心脏右向左分流对偏头痛患者临床症状的影响

目的:探讨心脏右向左分流(RLS)对偏头痛患者临床特征是否存在影响,并研究RLS分级与头痛强度之间的关系。方法:选择2016年6月-2018年12月青岛大学附属医院收治的偏头痛患者216例作为偏头痛组,选择于青岛大学附属医院体检的健康志愿者60例作为对照组。216例偏头痛患者根据有无RLS分为有RLS偏头痛组(127例)和无RLS偏头痛组(89例)。有RLS偏头痛患者根据RLS分级将其分为大分流组(n=51)、中分流组(n=11)和小分流组(n=65)。观察对照组与偏头痛组RLS情况,比较有RLS偏头痛组和无RLS偏头痛组患者的一般资料情况,比较大分流组、中分流组和小分流组患者的一般资料情况,采用多因素Logistic回归分析偏头痛患者产生RLS的危险因素。结果:对照组与偏头痛组小分流、中分流患病率比较差异无统计学意义(P0.05),而偏头痛组大分流患病率高于对照组(P0.05)。有RLS偏头痛组患者的视觉先兆、感觉先兆的比例均大于无RLS偏头痛组,头痛初始年龄均小于无RLS偏头痛组,头痛强度均高于无RLS偏头痛组(P0.05),两组患者年龄、性别、吸烟、饮酒、高血压、糖尿病、高血脂、运动先兆、遗传、头痛频率、头痛持续时间比较差异无统计学意义(P0.05)。不同RLS分级的偏头痛患者的视觉先兆、感觉先兆、头痛初始年龄、头痛强度整体比较差异有统计学意义(P0.05)。多因素Logistic回归分析显示,视觉先兆、感觉先兆、头痛初始年龄是偏头痛患者产生RLS的独立危险因素(P0.05)。结论:偏头痛发病年龄较小或有视觉先兆、感觉先兆可能提示偏头痛患者伴有RLS,RLS分级与头痛强度没有关系。     

Precipitating and relieving factors of migraine versus tension type headache

ABSTRACT: BACKGROUND: To determine the differences of precipitating and relieving factors between migraine and tension type headache METHODS: This is a cross sectional study. We retrospectively reviewed the records of 250 migraine patients and 250 patients diagnosed as tension type headache from the specialized headache clinic in Dept. of Neurology, Dhaka Medical College Hospital. Data were collected through a predesigned questionnaire containing information on age, sex, social status and a predetermined list of precipitating and relieving factors. RESULTS: In this study, the female patients predominated (67%). Most of the patients were within 21--30 years age group (58.6%). About 58% of them belonged to middle class families. The common precipitating factors like stress, anxiety, activity, journey, reading, cold and warm were well distributed among both the migraine and tension type headache (TTH) patients. But significant difference was demonstrated for fatigue (p < 0.05), sleep deprivation (p < 0.05), sunlight (p < 0.01) and food (p < 0.05), which were common among migraineurs. In consideration of relieving factors of pain, different maneuvers were commonly tried by migraineurs and significant difference were observed for both analgesic drug and massage (p < 0.05), which relieved migraine headache. But maneuvers like sleep, rest and posture were used by both groups. CONCLUSION: The most frequent precipitating factors for headache appear to be identical for both migraine and TTH patients. Even though some factors like fatigue, sleep deprivation, sunlight and food significantly precipitate migraine and drug, massage are effective maneuver for relieving pain among migrianeurs.     

