头痛宁胶囊治疗紧张型头痛70例

目的探讨头痛宁胶囊治疗紧张型头痛的疗效。方法将119例患者随机分为观察组70例和对照组49例,观察组采用步长集团生产的头痛宁胶囊治疗,对照组采用盐酸乙哌立松治疗,比较两组患者的临床治疗效果和不良反应。结果头痛宁胶囊治疗紧张型头痛的总有效率为92.86%,高于对照组的总有效率65.31%,经χ2检验,差异有统计学意义(P<0.05)。观察组5例患者出现头胀痛、胃部不适等症状,均未影响治疗。结论头痛宁胶囊治疗紧张型性头痛疗效较好,值得临床推广。     

儿童原发性头痛研究进展

儿童原发性头痛主要包括偏头痛、紧张性头痛及丛集性头痛等,是儿童神经内科常见病。通常认为其发 病机制是遗传因素及环境因素共同作用所致。头痛反复发作严重影响了患儿的身心健康,给患儿、家庭、学校和社 会带来极大的负担。部分患儿可能发展为慢性每日头痛,甚至可能迁延至成年。因此,对患儿原发性头痛的正确诊 断及治疗极为重要。儿童原发性头痛需要生理和心理的共同关注,需要联合药物、心理、社会学等多学科治疗,需要 改善生活方式、避免诱发因素,多方面共同推进才能达到好的效果。本文就儿童原发性头痛的临床表现、诊断以及 治疗管理进行综述。     

步长头痛宁胶囊治疗顽固性血管神经性头痛疗效分析

目的观察步长头痛宁胶囊治疗顽固性血管神经性头痛疗效。方法采用头痛宁胶囊治疗门诊顽固性血管神经性性头痛患者50例。结果头痛宁胶囊治疗有效率74％。结论头痛宁胶囊治疗顽固性血管神经性性头痛疗效满意,值得推广应用。     

头痛的药物治疗

国际头痛学会第二版《头痛疾患的国际分类》将头痛疾患分为原发性头痛和继发性头痛。原发性头痛又分为偏头痛、紧张型头痛、丛集性头痛和其他三叉自主神经性头痛、其他原发性头痛,其中以前3种最为常见,主要疗法是药物治疗。本文重点介绍这3种原发性头痛的药物治疗。偏头痛的药物治疗偏头痛的药物治疗分为急性发作期治疗和预防治疗。急性发作期治疗适于所有的偏头痛发作,目的是尽快终止头痛发作、消除伴随症状;频繁发作的偏头痛需要预防性治疗,目的是降低偏头痛发作的频率、减轻头痛的严重程度、缩短发作的持续时间等。1.偏头痛急性发作期的…     

头痛散治疗血管性头痛33例

偏头痛是一种临床常见的神经科疾病。发病率占人群的0.4％以上,其中女性较多。临床表现为周期性发作性头痛,间歇期正常。一部分病人发作频繁,工作和生活受到严重影响,其发作机理尚未完全阐明,较多认为系发作性血管神经功能障碍所致,可能与血小板的功能改变有关。本科于1997年1～11月用自拟方头痛散治疗血管性头痛33例,并与尼莫地平治疗血管性头痛13例作对照,本文对此作一报道。     

硫酸镁治疗头痛疗效分析

目的：观察硫酸镁（MgSO4）静脉给药治疗神经内科常见头痛性疾病（包括偏头痛、脑卒中性头痛、高血压性头痛、紧张性头痛、丛集性头痛和与结构性疾患无关的头痛）的临床疗效。方法：用25%硫酸镁5ml加入10%葡萄糖20ml或10%硫酸镁10ml溶液静脉注入,每日1次,头痛缓解后可改用1～2.5g的MgSO4稀释成1%浓度溶液静脉滴注维持治疗,疗程5～7天。结果：显效50.0%,总有效率为86.4%。结论：硫酸镁静脉注射治疗血管源性头痛（偏头痛、丛集性头痛、高血压性头痛等）有显著疗效。     

头痛宁胶囊联合氟桂利嗪对丛集性头痛患者疼痛程度改善及生活质量的影响

目的:通过对比丛集性头痛(Cluster Headache,CH)采用不同的药物联合方案医治效果,探讨头痛宁胶囊结合氟桂利嗪用于临床治疗疗效,确定最佳的临床药物治疗措施.方法:研究以入院治疗的54例丛集性头痛患者(2015年1月～2017年1月)为对象,按照用药的差异,随机分成两组.采用头痛宁胶囊治疗的为常规组(27例),在应用该药物治疗的同时,使用氟桂利嗪医治的为治疗组(27例),分析两种药物治疗丛集性头痛对疗效影响.结果:对照组经用药医治头痛程度、头痛发作次数及丛集期变化程度均小于治疗组,治疗组用药后的生活质量评分(SF—36)显著高于对照组,差异有统计学意义(P<0.05).结论:丛集性头痛在服用头痛宁胶囊和氟桂利嗪后,不仅头痛次数减少了,头痛症状减轻了,而且日常生活能力越来越强,适合临床应用.     

