女性紧张性头痛及经期偏头痛影响因素的比较

目的比较女性紧张性头痛(TTH)及经期偏头痛(MM)的影响因素。方法收集104例女性TTH患者(TTH组)及91例MM患者(MM组)的临床资料。采用视觉模拟评分法(VAS)和头痛影响测评量表-6(HIT-6)对其头痛程度、生活质量进行评估,并采用汉密尔顿焦虑(HAMA)、抑郁量表(HAMD)对患者情绪障碍进行测定。结果 TTH组与经期相关19例,累积发病率18.3%;MM组与经期相关59例,累积发病率64.8%。与TTH组比较,MM组发病年龄显著降低,病程、家族史,焦虑、抑郁、重度疼痛、HIT-6(Ⅳ级)、共病的比率,以及HAMA、HAMD评分均显著升高(P0.05~0.01),而文化程度、吸烟、饮酒、职业差异无统计学意义(均P0.05)。无先兆的月经相关性偏头痛(MRM)、无先兆的单纯月经性偏头痛(PMM)及非月经性无先兆偏头痛患者发病年龄、家族史、VAS及HIT-6评分差异有统计学意义(P0.05~0.01)。结论与女性TTH比较,MM发病年龄更轻、病程更长,也更易合并焦虑、抑郁。在不同类型MM中,PMM发病年龄更早,有家族史的比率更高;而MRM的重度疼痛率及HIT-6评分最高。     

不同类型偏头痛局部脑血流量变化的研究

目的检测有先兆及无先兆的偏头痛脑局部血流量(rCBF)的变化。方法研究对象共分4组:分别为无先兆的偏头痛组40例(M组)、有先兆的偏头痛25例(MA组)、肌紧张型头痛25型(TH组)以及对照组(C组)40名,用133Xe吸入法测定三组头痛及正常对照组的脑局部血流量。结果无先兆偏头痛组(M)平均脑局部血流量(71.04±12.01)ml/100 g脑组织/分,而有先兆偏头痛MA组平均脑局部血流量(55.27±10.13)ml/100 g脑组织/分,肌紧张头痛(TH)组平均脑局部血流量(60.82±7.64)ml/100 g脑组织/分,正常对照(C)组平均脑局部区域血流(59.96±7.63)ml/100 g脑组织/分,经统计学处理,F=12.01,P<0.001,M组平均rCBF明显高于正常对照组及肌紧张头痛组,而MA组的rCBF明显低于常对照组及肌紧张头痛组。TH组rCBF与正常对照组相比无明显差异(P>0.05)。结论无先兆偏头痛组平均脑局部血流量呈弥漫性高血流量状态,而有先兆偏头痛组明显低于正常对照组(P<0.001),尤以后枕部血流量降低更为明显。肌紧张头痛组rCBF与正常对照组相比无明显差异(P>0.05)。     

偏头痛和癫痫

偏头痛和癫痫在临床表现、发病机制和治疗上均存在联系,两者在临床上不易鉴别.本文评价了国际头痛协会发布的国际分类中的定义及诊断标准,并对三种分类,即偏头痛引起的癫痫发作、偏头痛型癫痫和癫痫后头痛分别进行简述,同时比较了偏头痛和头痛型癫痫二者之间的脑电图差异及关系,并建议尽快重新修订分类标准,明确这几种疾病的定义.     

偏头痛和慢性紧张型头痛血浆精氨酸加压素、催产素及环核着酸含量测定

用放射免疫分析法测定了２８例偏头痛、１０例慢性紧张型头痛患者和１６例健康对照组血浆精氨酸加压素（ＡＶＰ）、催产素（ＯＴ）、环磷酸腺苷（ｃＡＭＰ）及环磷酸鸟苷（ｃＧＭＰ）含量。结果表明，偏头痛发作期ＡＶＰ含量下降、ｃＡＭＰ含量升高，偏头痛间歇期ｃＧＭＰ含量下降，血浆ＯＴ含量在发作期和间歇期均明显下降。慢性紧张型头痛患者血浆ＡＶＰ、ＯＴ、ｃＡＭＰ和ｃＧＭＰ与对照组比较均无显著性差异。结果提示，血浆ＡＶＰ和ＯＴ水平降低以及环核苷酸的代谢异常与偏头痛发病机制有关。     