Surgical treatment of migraine headaches by corrugator muscle resection

The authors, a plastic surgeon (Dirnberger) and a neurologist (Becker), conducted this study after reading the article by of Bahman Guyuron et al. in the August 2000 issue of Plastic and Reconstructive Surgery (106: 429, 2000). Sixty patients were operated on between June of 2001 and June of 2002; postoperative follow-up ranged between 6 and 18 months. Patients' charts were reviewed to confirm the diagnosis of migraine headache according to the criteria of the International Headache Society. Sixty patients (13 men and 47 women) from Austria and four neighboring countries took part in the study. The patients were divided into three groups, based on the severity of their migraines: group A comprised patients with up to 4 days of migraine per month; group B included patients with 5 to 14 days of migraine per month; and group C was composed of patients with more than 15 days of headache per month ("permanent headache") or evidence of drug abuse and drug-related headaches. The effectiveness of the operation was evaluated using the following factors: percentage reduction of headache days; percentage reduction of drugs; percentage reduction of side effects, severity of headaches, and response to drugs; and patient grade of personal satisfaction, using a scale from 1 to 5 [1 = excellent (total elimination of migraine headache) to 5 = insufficient or no improvement]. From the entire group of 60 patients, 17 (28.3 percent) reported a total relief from migraine, 24 (40 percent) reported an essential improvement, and 19 (31.7 percent) reported minimal or no change. Patients with a rather mild form of migraine headache had a much better chance (almost 90 percent in group A and 75 percent in group B) to experience an improvement or total elimination of migraine than those patients (n = 27) from group C with severe migraine, "permanent headaches," and drug-induced headaches. Contrary to the reports by Guyuron, 11 patients who had a very favorable response immediately and in the first weeks after the operation experienced a gradual return of their headaches to preoperative intensity after about 4 postoperative weeks. After 3 months, the results in all patients could be declared permanent. All side effects, such as paraesthesia in the frontal region, disappeared in all patients within 3 to 9 months.     

Prevalence of headache and migraine in schoolchildren.

OBJECTIVES--To determine the prevalence rates of the various causes of severe headache in schoolchildren, with special emphasis on migraine and its impact on school attendance. DESIGN--Population based study in two stages, comprising an initial screening questionnaire followed by clinical interviews and examination of children with symptoms and a control group of asymptomatic children matched for age and sex. SETTING--67 primary and secondary schools in the city of Aberdeen. SUBJECTS--2165 children, representing a random sample of 10% of schoolchildren in Aberdeen aged 5-15 years. MAIN OUTCOME MEASURES--(a) the prevalence of migraine (International Headache Society criteria) and of other types of headache; (b) the impact of migraine on school attendance. RESULTS--The estimated prevalence rates of migraine and tension headache were 10.6% (95% confidence interval 9.1 to 12.3) and 0.9% (0.5 to 1.5) respectively. The estimated prevalence rates for migraine without aura and migraine with aura were 7.8% (95% confidence interval 6.5 to 9.3) and 2.8% (2.0 to 3.8) respectively. In addition, 10 children (0.7%) had headaches which, though lasting less than two hours, also fulfilled the International Headache Society criteria for migraine, 14 (0.9%) had tension headaches, and 20 (1.3%) had non-specific recurrent headache. The prevalence of migraine increased with age, with male preponderance in children under 12 and female preponderance thereafter. Children with migraine lost a mean of 7.8 school days a year due to all illnesses (2.8 days (range 0-80) due to headache) as compared with a mean of 3.7 days lost by controls. CONCLUSIONS--Migraine is a common cause of headache in children and causes significantly reduced school attendance.     

Propranolol in the Treatment of Migraine

Beta-blocking drugs that prevent cranial vasodilatation are potentially valuable in the prophylaxis of migraine. Forty-nine patients with either classic or common migraine were treated with propranolol 160 mg/day for an average of six months. The first 30 of the patients to respond well to this treatment then participated in a double-blind cross-over trial with a placebo and propranolol. The mean frequency of headache attacks was significantly reduced by propranolol. None of the patients expressed a preference for placebo. Propranolol seems to be an effective prophylactic for common and classic migraine but the antimigraine properties of the various beta-blocking agents probably differ.     

