丙酸睾丸酮治疗丛集性头痛的效果分析

目的:观察丙酸睾丸酮治疗丛集性头痛的疗效并分析其可能的作用途径。方法:选择1987-01/2002-12在青岛大学医学院附属医院神经内科门诊就诊丛集性头痛患者64例为治疗组。其中,男49例,女15例,年龄13～65岁,平均(36.78±10.28)岁。同期选取健康查体者49例为对照组,男34例,女15例,年龄20～59岁,平均(35.49±9.64)岁。治疗组在治疗1周后给予丙酸睾丸酮治疗,25mg/d,肌注,1次/d,治疗7～10d,疗效不明显者继续一个疗程,剂量改用12.5mg/d。对照组不用任何药物。每7天随访1次,共3次,记录每周丛集性头痛周内的发作次数。利用放射免疫分析法分别测定治疗前及治疗后患者的血清睾酮和生长激素水平。结果:治疗组中2例患者未按照方案用药,3例患者随访不足1月而排除,最终59例进入结果分析,男47例,女12例。对照组49例均进入结果分析。①发作次数比较:患者在丙酸睾丸酮治疗前发作(8.50±3.78)次/周,应用丙酸睾丸酮治疗第1周、第2周、第3周后分别发作(5.06±3.59),(1.50±2.80),(0.71±2.05)次,(F=81.379,P<0.01),呈现每周递减趋势。②发作指数比较:应用丙酸睾丸酮治疗第1周、第2周、第3周后明显低于基线期(0.723,0.214,0.103,1.214,F=0.467～31.057,P<0.01)。③血清睾酮水平比较:男性,治疗组治疗后和对照组高于治疗前(7.40±2.6,7.51±2.10,6.06±2.35,F=5.017,P<0.01);女性,治疗组治疗后和对照组明显高于治疗前(0.98±0.18,1.07±0.14,0.48±0.12,F=58.931,P<0.01)。④生长激素水平比较:治疗组治疗后和对照组明显高于治疗前(4.22±1.09,4.33±0.81,3.86±0.88,F=2.789～71.936,P<0.05)。结论:丙酸睾丸酮可通过提高丛集性头痛患者的血清睾酮水平而治疗丛集性头痛,且疗效显著。     

丛集性头痛

丛集性头痛 (曾称蝶腭神经痛、睫状神经痛、Ｖｉｄｉａｎ神经痛、Ｓｌｕｄｅｒ神经痛、偏头痛样神经痛、岩神经痛、组织胺头痛、Ｈｏｒｔｏｎ头痛 ) ,是原发性神经血管性头痛之一。其特点为密集 (群集、丛集 )短暂头痛发作 ,剧烈、锐痛、爆炸样、位于一侧眼眶、球后、额颞部 ,伴同侧眼球结合膜充血、流泪、鼻堵及 /或Ｈｏｒｎｅｒ综合征。丛集期持续数周至数月。好发于男性。无家族遗传史。为罕见的头痛类型。发病机理认识丛集性头痛已有约 2 5 0年 (Ｉｓｌｅｒ ,1993) ,但其发病机理仍不清楚。Ｅｋｂｏｍ(1970年 )首先发现在丛集性头痛患者…     

高压氧治疗丛集性头痛

丛集性头痛是一种特殊类型偏头痛,因其疼痛剧烈,难以忍受,严重影响患者的生活质量。以往对丛集性头痛无特效治疗,一般多给予麦角胺制剂、苯噻啶、心得安和中成药等口服,可减轻部分患者的症状,但不能终止其发作。为探讨高压氧(HBO)对其治疗的疗效,1999-01/2001-123年间对20例患者行HBO治疗。     

丛集性头痛96例临床分析

由于丛集性头痛易误诊为其它类型的头痛,因此本文分析了本院1989年～1995年96例丛集性头痛,以共同提高对本病的认识。 1 临床资料 1.1 一般资料 年龄与性别:男72例,女24例,男女之比为3∶1。起病年龄25岁～48岁,平均年龄36∶5岁,其中30岁～40岁占绝大多数(70％)。 1.2 临床表现 1.2.1 头痛发作频数 多数患者(72例),每日发作1次,隔日发作1次者18例,每日发作超过2次者6例。发作持续时间平均80分钟。 1.2.2 头痛部位和性质 92例为1侧头痛,有4例为整个头痛,其疼痛性质为严重头痛,主诉为刀割或烧灼感,患者难以忍受、坐立不安。多数患者(72例)伴同侧流泪、流涕、鼻塞和眼结膜充血。     

