血管性头痛165例TCD分析

血管性头痛是临床上一种常见病、多发病,为了解血管性头痛患者的血流动力学情况、了解其血管状态,我们利用经颅多普勒技术（ＴＣＤ）对１６５例临床诊断为血管性头痛患者进行分析,结果报道如下。１　资料与方法１－１　一般资料　本组１６５例均来自我院门诊和住院患者,男４２例,女１２３例,年龄１６～５５岁,平均３５－８岁,病程３个月至３０年以上。１－２　临床表现　患者均有反复发作性头痛史,每次发作的性质和过程相似,发作间歇期正常。疼痛呈搏动性,大多局限在一侧或从一侧开始扩展到双侧甚至全头部,疼痛可持续数小时至数…     

中老年头痛患者TCD检查分析

头痛与脑血管疾病之间有明显的相关性，现代经颅超声多谱勒(TCD)对脑血管疾病的检测技术已从单一的颅外血管转为颅内外各主要血管的联合检测。本通过对699例TCD受检的资料分析，探讨头痛与颅内外血管严重狭窄或闭塞的相关性。     

头痛儿童颅多普勒超声检测33例分析

对我院头痛儿童经颅多普勒超声（TCD）检测33例分析如下。     

TCD傅里叶分析对临床检测正常值确定的意义

ＴＣＤ傅里叶分析对临床检测正常值确定的意义李英秋①经颅多普勒超声（ＴＣＤ）能通过脑血流速度变化来间接反映脑血流量变化，但不能直接测量脑血管的横截面积。德国产ＴＣ－２０００彩色经颅多普勒超声诊断仪新增添了傅里叶分析软件系统，该系统能实时显现所测血管的相...     

尼莫地平治疗脑血管痉挛性头痛500例经颅多普勒(TCD)观察

头痛是临床上极为常见的一种症状,其中以血管性头痛占多数。我院自1995年5月引进TCD仪器,检测出血管性头痛900例,其中发现有脑血管痉挛所致的有500例,均采用尼莫地平进行治疗,并应用TCD检测治疗后的脑血管血流变化与临床症状的改变来加以确定疗效,现报道如下:     

血管性头痛患者87例的经颅多普勒与脑电图对比分析

目的探讨经颅多普勒（TCD）与脑电图（EEG）在诊断血管性头痛中的作用。方法对87例血管性头痛患者同时做TCD与EEG检测，分别观察其相应变化，对比分析其结果。结果血管性头痛患者TCD检测异常率高（92．0％），EEG异常率低（12．6％）。结论TCD对血管性头痛患者的诊断及其分类具有重要的参考价值。     

TCD对烟雾病的脑血流检测分析

烟雾病是由于先天性或获得性各种脑血管疾病引起颅底动脉异常血管网形成导致的脑血管病理改变。通过对５０００例患者的脑血流检查获得了１５例烟雾病患者的颅内、外动脉的血流动力学变化特征，提出采用无创的ＴＣＤ检查手段，对烟雾病患者的脑血流追踪观察，达到早期诊断烟雾病的目的，具有重要的临床意义。     

经颅多普勒诊断血管性头痛86例分析

我院自 1997- 0 7～ 2 0 0 0 - 0 7采用德国 EME公司 BL T-2 0 0 0 A型经颅多普勒 (TCD)仪 ,用 2 MHz型脉冲多普勒探头检测 ,并进行光谱分析如下。1　临床资料本组男 34例 ,女 5 2例 ,年龄 7～ 4 6岁 ,平均 2 6岁。1a以内31例 ,1～ 10 a2 9例。>10 a2 6例。临床表现 :为发作性头痛伴头晕、恶心、呕吐 ,经神经系统检查未发现阳性体征。所有入选患者 ,血糖、血脂在正常范围 ,眼底检查排除动脉硬化 ,MRI或 CT排除了颅内器质性病变。临床追踪观察血管性头痛 37例 ,经服用尼莫地平或西比灵临床症状明显改善后 ,复查 TCD。本组 38例脑动脉…     

TCD对头晕或眩晕患者脑血管病变的分析

目的分析神经科门诊头晕或眩晕患者颅内外血管狭窄发生频率,以及狭窄血管的分布情况,探讨导致头晕或眩晕的动脉狭窄原因。方法对2001年1月~2001年12月神经科门诊筛选主诉为头晕或眩晕,且无其他神经系统局灶体征者1676例。应用经颅多普勒超声(TCD)检测颅内Willis环及颅外颈部血管。结果(1)202例有脑血管的狭窄,血管狭窄的发生率为202/1676(12.10%)。其中,单纯颈动脉系统血管病变的发生率45.05%,高于单纯椎基底动脉系统32.18%(P<0.01);(2)椎动脉狭窄者占11.88%,其中,单侧椎动脉病变占79.167%,左右无明显差别;3.锁骨下动脉狭窄者占32.673%,其中伴盗血综合征者为28.79%。结论临床上不能仅仅简单的把单纯头晕或眩晕患者诊断为功能性疾病或椎基底动脉供血不足。     