Oxidative Stress in Migraine with and Without Aura

Migraine is the most common neurological disorder, but the molecular basis is still not completely understood. An impairment of mitochondrial oxidative metabolism might play a role in the pathophysiology. The goal of this study was to investigate the differences in oxidative stress status with the measurement of erythrocyte superoxide dismutase (SOD), catalase activity, and malondialdehyde (MDA) levels in the migraine patients with or without aura and attack. There were 56 patients (46 female, 10 male) in the migraine group and 25 matched healthy subjects in the control group. The patients comprised 37 with migraine without aura (MWoA], 19 with migraine with aura (MWA), and 22 with headache attack. The MDA levels of patients in the migraine group were significantly higher than that in the control group. The SOD activity was significantly higher in the MWA as compared to MWoA. There was no significant correlation between these levels and headache attack period. Conclusively, in this preliminary study, we had found increased oxidative stress in the migraine patients especially the patients with MWA. Further knowledge about this issue may contribute the cause and complications of migraine and may be essential for development of treatment approaches.     

Comprehensive surgical treatment of migraine headaches

The purpose of this study was to investigate the efficacy of surgical deactivation of migraine headache trigger sites. Of 125 patients diagnosed with migraine headaches, 100 were randomly assigned to the treatment group and 25 served as controls, with 4:1 allocation. Patients in the treatment group were injected with botulinum toxin A for identification of trigger sites. Eighty-nine patients who noted improvement in their migraine headaches for 4 weeks underwent surgery. Eighty-two of the 89 patients (92 percent) in the treatment group who completed the study demonstrated at least 50 percent reduction in migraine headache frequency, duration, or intensity compared with the baseline data; 31 (35 percent) reported elimination and 51 (57 percent) experienced improvement over a mean follow-up period of 396 days. In comparison, three of 19 control patients (15.8 percent) recorded reduction in migraine headaches during the 1-year follow-up (p < 0.001), and no patients observed elimination. All variables for the treatment group improved significantly when compared with the baseline data and the control group, including the Migraine-Specific Questionnaire, the Migraine Disability Assessment score, and the Short Form-36 Health Survey. The mean annualized cost of migraine care for the treatment group (925 dollars) was reduced significantly compared with the baseline expense (7612 dollars) and the control group (5530 dollars) (p < 0.001). The mean monthly number of days lost from work for the treatment group (1.2) was reduced significantly compared with the baseline data (4.41) and the control group (4.4) (p = 0.003). The common adverse effects related to injection of botulinum toxin A included discomfort at the injection site in 27 patients after 227 injections (12 percent), temple hollowing in 19 of 82 patients (23 percent), neck weakness in 15 of 55 patients (27 percent), and eyelid ptosis in nine patients (10 percent). The common complications of surgical treatment were temporary dryness of the nose in 12 of 62 patients who underwent septum and turbinate surgery (19.4 percent), rhinorrhea in 11 (17.7 percent), intense scalp itching in seven of 80 patients who underwent forehead surgery (8.8 percent), and minor hair loss in five (6.3 percent). Surgical deactivation of migraine trigger sites can eliminate or significantly reduce migraine symptoms. Additional studies are necessary to clarify the mechanism of action and to determine the long-term results.     

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。     

Weekly headache periodicity and the effect of weather changes on headache

A weekly periodicity in the occurrence of headache was found in 53 patients with migraine and in 20 with tension headache during an observation period of four weeks. In the migraine group the frequency was highest on Thursday and on Saturday and lowest on Sunday–Monday, and in patients with tension headache it was lowest on Sunday–Tuesday and highest on Friday. During the observation period several climatic factors were recorded. After correction for the weekly periodicity a highly significant correlation was found in the migraine group between headache frequency, on the one hand, and atmospheric pressure and outdoor temperature recorded 1–3 days later, on the other.     