丛集性头痛的脑血流研究

用ＴＣＤ脑血流分析技术对丛集性头痛患者丛集期之无头痛时与头痛时的脑血流速度（ＭＦＶ）进行了研究。患者共１８例，均为男性，平均年龄３０．０±５．６岁。正常对照组也均为男性，平均年龄３２．８±９．９岁。以ＴＣＤ测定了颅内双侧ＭＣＡ、ＡＣＡ、ＰＣＡ以及ＢＡ的ＭＦＶ。结果发现：（１）无头痛时，患者诸动脉之ＭＦＶ与正常对照组比较均无显著差异；（２）头痛时，其痛侧ＭＣＡ之ＭＦＶ与非头痛侧的ＭＦＶ比较显著升高（Ｐ＜０．０１），ＡＣＡ则相反，即显著降低（Ｐ＜０．０１）；头痛时，头痛侧与该侧非头痛时比较，头痛时ＭＣＡ的ＭＦＶ显著高于非头痛时（Ｐ＜０．０１），而ＡＣＡ则相反（Ｐ＜０．０１）。结果表明：丛集性头痛在丛集期头痛时颈内动脉系统之主要分支确有血管收缩，也有扩张的表现。并对其发病机理进行了探讨。     

中国丛集性头痛流行病学调查

对全国２６个省、自治区（除台湾省）以１９８６年６月３０日零时为始点进行了丛集性头痛（ＣＨ）流行病学调查。城市按半数区多级抽样到居委会，农村按论证选点，全国共１３５处调查点，每调查点人群不少于２．５万人，共调查了３４５７１７０人，按最新国际诊断标准，查出ＣＨ患者２３６例，其患病率、１９８２年中国人口标化率和世界人口标化率分别为６．８／１０万、４．７９８／１０万和５．０３６／１０万；男性分别为１１．７     

丛集性头痛基因遗传学研究进展

丛集性头痛是一种疼痛性质非常剧烈的相对少见的原发性头痛,其病因及发病机制仍未完全阐明。有研究认为丛集性头痛的发生是基因遗传与环境多种因素共同作用的结果。本文对近年来基因遗传学与丛集性头痛的研究进行综述。由于丛集性头痛发病率相对较低、病因复杂,使基因遗传学研究相对困难。虽然大部分试验结果是阴性的,但有研究发现:ADH4基因(rs1126671)、CLOCK基因(rs12649507)和HCRTR2基因(rs2653349)多态性与丛集性头痛发病相关。     

穴位注射法治疗丛集性头痛24例

目的:观察穴位注射法治疗丛集性头痛的疗效。方法:取穴：头维、阳白；药物：地塞米松 20g／L普鲁卡因，每穴注射1mL的混合液。疗程：1个疗程8～16d天共注射4次，每次治疗的间隔时间为隔日1次或每4d 1次。结果:共治疗24例丛集性头痛患者：1次治疗后头痛发作停止者5例(5／24，20．8％)；2次治疗后头痛发作停止者11例(1l／24，45．8％)；3次治疗后头痛发作停止者5例(5／24，20．8％)；4次治疗后头痛发作停止者1例(1／24，4．16％)。故在1个疗程内发作被控制者91．6％(22／24)，还有2例于6次治疗后头痛发作被控制。结论:穴位注射法治疗丛集性头痛简便、安全、经济、有效。     

丛集性头痛1例并文献复习

回顾性分析1例丛集性头痛患者的临床资料及相关文献,探讨丛集性头痛的临床特点,提高对疾病的认识。42岁女性患者,反复头痛6天,每天发作1~2次,持续2~3小时,表现为左侧持续性剧烈头痛,伴左眼流泪,入院体格检查、实验室检查及影像学检查排除其他原因引起的头痛。根据患者结合头痛发作频率、症状、体征及影像学检查,考虑丛集性头痛可能,予以泼尼松治疗后症状消失,随诊六个月无复发。丛集性头痛可通过药物及避免诱因来预防发作,其急性发作期主要治疗方法有药物、手术及微创治疗等。     

Low plasma testosterone levels in cluster headache

Serum levels of various hormones have been estimated in cluster headache and non-cluster headache controls. Cluster headache patients were studied prior to, during, and after attack. During the cluster phase, plasma testosterone levels were low, whereas levels were within the reference limits. Normal values were also found in control patients with non-cluster headache. It is suggested that a decrease of plasma testosterone levels in episodic cluster headache should be viewed in context with disordered REM sleep in cluster headache.     

