understanding the role of AVP on pain modulation in human, the communication tried to investigate the effect of intranasal AVP on human headache. The results showed that (1) AVP concentration in both plasma and cerebrospinal fluid (CSF) increased significantly in headache patients, who related with the headache level; (2) there was a positive relationship between plasma and CSF AVP concentration in headache patients; and (3) intranasal AVP could relieve the human headache in a dose-dependent manner. The data suggested that intranasal AVP, which was delivered to the brain through olfactory region, could treat human headache and AVP might be a potential drug of pain relief by intranasal administration.     

经筋推拿治疗颈源性头痛的疗效及对颈椎活动度的影响

目的:探讨经筋推拿治疗颈源性头痛(CEH)的临床疗效,分析其对患者颈椎活动度的影响。方法:选取2017年3月至2017年6月山东省中医院收治的70例CEH患者,按照随机数字表法分为推拿组36例和针刺组34例,推拿组给予经筋推拿治疗,针刺组给予针刺治疗。观察两组治疗前后的疼痛视觉模拟(VAS)评分、头痛积分及颈椎活动度评分,比较两组临床总有效率。结果:推拿组患者治疗后总有效率为97.22%,显著高于针刺组患者82.35%(P0.05)。两组治疗1个疗程后、治疗后1个月的VAS评分、头痛积分、颈椎活动度评分均较治疗前降低,且推拿组低于针刺组(P0.05)。结论:经筋推拿治疗CEH能够缓解疼痛和改善颈椎功能,疗效显著,值得临床推广应用。     

Effect of natriuretic peptides on cerebral artery blood flow in healthy volunteers

The natriuretic peptides (NPs), atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and C-type natriuretic peptide (CNP), have vasoactive functions that concern humans and most animals, but their specific effects on cerebral circulation are poorly understood. We therefore examined the responsiveness of cerebral arteries to different doses of the natriuretic peptides in animals and humans. We conducted a dose-response experiment in guinea pigs (in vitro) and a double-blind, three-way cross-over study in healthy volunteers (in vivo). In the animal experiment, we administered cumulative doses of NPs to pre-contracted segments of cerebral arteries. In the main study, six healthy volunteers were randomly allocated to receive two intravenous doses of ANP, BNP or CNP, respectively, over 20 min on three separate study days. We recorded blood flow velocity in the middle cerebral artery (V_MCA) by transcranial Doppler. In addition, we measured temporal and radial artery diameters, headache response and plasma concentrations of the NPs. In guinea pigs, ANP and BNP but not CNP showed significant dose-dependent relaxation of cerebral arteries. In healthy humans, NP infusion had no effect on mean V_MCA, and we found no difference in hemodynamic responses between the NPs. Furthermore, natriuretic peptides did not affect temporal and radial artery diameters or induce headache. In conclusion, natriuretic peptides in physiological and pharmacological doses do not affect blood flow velocity in the middle cerebral artery or dilate extracerebral arteries in healthy volunteers.     

Natural very-low-frequency sferics and headache

Very-low-frequency (VLF) atmospherics or sferics are pulse-shaped alternating electric and magnetic fields which originate from atmospheric discharges (lightning). The objective of the study was threefold: (i) to analyse numerous parameters characterizing the sferics activity with regard to their suitability for field studies, (ii) to identify meteorological processes related to the sferics activity and (iii) to investigate the possible association of sferics with pain processes in patients suffering from migraine- and tension-type headaches. Over a period of 6 months (July through December) the sferics activity in the area of Giessen (Germany) was recorded. Three sferics parameters were chosen. The number of sferics impulses per day, the variability of the impulse rate during a day and the variability in comparison to the preceding day were correlated with weather processes (thunderstorm, temperature, vapour pressure, barometric pressure, humidity, wind velocity, warm sector). Significant correlations were obtained during the summer months (July, August) but not during the autumn months (October, November, December). During autumn, however, the sferics activity was correlated with the occurrence of migraine-type headaches (r=0.33, P<0.01) recorded by 37 women who had filled out a headache diary over a period of 6 months (July–December). While the thunderstorm activity was very intense during July and August, no relationship between sferics and migraine was found. In summer, tension-type headaches were associated with meteorological parameters such as temperature (r=0.42, P<0.01) and vapour pressure (r=0.28, P<0.05). Although the sferics activity can explain a small percentage of the variation in migraine occurrence, a direct influence was more likely exerted by visible or otherwise perceptible weather conditions (thunderstorms, humidity, vapour pressure, warm sector, etc.) than by the sferics activity itself. Received: 9 January 2001 / Revised: 1 May 2001 / Accepted: 9 May 2001     

Cox-2 gene variants in migraine

Purpose

Migraine is a multifactorial and complex disorder, and any clear diagnostic marker to assess the status of the migraineurs has not been established, yet. Nonsteroidal anti-inflammatory drugs reduce production of prostanoids including PGE2 by inhibiting COX-1 and/or COX-2, and thereby suppress inflammatory pain in patients suffering from rheumatoid arthritis, osteoarthritis, and migraine. Thus, COX-2 regulation is important in the pathogenesis and treatment of migraine. We prospectively investigated COX-2-765G → C and COX-2-1195A → G gene polymorphisms which may account for an increased risk of migraine.