Low serum diamine oxidase (DAO) activity levels in patients with migraine

Histamine intolerance is a disorder in the homeostasis of histamine due to a reduced intestinal degradation of this amine, mainly caused by a deficiency in the enzyme diamine oxidase (DAO). Among the several multi-faced symptoms associated with histamine intolerance, headache is one of the most recognized and disabling consequences. The aim of this study was to determine the prevalence of DAO deficiency in patients with a confirmed migraine diagnosis according to the current International Headache Society (IHS) and in non-migraine subjects. DAO activity was assessed in a total of 198 volunteers recruited at the Headache Unit of the Hospital General de Catalunya, 137 in the migraine group and 61 as a control group. DAO enzyme activity in blood samples was determined by ELISA test. Values below 80 HDU/ml (Histamine Degrading Unit/ml) were considered as DAO deficient. Mean value of DAO activity from migraine population (64.5 ± 33.5 HDU/ml) was significantly lower (p < 0.0001) than that obtained from healthy volunteers (91.9 ± 44.3 HDU/ml). DAO deficiency was more prevalent in migraine patients than in the control group. A high incidence rate of DAO deficiency (87%) was observed in the group of patients with migraine. On the other hand, 44% of non-migranous subjects had levels of DAO activity lower than 80 HDU/ml. Despite the multifactorial aetiology of migraine, these results seem to indicate that this enzymatic deficit could be related to the onset of migraine.     

Migraine: Intelligence,Social Class,and Familial Prevalence

Groups of individuals with headache, unilateral headache, and migraine, and a fourth group who had not had a headache in the previous year, were identified by questionnaire from a random sample of adults in the general population. Intelligence and social class were assessed in about 400 individuals. There was no evidence that individuals with migraine were more intelligent or of higher social class. There was, however, a suggestion that the more intelligent individuals with migraine, and those in social classes I and II, were more likely to consult a doctor for their headaches. This trend might explain the origin of the hypotheses associating migraine with intelligence and with social class.Random samples of individuals with migraine with headache and without headache in the previous year were the probands for a family study. There were 524 first-degree relatives over 21 years of age who lived in South Wales. Headache histories, obtained “blindly” from over 99% of these relatives with a standard questionnaire, were classified as migraine, possible migraine, headache, or without headache in the previous year. The prevalence of migraine in the families of the migrainous probands was nearly twice as high as the prevalence in the other families, but this difference was not statistically significant. It is suggested that family history should not be included in the definition of migraine and that heredity is much less important in migraine than is usually supposed.     

Long-term maintenance of improvements achieved with (abortive) pharmacological and nonpharmacological treatments for migraine: preliminary findings

This report presents the first prospective comparison of the long-term maintenance of reductions in recurrent migraine headaches achieved with (abortive) pharmacological and nonpharmacological (combined relaxation training and thermal biofeedback training) treatments. Nineteen of 21 (90%) successfully treated patients (50% or greater reduction in headache activity) were contacted for follow-up evaluation 3 years later. Migraine sufferers who had been treated with ergotamine were less likely to still be relying on the treatment they had received and more likely to have additional medical treatment for their headaches and to be using prophylactic or narcotic medication than were migraine sufferers who had been treated with relaxation/biofeedback training. However, daily headache recordings revealed that patients in both treatment groups continued to show lower headache activity at 3-year follow-up than prior to treatment. Although preliminary, these findings raise the possibility that improvements achieved with nonpharmacological treatment are more likely to be maintained without additional treatment than are similar improvements achieved with abortive pharmacological treatment.     

Long-term maintenance of improvements achieved with (abortive) pharmacological and nonpharmacological treatments for migraine: Preliminary findings

This report presents the first prospective comparison of the long-term maintenance of reductions in recurrent migraine headaches achieved with (abortive) pharmacological and nonpharmacological (combined relaxation training and thermal biofeedback training) treatments. Nineteen of 21 (90%) successfully treated patients (50% or greater reduction in headache activity) were contacted for follow-up evaluation 3 years later. Migraine sufferers who had been treated with ergotamine were less likely to still be relying on the treatment they had received and more likely to have additional medical treatment for their headaches and to be using prophylactic or narcotic medication than were migraine sufferers who had been treated with relaxation/biofeedback training. However, daily headache recordings revealed that patients in both treatment groups continued to show lower headache activity at 3-year follow-up than prior to treatment. Although preliminary, these findings raise the possibility that improvements achieved with nonpharmacological treatment are more likely to be maintained without additional treatment than are similar improvements achieved with abortive pharmacological treatment.A Baker Award from Ohio University provided support for the original outcome study.Abgelo Theofanous with R. L. Associates (Ann Arbor).     

