合理用药防治药物滥用性头痛的有效性评价

目的:探讨合理用药防治药物滥用性头痛的有效性.方法:选取2017年9月到2019年3月我院收治的116例药物滥用性头痛患者,采用随机数字表法将其分为对照组(n=58)与试验组(n=58),对照组施以常规用药管理,试验组在常规基础上施以合理用药管理,观察两组患者的临床治疗效果、患者的满意度情况及患者关于合理用药知识的掌握...     

头痛粉中阿斯匹林、非那西丁和咖啡因含量测定方法比较

头痛粉是民间常用的解热止痛药，其功效为解热镇痛。部分省市药品标准’‘”均有收载，但含量测定方法为化学法，操作复杂、费时。本文采用高效液相色谱法，以扑热息痛为内标；同时测定头痛粗中阿斯匹林、非那西丁和咖啡因的含量，与药典方法比较，本法简便、快速、重现性好，结果可靠，适用于头痛粉制剂的定量分析。目实验材料11药品与试剂：阿斯匹林、非那西丁和咖啡因对照药品均符合《中国药典》1990年版规定，内标物扑热息痛和样品由重庆制药厂提供。冰醋酸、甲醇为分析纯，水为重蒸馏水。1．2仪器：日本岛津LC－10AD泵，SPD－10A紫…     

硬币性头痛七例报告

硬币性头痛(Nummular headache,NH)首先由Pareja等[1]在2002年报道。本文介绍7例NH的临床表现、可能病因及治疗方法,旨在普及对NH的认识。     

头痛性癫痫100例分析

头痛是临床常见的症状,头痛性癫痫则是头痛的一种特殊类型。从众多的头痛病人中识别此症,对其病人的治疗有其重要意义,为此我们报告100例头痛性癫痫,分析其诊断和鉴别诊断的特点。 1 诊断标准:①头痛突然发生,突然中止,间歇期完全正常。②头痛反复发作,剧烈难忍,每次发作症状相似。③自发或诱发脑电图出现棘波或较多慢波。④抗痫治疗有效。 2 临床资料:①本组100例男62例,女38例,年龄4岁—52岁,平均13.64±3,82岁。②头痛部位两额区疼(30％)、颞部疼(25％)、枕部疼(7％)、全头痛(14％)、部位不清(16％)、。③     

药物滥用所致脑损伤及脑治疗研究进展

美国药物滥用研究所 ( National Institute on DrugAbuse,NIDA)多年的研究表明药物滥用对大脑有损伤 ,特别是近年来发现滥用甲基苯丙胺 (即“冰”毒 )导致的脑损伤比以前想象的要广泛得多。为此 ,NIDA将如何使滥用药物后出现的脑功能改变恢复正常作为重点进行研究。下面就 NIDA     

综合治疗颈性头痛68例

头痛是临床常见症状之一,由颈椎间盘,椎间关节等骨性病变及周围软组织损伤引起的头痛称为颈性头痛。主要病理变化是颈椎失稳,关节紊乱而导致一侧或两侧椎枕肌群痉挛,从而压迫或刺激枕大神经、枕小神经、耳大神经引起疼痛。2006年～2008年笔者运用针刺与推拿治疗颈性头痛68例,疗效满意,现分析如下：     

1427例药物滥用者的流行学调查

采用卫生部药物滥用监测中心统一印制的《药物滥用监测登记表》,于１９９６年１月至１２月对贵阳市和毕节地区两所戒毒机构收治的１４２７例药物滥用者调查登记。统计结果显示：男性、未婚、初中文化程度、２０－２９ａ年龄段的无业、工人和个体者是滥用药物主要人群;滥用药物１年内占６２．６５％;烫吸是主要滥用方式,滥用的主要药物是海洛因;多种药物滥用现象严重,药物主要来自“黑市”     