偏头痛与癫痫

偏头痛和癫痫是神经系统常见病症，它们的临床表现、发作特点以及治疗有许多相似之处，而且偏头痛和癫痫具有高度的共病性。这使得医师有时很难做出诊治。本文从流行病学、发病机制、诊断和治疗上对两种病症及其相关病症进行比较，作一综述。     

偏头痛性脑梗死

正偏头痛是一种常见疾病,发病率11%~15%。国际头痛学会头痛疾病分类第3版(t h e International Classification of Headache Disorders 3rd Edition,ICHD-3)将偏头痛分为5类:(1)无先兆偏头痛;(2)有先兆偏头痛(migraine with aura,MA);(3)慢性偏头痛;(4)偏头痛并发症;(5)很可能的偏头痛[1]。偏头痛     

头痛严重程度对偏头痛患者生活质量的影响

目的 探讨头痛严重程度对偏头痛患者生活质量的影响.方法 根据头痛严重程度将84例偏头痛患者分为轻、中、重度3组,采用生活质量综合评定问卷-74(GQOLI-74)对患者进行测试.结果 轻、中、重度3组偏头痛患者在躯体不适感、进食功能、工作与学习、婚姻与家庭方面评分的平均值差异均有统计学意义(均P＜0.05),其余牛活质...     

癫痫及偏头痛相关诊断标准解读

国际头痛学会相继提出“偏头痛癫痫”和“发作性癫痫性头痛”等概念和诊断标准,并在临床上广泛应用。笔者认为上述诊断标准均有值得商榷之处。头痛可以作为癫痫发作的症状,也常见于癫痫发作后,偏头痛和癫痫可以共病。从癫痫专业角度来看,偏头痛癫痫也许是一种局灶性癫痫。医学观点百家争鸣,癫痫和头痛亚专业组应加强对话,科学地制订癫痫和偏头痛相关诊断标准。     

偏头痛与睡眠质量关系的研究

目的:探讨偏头痛与睡眠质量的关系.方法:采用阿森斯睡眠量表(AIS)对112例偏头痛患者(偏头痛组)及112名健康体检者(正常对照组)的睡眠质量进行评分,比较两组间失眠的发生率.对偏头痛组中无睡眠障碍亚组、可疑失眠亚组和失眠亚组先兆发作率及疼痛程度进行比较,分析睡眠质量与偏头痛的关系.结果:偏头痛组失眠的发生率(58.9%)明显高于正常对照组(24.1%)(P<0.001).偏头痛各亚组间先兆发作率的差异无统计学意义;失眠亚组中、重度头痛的比例(53.0%,37.9%)明显高于无睡眠障碍亚组(23.8%,19.1%)和可疑失眠亚组(40.0%,16.0%)(均P<0.001).相关性分析显示,偏头痛组睡眠质量与头痛程度呈负相关(P<0.001).结论:偏头痛患者睡眠质量较差,且睡眠质量越差的患者头痛程度越重,改善睡眠质量有可能减轻头痛程度.     

Causes and mechanisms of primary headaches: toward a bio-behavioral model

Pathophysiological mechanisms of primary headache remain obscure, despite of numerous hypotheses that have been postulated for either migraine and cluster headache. Human experimental models are not available, however, observation of clinical features of migraine or cluster headache attacks support animal studies documenting the development of neurogenic inflammation in tissues receiving trigeminal innervation. The latter studies provided also the background for better understanding the mechanism of action of aborting drugs such as sumatriptan and dihydroergotamine. The debate is whether the primary cause of migraine and other neurovascular headaches is central or peripheral in origin. Trigger factors (stressful events) and personality traits in migraine patients suggest that activation of neurovascular systems is secondary to more complex events taking place in the central nervous system.