Muscle discrimination ability at three muscle sites in three headache groups

The present study examined the ability of three headache groups (migraine, mixed migraine/tension, and tension) to accurately discriminate subjective levels of muscle tension at the forearm flexor, frontalis, and trapezius muscle sites. Discrimination ability was assessed at pre- and posttreatment using a psychophysical method of magnitude production. Results show that the ability to discriminate muscle tension levels at pretreatment varied across the headache groups, with migraineurs being the most accurate (r = .854), followed by the mixed headache group (r = .785), and finally the tension headache group (r = .732). Discrimination ability significantly increased at the posttreatment assessment. A multiple regression analysis showed that pretreatment performance on the muscle discrimination task significantly predicted outcome (r = .75) from relaxation and biofeedback training for migraine patients but not for the mixed or tension headache groups.     

Classification and Clinical Features of Headache Disorders in Pakistan: A Retrospective Review of Clinical Data

Background

Morbidity associated with primary headache disorders is a major public health problem with an overall prevalence of 46%. Tension-type headache and migraine are the two most prevalent causes. However, headache has not been sufficiently studied as a cause of morbidity in the developing world. Literature on prevalence and classification of these disorders in South Asia is scarce. The aim of this study is to describe the classification and clinical features of headache patients who seek medical advice in Pakistan.

Methods and Results

Medical records of 255 consecutive patients who presented to a headache clinic at a tertiary care hospital were reviewed. Demographic details, onset and lifetime duration of illness, pattern of headache, associated features and family history were recorded. International Classification of Headache Disorders version 2 was applied.66% of all patients were women and 81% of them were between 16 and 49 years of age. Migraine was the most common disorder (206 patients) followed by tension-type headache (58 patients), medication-overuse headache (6 patients) and cluster headache (4 patients). Chronic daily headache was seen in 99 patients. Patients with tension-type headache suffered from more frequent episodes of headache than patients with migraine (p<0.001). Duration of each headache episode was higher in women with menstrually related migraine (p = 0.015). Median age at presentation and at onset was lower in patients with migraine who reported a first-degree family history of the disease (p = 0.003 and p<0.001 respectively).

Conclusions/Significance

Patients who seek medical advice for headache in Pakistan are usually in their most productive ages. Migraine and tension-type headache are the most common clinical presentations of headache. Onset of migraine is earlier in patients with first-degree family history. Menstrually related migraine affects women with headache episodes of longer duration than other patients and it warrants special therapeutic consideration. Follow-up studies to describe epidemiology and burden of headache in Pakistan are needed.     

Safety and efficacy of intravenous sodium valproate in the treatment of acute migraine

This multicenter study investigated the safety and efficacy of intravenous valproate in acute migraine attacks and the possible impact of prophylactic valproate pre-treatment. Thirty-six patients established on migraine prophylaxis were administered 500 mg sodium valproate intravenously against acute migraine attacks. Pain development was assessed by visual analogue scale up to a 24 hours follow up interview to detect e.g. possible relapse symptoms. A subgroup analysis examined whether prophylactic treatment with valproate affected its acute anti-migraine efficacy. A meaningful headache reduction within two hours was achieved in all 12 patients with and in 20 out of 24 patients without valproate prophylaxis. Headache-associated signs and symptoms were substantially reduced. No serious side-effects were reported. The results confirm the therapeutic value of intravenous valproate in acute migraine attacks described in literature and show a beneficial effect on all investigated efficacy parameters with a trend to even better response in patients receiving valproate prophylaxis.     

Increased prevalence of mitral valve prolapse in patients with migraine.