鼻源性头痛误诊为血管神经性头痛12例分析

我院从2000～2003年共收治因鼻腔解剖异常所致的头痛(鼻源性头痛 )误诊为血管神经性头痛12例 ,现分析如下 :1临床资料1.1一般资料 :本组12例中 ,男5例 ,女7例 ,年龄21～58岁 ,病程3个月～10年。1.2就诊过程 :12例病人首诊门诊内科 ,均先后作脑电图、头颅CT、副鼻窦摄片、副鼻窦     

儿童期复发性头痛误诊为头痛性癫痫的原因分析

复发性头痛是儿科神经专业门诊常见的主诉,病因众多,其中最常见的为偏头痛,而头痛性癫痫甚为罕见。但在临床实践中,屡屡见到因头痛被诊为癫痫进行治疗的儿童。现将16例患儿的资料进行分析,以期进一步提高临床医生对头痛性癫痫特点的了解,减少误诊误治。1　临床资料1.1　一般资料:1998年2月至1999年2月以头痛为主诉,且已在院外被诊为头痛性癫痫用药治疗的患儿16例,男9例,女7例,年龄8～15岁。其中5例用抗癫痫中药治疗,其余分别用苯妥英钠、卡马西平、丙戊酸钠、苯巴比妥等,治疗时间3～9个月。1.2　脑电图:16例患儿均有不同程度的脑电图异常,其…     

Endocannabinoids in platelets of chronic migraine patients and medication-overuse headache patients: relation with serotonin levels

Background Chronic migraine (CM) and medication-overuse headaches (MOH) are well-recognized disabling conditions affecting a significant portion of the headache population attending centers specialized in treating headaches. A dysfunctioning of the serotonergic system has been demonstrated in MOH and CM patients. Here we report on our assessment of the dysfunctioning of the endocannabinoid system as a potential underlying factor in pathogenic mechanisms involved in CM and MOH. Method To test the hypothesis of an impairment in the endocannabinoid system in patients with MOH and CM and to assess its relationship with any disruption of the serotonergic system, we determined the levels of the two main endogenous cannabinoids, anandamide (AEA) and 2-acylglycerol (2-AG), in platelets of 20 CM patients, 20 MOH patients and 20 control subjects and also measured the platelet serotonin levels in the same patients. Results We found that 2-AG and AEA levels were significantly lower in MOH patients and CM patients than in the control subjects, without significant differences between the two patient groups. Serotonin levels were also strongly reduced in the two patient groups and were correlated with 2-AG levels, with higher values for MOH patients. Conclusion These data support the potential involvement of a dysfunctioning of the endocannabinoid and serotonergic systems in the pathology of CM and MOH. These systems appear to be mutually related and able to contribute to the chronification of both CM and MOH.     

丹珍头痛胶囊治疗高血压头痛68例临床观察

目的：探究丹珍头痛胶囊治疗高血压头痛的临床疗效。方法高血压头痛患者68例采用随机数字表法分为治疗组（n ＝38）和对照组（n ＝30）。对照组单采用常规降压治疗;治疗组在对照组基础上加用丹珍头痛胶囊治疗。比较两组临床疗效。结果治疗组高血压头痛症状得到缓解的总有效率显著高于对照组（84．21％比53．33％）,差异有统计学意义（χ2＝7．992,P ＜0．05）,且无毒副反应。结论丹珍头痛胶囊治疗高血压头痛疗效肯定,可作为改善临床症状的首选药,值得临床进一步研究和推广。     

观察普瑞巴林对因药物过度使用而致头痛患者的疗效

目的观察普瑞巴林治疗因药物过度使用而致头痛的疗效。方法 69例符合偏头痛和药物过度使用头痛患者,每次口服普瑞巴林75～150 mg,每日2次,连用3周后,缓慢停药;观察期间,每晚口服盐酸氟桂利嗪5 mg,连用12周。记录治疗前后患者头痛发作频率、头痛持续时间、严重程度和治疗后药物不良反应。测定治疗前后生命质量测定量表(SF-36)、视觉模拟评分法评分(VAS),以评定疗效。结果普瑞巴林治疗后,患者头痛发作频率、头痛持续时间、头痛严重程度以及生命质量测定量表评分均有明显改善(P﹤0.01)。结论普瑞巴林可以改善药物过度使用性头痛患者停用止痛药物后的症状,改善患者的生命质量和头痛程度。     