Reduced testosterone levels in cluster headache: a stress-related phenomenon?

The circadian changes in testosterone (T) and cortisol secretion and morning luteinizing hormone (LH) levels were evaluated in nine episodic cluster headache (CH) patients in active phase and in seven healthy volunteers, with collection of blood samples every 2 h for 24 h. CH showed a significant reduction of the 24-h integrated mean T value (mesor) (4.4 + 1.1 ng/ml; chi +/- SD) in comparison with controls (6.6 +/- 0.8 ng/ml) (P less than 0.01). Both groups had plasma T circadian rhythm with peak values in early morning, but in CH single cosinor analysis showed its absence in three out of nine CH patients. The rhythm showed an acrophase delay of 101 min in CH. Both patients and controls had a significant circadian rhythm of plasma cortisol concentration. CH patients, however, showed an acrophase delay of 106 min and significantly increased concentrations from 1200 h to 2000 h. Morning LH values were similar in the two groups. The reduced secretion of plasma T in CH patients in the active phase coexisted with an acrophase delay of its circadian rhythm. A similar delay was found in 24-h plasma cortisol levels. We suggest that stress accompanying attack expectancy in the active phase is the mechanism behind the elevated plasma cortisol levels. This in turn could reduce T concentrations, acting at the testicular level. These disturbances in internal chronoorganization support the hypothesis that cluster headache is basically a dyschronic disorder.     

Quantitative evaluation of photophobia and phonophobia in cluster headache

In order to evaluate photophobia and phonophobia in cluster headache (CH), light and sound-induced discomfort and pain thresholds were measured quantitatively in 50 patients and 50 sex-matched and age-matched headache-free controls. During bout (i.e., during the active period with attacks), CH patients were more sensitive to light and sound than controls ( p <0.00l). Outside bout they did not differ significantly from controls except for binaural stimulation. Patients were more photophobic and phonophobic during bout than in the remission period ( p 0.05). However, for those tested during bout, the sensitivity to light and sound was not related to the presence of pain during test, usual pain intensity, or pain laterality. In response to a questionnaire about their sensitivity, a significantly higher proportion of patients considered themselves sensitive during bout than outside (91% vs 46% for light [χ²=5.9, p <0.05] and 89%, vs 49% for sound [χ²=4.7, p <0.05]). These results indicate that photophobia and phonophobia are important accompanying phenomena of cluster bouts.     

Valsalva-induced cluster headache

A case valsalva-induced cluster headache is presented. Cluster attacks induced by valsalva manoeuvres alone were only recently described, and such patients have features of cough headache and cluster headache. Attacks occurred a couple of times a week in the patient presented, solely triggered by valsalva manoeuvres including coughing, sneezing or straining and not by exercising.     

Epidemiology of cluster headache

Cluster headache was first described over 300 years ago, but in the last century our knowledge of the disorder has exploded through both clinical observation and epidemiological data. Although some of the data are conflicting and more need to be obtained, much is known about the disorder. This article reviews the data to date on the prevalence and incidence of the disorder, population differences including gender and race, genetics, comorbid conditions, risk factors for development of the disorder, prognosis, and socioeconomic burden.     

Burden of cluster headache

The aim was to analyse the socioeconomic burden of cluster headache in patients from a tertiary headache centre. One hundred consecutive patients from the Danish Headache Centre were invited to an interview about the socioeconomic impact of cluster headache. Work absence and use of medical services were compared with a Danish population-based survey. Eighty-five patients participated; 78% reported restrictions in daily living and 13% also outside of cluster periods; 25% reported a major decrease in their ability to participate in social activities, family life and housework. The disease caused lifestyle changes for 96%, most frequently in sleeping habits and avoidance of alcohol. The absence rate among patients was 30%, which was significantly higher than 12% among the general population (P < 0.001). Use of health services due to headache was also higher among the patients (P < 0.001). Cluster headache, although periodic in most cases, has considerable impact on social functions, quality of life and use of healthcare.