Patients with classic migraine (69 women and 31 men) selected randomly from a practice list of over 1000 were matched for age, sex and neighbourhood with 100 people who did not have headache problems, and both groups underwent M-mode and two-dimensional echocardiography and clinical examination by cardiologists blinded to the subjects'' clinical status. The mean ages were 34.9 +/- 11.3 years for the migraine group and 33.1 +/- 9.9 years for the control group. Definite and possible mitral valve prolapse (MVP), diagnosed according to predefined echocardiographic criteria, were found about twice as often in the migraine group as in the control group (in 15 v. 7 and 16 v. 8 patients respectively); the echocardiograms were definitely normal in 69 migraine patients and 85 controls (chi 2 = 8.39, p less than 0.025). Altogether 25% of the migraine group and 11% of the control group had evidence of MVP from a combination of the echocardiographic and auscultatory findings (chi 2 = 5.72, p less than 0.025). The odds ratio was 2.7, with 95% confidence limits of 1.17 and 6.29. The association between migraine and MVP has implications for the understanding of platelet abnormalities and episodes of cerebral ischemia occurring in both these conditions.     

Muscle discrimination ability at three muscle sites in three headache groups

The present study examined the ability of three headache groups (migraine, mixed migraine/tension, and tension) to accurately discriminate subjective levels of muscle tension at the forearm flexor, frontalis, and trapezius muscle sites. Discrimination ability was assessed at pre- and posttreatment using a psychophysical method of magnitude production. Results show that the ability to discriminate muscle tension levels at pretreatment varied across the headache groups, with migraineurs being the most accurate (r=.854), followed by the mixed headache group (r=.785), and finally the tension headache group (r=.732). Discrimination ability significantly increased at the posttreatment assessment. A multiple regression analysis showed that pretreatment performance on the muscle discrimination task significantly predicted outcome (r=.75) from relaxation and biofeedback training for migraine patients but not for the mixed or tension headache groups.This research was supported by a grant from NINCDS, NS-15235.     

The effect of electrode placement on frontalis EMG measurement in headache patients

Comparisons were made between frontalis EMG surface recordings concurrently taken from horizontal, right vertical, and left vertical electrode placement configurations. Six migraine and seven tension headache patients were used as subjects. Results showed that, in general, a positive correlation existed between recordings from the three placements for both migraine and tension subjects as a group. However, marked individual differences were noted. It was concluded that electrode placement can be quite important in measuring changes in frontalis muscle tension for headache patients.     

Headaches in Multiple Sclerosis Patients Might Imply an Inflammatorial Process

Recent studies on Multiple Sclerosis (MS) pathology mention the involvement of “tertiary B cell follicles” in MS pathogenesis. This inflammatory process, which occurs with interindividually great variance, might be a link between MS pathology and headaches. The aim of this study was to detect the prevalence of headaches and of subtypes of headaches (migraine, cluster, tension-type headache [TTH]) in an unselected MS collective and to compile possibly influencing factors. Unselected MS patients (n = 180) with and without headache were examined by a semi-structured interview using a questionnaire about headache, depression and the health status. Additionally clinical MS data (expanded disability state score [EDSS], MS course, medication, disease duration) were gathered. N = 98 MS patients (55.4%) reported headaches in the previous 4 weeks. We subsequently grouped headache patients according to the IHS criteria and detected 16 (16.3%) MS patients suffering from migraine (migraine with aura: 2 [2%]; migraine without aura: 14 [14.3%]), 23 (23.5%) suffering from TTH and none with a cluster headache. Thus, headaches of 59 (60.2%) MS patients remained unclassified. When comparing MS patients with and without headaches significant differences in age, gender, MS course, physical functioning, pain and social functioning occurred. MS patients with headaches were significantly younger of age (p = 0.001), female (p = 0.001) and reported more often of a clinically isolated syndrome (CIS) and relapsing/remitting MS (RRMS) instead of secondary chronic progressive MS (SCP). EDSS was significantly lower in MS patients suffering from headaches compared to the MS patients without headaches (p = 0.001). In conclusion headache in MS patients is a relevant symptom, especially in early stages of the MS disease. Especially unclassified headache seems to represent an important symptom in MS course and requires increased attention.