长春西汀治疗外伤性蛛网膜下腔出血所致头痛的疗效分析

目的:观察长春西汀治疗外伤性蛛网膜下腔出血的临床疗效.方法:将外伤性蛛网膜下腔出血患者90例分为两组,对照组45例仅行腰穿脑脊液置换及常规治疗,治疗组45例在行腰穿脑脊液置换、常规治疗基础上,加用长春西汀治疗,疗程14天.结果:治疗组头痛缓解有效率(93%)高于常规治疗组(71%)(P＜0.05).结论:长春西汀对外伤性蛛网膜下腔出血所致头痛疗效显着,可推广应用.     

The efficacy of goshuyuto,a typical Kampo (Japanese herbal medicine) formula,in preventing episodes of headache

ABSTRACT

Objective: The purpose of this clinical trial was to assess the efficacy of goshuyuto, a typical Kampo formula, in preventing episodes of headache in chronic headache patients.

Research design and methods: Because the treatment target of a Kampo formula is decided on a basis different to that of Western medicine, we first selected patients belonging to a subgroup that responded to goshuyuto before conducting the usual randomized controlled trial. During stage 1, the subjects were instructed to orally consume goshuyuto for 4 weeks. Only those subjects judged as responders advanced to stage 2, during which a double-blind, randomized, placebo-controlled study was conducted. The subjects consumed the same dose of goshuyuto or placebo for 12 weeks.

Results: Of the 91 subjects enrolled in stage 1, 60 were judged as responders. Of these, 53 advanced to stage 2; 28 were assigned to the goshuyuto group and 25 to the placebo group. The decrease in the number of days on which headache episodes occurred was greater in the goshuyuto group than in the placebo group (2.6 ± 3.7 vs. 0.3 ± 4.0 days, p = 0.034); no difference was observed with regard to the reduction in the frequency of consuming reliever medications (2.2 ± 4.0 vs. 1.4 ± 8.2, p = 0.672). Improvement in the associated symptoms was observed in more than 50% of the subjects in the goshuyuto group.

Conclusion: Goshuyuto is useful in preventing episodes of headache in chronic headache patients. Responder-limited design is a candidate for evaluating Kampo medicine.     

奥扎格雷联合头痛宁胶囊治疗112例血管性头痛的临床观察

目的探讨奥扎格雷治疗血管性头痛的临床疗效。方法选取2006年3月至2011年3月在我院治疗的224例血管性头痛患者,随机均分为观察组和对照组,两组均给予头痛宁胶囊治疗,观察组加用奥扎格雷注射液治疗,对照组给予川芎嗪辅助治疗,比较两组治疗效果。结果观察组控制率为63.39%,总有效率为90.18%;对照组控制率为9.82%,总有效率为69.64%,观察组控制率、总有效率、日常生活情况、活动能力、生活感受、健康感受、家庭支持评分及总分明显高于对照组,差异显著(P<0.05)。结论奥扎格雷应用于血管性头痛的治疗可明显提高疗效,值得临床推广应用。     

Pregnancy and chronic headache

Headache patterns in women change in relation to fluctuations in oestrogen levels. Increasing oestrogen levels in early pregnancy offer a protective effect against headache, particularly for women with migraine. However, some women continue to experience troublesome headache throughout pregnancy. Headache persisting at the end of the first trimester will usually continue without improvement for the remainder of pregnancy and should be treated. Safe and effective acute care treatment options include paracetamol, opioids and anti-emetics. The use of triptans during pregnancy is controversial and not broadly recommended. Safe and effective preventive treatments include relaxation, biofeedback, β-blockers, some antidepressants and gabapentin in early pregnancy.     