头痛宁胶囊联合尼莫地平治疗高血压性头痛临床观察

目的 探讨头痛宁胶囊联合尼莫地平对原发性高血压性头痛的临床疗效.方法 将2011年6月至2012年1月期间收治的85例原发性高血压性头痛患者,随机分为治疗组45例和对照组40例,治疗组口服头痛宁胶囊4粒tid和尼莫地平片40 mg tid,对照组口服尼莫地平片40 mg tid.结果 治疗组总有效率91.6%,与对照组72.3%,2组比较差异有统计学意义(P<0.05).结论 头痛宁胶囊联合尼莫地平治疗高血压性头痛有良好疗效.     

原发性头痛82例临床分析

目的：分析各类原发性头痛患者的临床特点，研讨其流行情况和危害因素，了解其治疗概况，为该病的预防及诊断、治疗提供科学依据。方法82例临床诊断为原发性头痛患者的临床资料作回顾性研究，总结其人口特征、临床特点、治疗概况。结果在82例原发性头痛患者中紧张型头痛42例，所占比例最高约51.2%，且治疗效果一般；偏头痛其次，共约26例，占31.7%，治疗效果相对较好；丛集性头痛及其他原发性头痛共14例，占17.1%。结论在对原发性头痛的诊治时应加强对紧张型头痛、偏头痛的认识，需提高诊治水平，以改善原发性头痛患者的生活质量。     

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…     

Sodium valproate in migraine without aura and medication overuse headache: A randomized controlled trial

ObjectiveTo assess the efficacy, safety and tolerability of sodium valproate (800 mg/die) compared with placebo in medication-overuse headache patients with a history of migraine without aura.MethodsThis is a multicenter, randomized, double-blind, placebo-controlled study enrolled medication-overuse headache patients for a 3-month treatment period with sodium valproate (800 mg/day) or placebo after a 6 day outpatient detoxification regimen, followed by a 3-month follow-up. Primary outcome was defined by the proportion of patients achieving ≥50% reduction in the number of days with headache per month (responders) from the baseline to the last 4 weeks of the 3-month treatment. Multivariate logistic regression models were used on the primary endpoint, adjusting for age, sex, disease duration, comorbidity and surgery. The last-observation-carried-forward method was used to adjust for missing values.ResultsNine sites enrolled 130 patients and, after a 6-day detoxification phase, randomized 88 eligible patients. The 3-month responder rate was higher in the sodium valproate (45.0%) than in the placebo arm (23.8%) with an absolute difference of about 20% (p=0.0431). Sodium valproate had safety and tolerability profiles comparable to placebo.ConclusionsThe present study supports the efficacy and safety of sodium valproate in the treatment of medication overuse headache with history of migraine after detoxification.     

Investigating prophylactic botulinum toxin type A for chronic headache disorders

There is an increasing number of studies on botulinum toxin A in the treatment of idiopathic and symptomatic headache; however, many studies can hardly be compared with each other because of different end points and different trial designs. For the prophylactic treatment of tension-type headache, migraine and cervicogenic headache, no sufficient positive evidence for a successful treatment can be obtained from the randomised, double-blind and placebo-controlled trials performed so far. For the treatment of chronic daily headache (including medication-overuse headache), there is inconsistent positive evidence for subgroups (e.g., patients without other prophylactic treatment). This means that most of the double-blind and placebo-controlled studies do not confirm the assumption that botulinum toxin A is efficacious in the treatment of idiopathic headache disorders; however, it is possible that some subgroups of patients with chronic migraine benefit from a long-term treatment for ≥ 6 months.     

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.     

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, beta-blockers, some antidepressants and gabapentin in early pregnancy.     