TCD诊断短暂性脑缺血发作87例分析

目的探讨短暂性脑缺血发作(TIA)急性发作期的经颅多普勒(TCD)改变,评价TCD在诊断TIA中的临床价值。方法选用2MHz PW对87例TIA患者经枕窗、颞窗探测颅内血管,检测血管的血流速度、血流方向、声频、频谱形态及各项脉动指标。结果TIA在急性发作期脑血管血流速度轻、中度升高51例,高度升高者21例。轻度脑动脉硬化者57例,高阻型动脉硬化8例,动脉硬化合并血流速升高者43例,8%的患者出现血流速减低。结论TCD是诊断TIA有效、可靠、简便的检测手段。     

小儿川崎病62例临床分析

川崎病(KD)是一种以全身血管炎为主要病理改变的急性发热出疹性疾病,由于其心血管系统并发症而日益受到重视。鉴于早期诊断应用丙种球蛋白和阿司匹林可防止或减轻心血管并发症,所以,对于早期诊断及非典型病例的认识更为重要。我科于1989~2005年共收治川崎病62例,现报告分析如下     

Medication-overuse headache in patients with cluster headache

Cluster headache (CH) is associated with the most severe pain of the primary headache disorders. Barriers to optimal care include misdiagnosis, diagnostic delay, undertreatment, and mismanagement. Medication-over-use headache (MOH) may further complicate CH and may present as increased CH frequency or development of a background headache, which may be featureless or have some migrainous quality. A personal or familial history of migraine appears to be strongly associated with the development of MOH in CH, at least with the phenotype of background headache. Patients with CH, especially those with a personal and/or family history of migraine, must be carefully monitored for MOH, and medication withdrawal should be considered if a CH patient presents with features of MOH.     

Muscle hardness in patients with chronic tension-type headache: relation to actual headache state

It has recently been reported that the pericranial muscles in patients with chronic tension-type headache are harder, i.e. have a higher consistency, than in controls. The primary aim of the present study was to investigate whether muscle hardness is influenced by the presence or absence of actual headache and whether hardness is correlated to tenderness. The secondary aim was to compare muscle hardness between patients and healthy controls. Hardness of the trapezius muscle was measured with a hardness meter in 20 patients with chronic tension-type headache and in 20 healthy controls. The patients were examined on 2 days, 1 day with headache and 1 day without headache. Pericranial myofascial tenderness was recorded with manual palpation. In addition, muscle hardness was measured in another five patients out-side headache and in 30 healthy controls. The muscle hardness recorded in patients (n = 20) on days with headache, 98 +/- 26 kPa/cm, did not differ significantly from the muscle hardness recorded on days without headache, 100 +/- 21 kPa/cm, (P = 0.62). The muscle hardness was positively correlated to the local tenderness score recorded from the trapezius muscle both on days with headache (R = 0.52, P = 0.02) and on days without headache (R = 0.53, P = 0.02). The total tenderness score (TTS) recorded in patients on days with headache, 23 +/- 10, was significantly higher than the TTS recorded on days without headache, 15 +/- 11, (P = 0.0001). There was a significant difference between the TTS recorded in patients without headache, 15 +/- 11, and in controls, 4 +/- 4, (P = 0.002). The muscle hardness was significantly higher in patients on days without headache (n = 25), 97 +/- 20 kPa/cm, than in controls (n = 30), 87 +/- 16 kPa/cm (P = 0.03). On basis of previous and present results, we suggest that muscle hardness and muscle tenderness are permanently altered in chronic tension-type headache and not only a consequence of actual pain. In addition, the positive correlation between muscle hardness and tenderness supports the common clinical observation that tender muscles are harder than normal muscles.     

Acupuncture in patients with headache

We aimed to investigate the effectiveness of acupuncture in addition to routine care in patients with primary headache (> 12 months, two or more headaches/month) compared with treatment with routine care alone and whether the effects of acupuncture differ in randomized and non-randomized patients. In a randomized controlled trial plus non-randomized cohort, patients with headache were allocated to receive up to 15 acupuncture sessions over 3 months or to a control group receiving no acupuncture during the first 3 months. Patients who did not consent to randomization received acupuncture treatment immediately. All subjects were allowed usual medical care in addition to study treatment. Number of days with headache, intensity of pain and health-related quality of life (SF-36) were assessed at baseline, and after 3 and 6 months using standardized questionnaires. Of 15 056 headache patients (mean age 44.1 ± 12.8 years, 77% female), 1613 were randomized to acupuncture and 1569 to control, and 11 874 included in the non-randomized acupuncture group. At 3 months, the number of days with headache decreased from 8.4 ± 7.2 (estimated mean ± s.e. ) to 4.7 ± 5.6 in the acupuncture group and from 8.1 ± 6.8 to 7.5 ± 6.3 in the control group ( P  < 0.001). Similarly, intensity of pain and quality of life improvements were more pronounced in the acupuncture vs. control group ( P  < 0.001). Treatment success was maintained through 6 months. The outcome changes in non-randomized patients were similar to those in randomized patients. Acupuncture plus routine care in patients with headache was associated with marked clinical improvements compared with routine care alone.     