Treatment of paediatric headache

Headaches are very common during childhood and become increasingly frequent during adolescence. The diagnosis of primary headache disorders (e.g., migraine and tension-type headache) rests principally on clinical criteria as set forth by the International Headache Society. Treatment options include acute or episodic measures, prophylactic agents and non-pharmacological or behavioural interventions. From review of available evidence, the most efficacious acute treatments of paediatric migraine include the non-steroidal anti-inflammatory agent ibuprofen at 7.5 – 10 mg/kg/dose or nasal sumatriptan at doses of 5 or 20 mg. For those patients with headaches that occur with sufficient frequency and severity to warrant daily prophylaxis, controlled data are limited. Agents which are likely to be beneficial include amitriptyline, flunarizine (not available in the US) and cyproheptadine. Clinical experience with the anti-epileptic agents topiramate and valproate suggests an expanding role for the prevention of paediatric migraine in the future.     

Evaluation of alternative statistical models for crossover studies to demonstrate caffeine adjuvancy in the treatment of tension headache

This paper discusses alternative statistical models for the analysis of six crossover studies to determine whether better relief of tension headache occurs from treatment with an analgesic plus caffeine (C) than with the analgesic alone (A) or with placebo (P). Each patient in these crossover studies randomly received a pair of distinct medications in such a way as to treat the first two of four headaches with the initial medication in the pair and to treat the third and fourth headaches with the last medication in the pair. In order to have greater power for the C versus A comparison, three times as many patients were randomly assigned to the A:C and C:A sequence groups as to the A:P, C:P, P:A, and P:C sequence groups.

An issue of statistical interest for these crossover studies is the extent to which the possibility of unequal carryover effects of the three medications influences the roles of alternative models for data analysis and the interpretation of results. When carryover effects for all three medications are equal, univariate analysis of variance for the difference scores between the average response for the first two headaches and the average response for the third and fourth headaches for each patient provides nearly the same power for pairwise treatment comparisons as more comprehensive multivariate methods for all four headaches. However, for comparisons concerning carryover effects and for treatment comparisons with adjustment for carryover effects, multivariate methods encompassing all four headaches jointly can provide greater power than univariate analysis for difference scores, particularly when there is low intraclass correlation for responses within the same patient. Another noteworthy role for multivariate methods in situations with potentially unequal carryover effects is their capacity to clarify whether multiple types of carryover effects occur across the second, third, and fourth headaches in the respective sequence groups.

Multivariate models with alternative specifications of carryover effects are fit to the data from the six crossover studies to compare C, A, and P by weighted least squares. The role of potential variation among centers is addressed in these analyses by the use of stratified proportional means over centers, means of center means, and means ignoring centers. The primary focus of attention in the respective analyses is the evaluation of treatment comparisons with and without adjustment for potential differences among carryover effects of the treatments. Comparisons among carryover effects are assessed as well, but they mainly serve a background purpose since the principal issue is the extent to which findings for treatment comparisons are similar across alternative ways of accounting for potential carryover effects.

For all models, the average predicted response across all headaches treated with C was significantly better than that for A or P. For models that adjusted treatment effects for carryover effects in a statistically efficient way, the adjusted direct treatment effect of C was significantly better than that of A or P. Thus, the superiority of C over A found robust support from models both with and without adjustment for potential differences among carryover effects of the treatments.     

Therapeutic options in the management of headache attributed to rhinosinusitis

Sinus headache is a common diagnosis when patients have facial pain and pressure accompanying their headache. However, acute sinus headache is in fact rare, and the headache must accompany acute bacterial rhinosinusitis (ABRS), a diagnosis which is based both on clinical and radiological evidence. In fact, sinus headache is a misnomer. The only headache related to sinus disease, as recognised by the International Headache Society (IHS), is headache attributed to rhinosinusitis (HARS; section 11.5 of IHS criteria). Many patients who are diagnosed with sinus headache and treated with antibiotics have a primary headache, usually migraine. This is an important distinction and the treatment is very different. This review covers the most recent definitions, epidemiology, pathophysiology, diagnostics and treatment of ABRS and the resulting headache as defined by the IHS.