Investigating prophylactic botulinum toxin type A for chronic headache disorders

There is an increasing number of studies on botulinum toxin A in the treatment of idiopathic and symptomatic headache; however, many studies can hardly be compared with each other because of different end points and different trial designs. For the prophylactic treatment of tension-type headache, migraine and cervicogenic headache, no sufficient positive evidence for a successful treatment can be obtained from the randomised, double-blind and placebo-controlled trials performed so far. For the treatment of chronic daily headache (including medication-overuse headache), there is inconsistent positive evidence for subgroups (e.g., patients without other prophylactic treatment). This means that most of the double-blind and placebo-controlled studies do not confirm the assumption that botulinum toxin A is efficacious in the treatment of idiopathic headache disorders; however, it is possible that some subgroups of patients with chronic migraine benefit from a long-term treatment for > or = 6 months.     

Effect of overuse of the antimigraine combination of indomethacin, prochlorperazine and caffeine (IPC) on the disposition of its components in chronic headache patients.

BACKGROUND: The combination of indomethacin, prochlorperazine and caffeine (IPC) is one of the most utilized formulations for the treatment of migraine attacks in Italy. Several patients suffering from chronic headache overuse this symptomatic medication in the attempt to control their headache. OBJECTIVE: To verify whether overuse of IPC combination by chronic headache patients is associated with modified disposition of its components. METHODS: We studied indomethacin, prochlorperazine, and caffeine disposition in 34 female subjects suffering from primary headaches, subdivided into four groups: eight migraine patients occasionally using IPC combination suppositories-group 1; nine patients with chronic headache and probable medication-overuse headache, daily taking one or more suppositories of the IPC combination-group 2; 11 migraine patients occasionally using "mild" suppositories of the IPC combination-group 3; six migraine patients occasionally taking tablets of the IPC combination-group 4. The IPC combination habitually used was administered to each patient. Blood samples were taken at baseline and at fixed intervals up to 6h after administration. Plasma levels of indomethacin and prochlorperazine were assayed by high-pressure liquid chromatographic (HPLC) method; caffeine levels were assayed by enzyme multiplied immunoassay test (EMIT). Pharmacokinetic parameters were calculated by means of a computer software (P K Solutions 2.0. Summit Research Services, Montrose, CO, USA). RESULTS: Half-life of indomethacin was longer, and clearance lower, in group 2 than in the other groups; AUC of indomethacin in group 2 was twice that in group 1 (P<0.05, Newman-Keuls' test). Peak concentrations and AUC(0-->infinity) of caffeine were significantly higher in group 2 than in the other groups (P<0.05, Newman-Keuls' test). We could not define prochlorperazine disposition because it was not detectable in the majority of blood samples. CONCLUSION: Overuse of IPC combination in chronic headache patients is associated with increased plasma levels of indomethacin and caffeine, and with delayed elimination of indomethacin; the high and sustained concentrations of these drugs may cause rebound headache, organ damages, and perpetuate medication-overuse headache.     

Treating tension-type headache -- an expert opinion

INTRODUCTION: Tension-type headache (TTH) is a highly prevalent disorder with enormous costs for the individual and the society. AREAS COVERED: Nonpharmacological and pharmacological treatments are reviewed. Electromyographic (EMG) biofeedback has a documented effect in TTH, while cognitive-behavioral therapy and relaxation training are most likely to be effective. Physical therapy and acupuncture may be valuable options for patients with frequent TTH. Simple analgesics and nonsteroidal anti-inflammatory drugs are recommended for treatment of episodic TTH. Combination analgesics containing caffeine are drugs of second choice. Triptans, muscle relaxants and opioids should not be used. It is crucial to avoid frequent and excessive use of analgesics to prevent the development of medication-overuse headache. The tricyclic antidepressant amitriptyline is the drug of first choice for the prophylactic treatment of chronic TTH. Mirtazapine and venlafaxine are second-choice drugs. EXPERT OPINION: There is an urgent need for more research in nonpharmacological as well as pharmacological treatment possibilities of TTH. Future studies should examine the relative efficacy of the various treatment modalities and clarify how treatment programs can be optimized and combined to best suit the individual patient. Frequent TTH may be difficult to treat, but an acceptable result can usually be obtained by a combination of nonpharmacological and pharmacological treatments.     

Medication overuse headache

The frequent use (>15 times/month) of medication for the treatment of acute migraine attacks may cause medication overuse headache. This kind of headache can be caused by the intake of a combination of analgesics, opioids, ergot alkaloids and triptans. The delay between first intake and these attacks is shortest for triptans (1-2 years), longer for ergots (3-5 years) and longest for analgesics (5-10 years). Treatment includes drug withdrawal followed by structured acute therapy and initiation of migraine prophylactic treatment.     

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.