Trigemino-cervical reflex in patients with headache

Neurophysiological studies have shown abnormal activity of some brainstem nuclei in headache patients. The trigemino-cervical reflex is an anti-nociceptive reflex that gives an opportunity for evaluation of the brainstem interneurone activity. It has not been previously examined in headache patients. We studied 15 patients with predominantly unilateral chronic tension-type headache, 15 patients with migraine without aura and 32 healthy subjects. The trigemino-cervical reflex was recorded bilaterally from the resting sternocleidomastoid muscle using surface electromyographic recordings. In all headache patients the trigemino-cervical reflex on the painful side was with shortened latency compared with the non-painful side and with healthy persons. The results suggest decreased activity of the brainstem inhibitory interneurones. We suggest that although the pathophysiological mechanisms of tension-type headache and migraine are different, they share common mechanisms of abnormal pain control.     

Migraine in patients with cluster headache

One hundred and twenty seven patients with cluster headache have been compared with 122 patients with migraine. Twenty of the patients with cluster headache have had migraine attacks but only 2 still have migraine attacks after the onset of cluster headache. No migraine patients had cluster headache. Among the 127 patients with cluster headache, one of the parents suffered from cluster headache in 4.7% of the cases. Among the 122 patients with migraine, 0.8% had a parent with cluster headache. Among the 122 patients with migraine 54.9% had parents with migraine, and in the cluster headache group 23.6% of the patients had one parent with migraine. The coexistence of migraine and cluster headache is rare. The two types of headache, as far as the heredity pattern is concerned, are independent entities.     

Psychiatric comorbidity in medication overuse headache patients with pre-existing headache type of episodic tension-type headache.

BACKGROUND: Medication overuse headache (MOH) mostly evolves from migraine and episodic tension-type headache (ETTH). Chronic tension-type headache (CTTH) is another headache type that evolves over time from ETTH. It is well known that psychiatric comorbidity is high in MOH patients. AIM: To investigate the frequency of psychiatric comorbidity, and the intensity of depression and anxiety in MOH patients evolving from ETTH and to compare results with CTTH patients and MOH patients evolving from migraine. METHODS: Twenty-eight CTTH (Group C) and 89 MOH patients were included into the study. MOH patients were divided into two groups according to their pre-existing headache types: MOH patients with pre-existing ETTH (Group E, n = 31), and with pre-existing migraine (Group M, n = 58). All patients were interviewed with a psychiatrist and SCID-CV and SCID-II were applied. Beck Anxiety Inventory and Beck Depression Inventory scales were also performed. RESULTS: Eleven patients (39.3%) in Group C, 21 patients (67.7%) in Group E, and 31 patients (53.7%) in Group M were diagnosed to have comorbid psychiatric disorders. The psychiatric comorbidity was found significantly higher in Group E than Group C. In Group E, mood disorders were found significantly higher, but the difference between the two groups with regard to anxiety disorders was insignificant. Mean depression scores were significantly higher in Group E than Group C. The mostly diagnosed type was obsessive-compulsive personality disorder in all the three groups, and was statistically significant in Group M than Group C. CONCLUSION: Psychiatric comorbidity in MOH patients with pre-existing ETTH is common as in those with pre-existing migraine headache and MOH with regard to developing psychiatric disorders should be interpreted as a risk factor in chronic daily headache patients.     

Possible mechanisms of glyceryl-trinitrate-induced immediate headache in patients with chronic tension-type headache

Nitric oxide (NO) plays an important role in the pathophysiology of primary headaches including chronic tension-type headache (CTTH). Thus, a NO synthase inhibitor reduces headache and muscle hardness while the NO donor glyceryl trinitrate (GTN) causes more headache in patients than in healthy controls. Sensitization of myofascial pain pathways is important in CTTH, and the aim of the present study was to investigate if such mechanisms may also explain GTN-induced immediate headache in patients with CTTH. In a randomized, double-blind, crossover study 16 patients with CTTH and 16 healthy subjects received intravenous infusion of GTN (0.5 microg/kg per min for 20 min) or placebo on two headache-free days separated by at least 1 week. Muscle hardness, myofascial tenderness, mechanical and heat pain thresholds were measured at baseline and at 60 min and 120 min after start of infusion. In patients, GTN infusion resulted in a biphasic response with immediate headache and more pronounced delayed headache. A similar but less pronounced response was seen in controls. There was no difference between GTN and placebo regarding muscle hardness, myofascial tenderness or pressure and heat pain thresholds in either patients or controls (P>0.05). The unchanged sensitivity of pericranial myofascial pain pathways indicates that peripheral and central sensitization is not involved in the mechanisms of GTN-induced immediate headache.