Methods

The present analyses are based on 144 case subjects with migraine disease and 123 non-case subjects. Genotyping of COX-2 gene polymorphisms (COX-2-765G → C, COX-2-1195A → G) was detected by PCR-RFLP.

Results

We, for the first time, demonstrated positive association of COX-2 gene variants with an increased risk for development of migraine. Carriers of COX-2-765 C + genotype in controls were higher than in the patients (57.7% and 36.1% respectively; P < 0.0001) and the frequencies of G + genotype in patients were higher than in the controls (97.9% and 88.6% respectively; P: 0.002). In addition, frequencies of COX-2-765 GG and GC genotypes in patients were higher than in the controls (P < 0.0001, P < 0.0001 respectively). It seems that COX-2-765 G + genotype had increased and COX-2-765 C + genotype had decreased risk for migraine. In COX-2-1195 polymorphism only AG genotype was statistically significantly different in patients than in the controls (P < 0.05).

Conclusions

Our findings have suggested that COX-2-765 G + genotype could facilitate the development of migraine disease.     

基于多学科协作的头痛单元组建与运作分析

基于目前国内头痛病诊治现状,提出“头痛单元”的概念,并系统论述中西医结合“头痛单元”的组建与运作思路。分析认为,构建中、西医在内的多学科协作的“头痛单元”模式,可实现对现有医疗资源的整合与高效运用,提高头痛病诊治效率,符合我国头痛病诊治与管理的发展趋势。     

Heritability and genome-wide linkage analysis of migraine in the genetic isolate of Norfolk Island

Migraine is a common neurovascular disorder with a complex envirogenomic aetiology. In an effort to identify migraine susceptibility genes, we conducted a study of the isolated population of Norfolk Island, Australia. A large portion of the permanent inhabitants of Norfolk Island are descended from 18th Century English sailors involved in the infamous mutiny on the Bounty and their Polynesian consorts.In total, 600 subjects were recruited including a large pedigree of 377 individuals with lineage to the founders. All individuals were phenotyped for migraine using International Classification of Headache Disorders-II criterion. All subjects were genotyped for a genome-wide panel of microsatellite markers. Genotype and phenotype data for the pedigree were analysed using heritability and linkage methods implemented in the programme SOLAR. Follow-up association analysis was performed using the CLUMP programme.A total of 154 migraine cases (25%) were identified indicating the Norfolk Island population is high-risk for migraine. Heritability estimation of the 377-member pedigree indicated a significant genetic component for migraine (h² = 0.53, P = 0.016). Linkage analysis showed peaks on chromosome 13q33.1 (P = 0.003) and chromosome 9q22.32 (P = 0.008). Association analysis of the key microsatellites in the remaining 223 unrelated Norfolk Island individuals showed evidence of association, which strengthen support for the linkage findings (P ≤ 0.05).In conclusion, a genome-wide linkage analysis and follow-up association analysis of migraine in the genetic isolate of Norfolk Island provided evidence for migraine susceptibility loci on chromosomes 9q22.22 and 13q33.1.     

基于专家问卷反馈的头痛活血化瘀药物功效强度及用药情况初探

目的:以专家临床经验为积淀,对治疗头痛活血化瘀药物功效强度的量化及用药规律进行初步的探讨。方法:基于专家咨询及中医传承辅助平台软件,将筛选出的活血化瘀中药的专家意见集中程度、协调程度、药物功效强度及常用度,采用Kmeans聚类分析法进行统计分析。结果:对于治疗头痛中活血化瘀功效较强的药物,专家意见在川芎、红花、莪术等,川芎、赤芍、桃仁等协调程度较高,川芎、当归、赤芍等活血化瘀功效较强且临床治疗血瘀头痛中较常使用。结论:对于活血化瘀药物在治疗头痛中的应用,应以辨证论治为先,活血化瘀药物可选择川芎、当归、赤芍等,结合疼痛不同部位选用引经药。此外,虫类药物在治疗血瘀头痛中起不可替代的作用。