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Sommario I meccanismi fisiopatologici che sottendono le cefalee primarie sono tuttora oscuri, nonostante le numerose ipotesi proposte sia per la cefalea di tipo emicranico che per la cefalea a grappolo. Modelli sperimentali umani non sono disponibili, comunque le caratteristche cliniche degli attacchi di emicrania o di cefalea a grappolo consentono di affermare che ad essi si accompagna attivazione del sistema trigeminovascolare e infiammazione neurogenica a questa conseguente, come dimostrato in animali di laboratorio. Questi modelli animali hanno peraltro permesso di chiarire possibili meccanismi di azione di farmaci communemente utilizzati per il trattamento sintomatico delle crisi emicraniche o di cefalea a grappolo. La controversia sulla causa primaria responsabile della attivazione dei sistemi neurovascolari non è comunque risolta. è pur vero che fattori scatenanti le crisi, quali ad esempio eventi stressanti, e tratti di personalità nei pazienti emicranici, fanno supporre che i fenomeni periferici conseguenti alla attivazione del sistema trigeminovascolare sono secondari a più complessi meccanismi che originano dal sistema nervoso centrale.

     

Prevalence and Impact of Migraine and Tension-Type Headache in Korea

Background and Purpose

The epidemiology and impact of headache disorders are only partially documented for Asian countries. We investigated the prevalence and impact of migraine and tension-type headache - which are the two most common primary headache disorders - in a Korean population.

Methods

A stratified random population sample of Koreans older than 19 years was selected and evaluated using a 29-item, semistructured interview. The questionnaire was designed to classify headache types according to the criteria of the International Classification of Headache Disorders, second edition, including migraine and tension-type headache. The questionnaire also included items on basic demographics such as age, gender, geographical region, education level, and income, and the impact of headache on the participant.

Results

Among the 1507 participants, the 1-year prevalence of all types of headaches was 61.4% (69.9% in women and 52.8% in men). The overall prevalence rates of migraine and tension-type headaches were 6.1% (9.2% in women and 2.9% in men) and 30.8% (29.3% in women and 32.2% in men), respectively. The prevalence of migraine peaked at the age of 40-49 years in women and 19-29 years in men. In contrast to migraine, the prevalence of tension-type headache was not influenced by either age or gender. Among individuals with migraine and tension-type headache, 31.5% and 7% reported being substantially or severely impacted by headache, respectively (Headache Impact Test score ≥56). Overall, 13.4% of all headache sufferers reported being either substantially or severely impacted by headache.

Conclusions

The 1-year prevalence rates of migraine and tension-type headache in the studied Korean population were 6.1% and 30.8%, respectively. One-third of migraineurs and some individuals with tension-type headache reported being either substantially or severely impacted by headache.     

Photophobia in primary headaches,in essential blepharospasm and in major depression

Objectives: Although photophobia is a well-known symptom in various disorders, it has rarely been studied explicitly and its definition in a clinical setting can be somewhat elusive. Here, we assessed photophobia with a common psychometric tool in different conditions, in which light intolerance is considered part of the syndrome. Patients and methods: A prospective study was undertaken in patients with migraine (MH), cluster headache (CH), tension-type headache (TH), essential blepharospasm (BS) and major depression (MD). Photophobia was assessed by the photophobia questionnaire (range 0–8). Symptom severity was measured in each patient group with appropriate scales. Finally, depression was assessed explicitly in each condition. Results: Hundred and six subjects met the inclusion criteria (MH: 27, CH: 21, TH: 20, BS: 18, MD: 20). Photophobia scores differed between patient groups, with migraineurs showing the highest (6.63) and TH patients the lowest (2.10) scores (ranking: MH, BS, CH, MD and TH). Symptom severity as well as depression had little, if any, influence on the degree of photophobia. Discussion: Photophobia is a core symptom of migraine but also constitutes a feature of other neurological conditions. The relative independence from other, disease-specific features, suggests that photophobia is a rather autonomous symptom.     

Chronic Daily Headache and Medication Overuse Headache in First-Visit Headache Patients in Korea: A Multicenter Clinic-Based Study

MethodsEleven neurologists enrolled first-visit patients with complaints of headaches into outpatient clinics for further assessment. Headache disorders were classified according to the International Classification of Headache Disorder (third edition beta version) by each investigator.ResultsPrimary CDH was present in 248 (15.2%) of the 1,627 included patients, comprising CM (143, 8.8%), chronic tension-type headache (CTTH) (98, 6%), and definite new daily persistent headache (NDPH) (7, 0.4%). MOH was associated with headache in 81 patients (5%). The association with MOH was stronger among CM patients (34.5%) than patients with CTTH (13.3%) or NDPH (14.3%) (p=0.001). The frequency of CDH did not differ between secondary and tertiary referral hospitals.ConclusionsThe frequencies of CDH and MOH diagnoses were 15.2% and 5%, respectively in first-visit headache patients presented at secondary or tertiary referral hospitals in Korea. CM was the most common subtype of CDH and was most frequently associated with MOH.     

Monocyte chemotactic and phagocytic responses in migraine and tension-type headache patients

Monocyte chemotactic and phagocytic responses were assessed in two groups of migraine patients (with and without aura) and in two groups of tensiontype headache patients (episodic and chronic). The chemotactic but not the phagocytic response, assessed interictally, is significantly lower in migraine patients (p<0.006) and in episodic tension-type headache patients, though not so significantly in the latter (p<0.05), than in the control individuals. The chemotactic response tends to increase significantly during attack in migraine patients both with and without aura (p<0.008 and p<0.007 respectively). The same was evident for the phagocytic response in both migraine patient groups (p<0.007 and 0.0004). No modifications of monocyte functions were found during attacks neither in episodic nor chronic tension-type headache patients. These findings suggest that one or more mediators of neurogenic inflammation having phagocytic and chemotactic enhancing properties (substance P, prostaglandin E and thromboxane A2 etc.) are implicated in the modification of monocyte function. The demonstration of a defect in monocyte function during the interictal period in migraine patients confirms the results of recent research which evidenced reduced capacity of monocyte to phagocyte and kill microorganisms in the course of migraine. Paper presented at the National Congress at Sorrento in 1991 and selected by the Editorial Board of the Journal     

Left parietal involvement in motion sickness susceptibility revealed by multimodal magnetic resonance imaging

Susceptibility to motion sickness varies greatly across individuals. However, the neural mechanisms underlying this susceptibility remain largely unclear. To address this gap, the current study aimed to identify the neural correlates of motion sickness susceptibility using multimodal MRI. First, we compared resting‐state functional connectivity between healthy individuals who were highly susceptible to motion sickness (N = 36) and age/sex‐matched controls who showed low susceptibility (N = 36). Seed‐based analysis revealed between‐group differences in functional connectivity of core vestibular regions in the left posterior Sylvian fissure. A data‐driven approach using intrinsic connectivity contrast found greater network centrality of the left intraparietal sulcus in high‐ rather than in low‐susceptible individuals. Moreover, exploratory structural connectivity analysis uncovered an association between motion sickness susceptibility and white matter integrity in the left inferior fronto‐occipital fasciculus. Taken together, our data indicate left parietal involvement in motion sickness susceptibility.     

Glyceryl trinitrate induced headache in migraineurs - relation to attack frequency.

Glyceryl trinitrate, a prodrug of nitric oxide, induces a mild to moderate headache in healthy subjects, whilst migraineurs develop a more severe headache, resembling spontaneous migraine attacks. In order to investigate whether this increased nitric oxide sensitivity depends upon the frequency of spontaneously occurring migraine attacks, intravenous infusion of glyceryl trinitrate (0.5 microg/kg/min) was given to 15 migraine patients with rare attacks (/=12 attacks/year) and 14 healthy subjects served as controls. No significant difference between the migraine groups for any of several parameters was detected, although the trend was always towards more headaches in frequent migraineurs. Both migraineurs with frequent and rare attacks experienced a headache that was significantly more severe, longer lasting, and fulfilled the diagnostic criteria for migraine without aura more often, compared to the healthy subjects (P = 0.0001). Conclusively, supersensitivity to glyceryl trinitrate in migraineurs seems to be related to a basic - probably genetically determined - pathophysiological mechanism involving nitric oxide, and not to the environmental influences, which to a large extent determine the expression of migraine.