BACKGROUND Patients with proteinase 3-antineutrophil cytoplasmic antibody associated vasculitis(AAV)experience different manifestations at the initial onset and relapse.However,such cases of different initial and rela...BACKGROUND Patients with proteinase 3-antineutrophil cytoplasmic antibody associated vasculitis(AAV)experience different manifestations at the initial onset and relapse.However,such cases of different initial and relapse manifestations have not been reported in myeloperoxidase(MPO)-AAV patients.CASE SUMMARY A 52-year-old woman was admitted to our hospital because of headache.Laboratory findings indicated nephrotic range proteinuria and microscopic hematuria,serum creatinine of 243μmol/L,anti-MPO antibody titer of>400 RU/mL,and positive perinuclearantineutrophil cytoplasmic antibody.Renal biopsy showed pauci-immune crescentic glomerulonephritis.The cerebrospinal fluid examination and brain magnetic resonance imaging did not show any abnormality.Therefore,MPO-AAV was diagnosed.Corticosteroids,plasmapheresis,and cyclophosphamide as induction therapy and mycophenolate mofetil(MMF)as maintenance therapy were administered.The patient’s headache disappeared;serum creatinine returned to normal;complete remission of microscopic hematuria and proteinuria was observed.Anti-MPO antibody titer reached normal limits after immunosuppressive treatment.Twenty-five months after stopping the immunosuppressive treatment,the patient relapsed with arthralgia,without neurological or renal involvement.The patient’s arthralgia improved after treatment with prednisone and MMF.CONCLUSION We have reported a rare case of MPO-AAV who initially presented with headache and kidney involvement.However,relapse presented with only arthralgia,which was completely different from the initial manifestations.This case suggests that AAV relapse should be highly suspected in MPO-AAV patients after remission,when clinical manifestations at relapse are different from those at onset.Prednisone and MMF may provide a good choice for refractory arthralgia during relapse in MPO-AAV patients.展开更多
The clinical effect of acupuncture on vascular headache caused by hyperactivity of liver-yang has been shown, but the specific mechanism is not yet clear. This paper is intended to discuss the etiology and pathogenesi...The clinical effect of acupuncture on vascular headache caused by hyperactivity of liver-yang has been shown, but the specific mechanism is not yet clear. This paper is intended to discuss the etiology and pathogenesis of vascular headache caused by hyperactivity of liver-yang and the mechanism of acupuncture, so as to provide a certain reference for clinical diagnosis and treatment of scalp acupuncture treatment of vascular headache caused by hyperactivity of liver-yang.展开更多
Aims: To evaluate the association between bruxism, headaches, and temporomandibular disorder (TMD). Methods: A keyword search of the clinical notes of patients’ charts in AxiUm<sup>TM</sup> was performed ...Aims: To evaluate the association between bruxism, headaches, and temporomandibular disorder (TMD). Methods: A keyword search of the clinical notes of patients’ charts in AxiUm<sup>TM</sup> was performed using the search terms “TMD”, “headache”, and “sleep bruxism” to identify these patients. The inclusion criteria were patients with partial of full dentition, aged 18 to 65 years old who attended the UNLV School of Dental Medicine clinics between January 2014 and September 2018. Patients with incomplete records and those who were completely edentulous formed the exclusion criteria. Data were analyzed using the Pearson Correlation Coefficient. Results: The final sample was made up of 529 patients. The highest percentage of study subjects were in the age range of 29 - 34 (17.9%), with a statistically significant correlation to pain on opening (P = 0.0403). Females showed a statistically significant correlation to TMJ clicking (P = 0.0033). Caucasians also had a statistically significant correlation to TMJ clicking (P = 0.0001). In addition, a statistically significant correlation between pain on opening or chewing and headaches was also observed (P = 0.0081). Conclusion: Within the limitations of the present study, Caucasians, and females presented with more TMJ clicking than the other study subjects. Young adults, in particular, experienced more pain on opening or chewing.展开更多
We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodissection for treatment of cervicogenic headache and occipital neuralgia. A 35-year-old female presented to the pain clinic ...We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodissection for treatment of cervicogenic headache and occipital neuralgia. A 35-year-old female presented to the pain clinic with severe chronic cervicogenic headache impacting her sleep, work and activities of daily living. Conservative management had failed to adequately resolve her pain. Ultrasound-guided suboccipital hydrodissection of the greater occipital nerve was performed with the patient in the prone position. After skin sterilization, the linear ultrasound transducer was oriented in a transverse orientation at the level of the C2-C3 vertebrae. The needle was advanced from medial to lateral “in-plane” under direct ultrasound visualization, until the needle was positioned at the C2 lamina. After confirming the needle tip position, 10 ml of hydrodissection fluid was injected with good visualization of distribution of the solution. The patient described immediate and significant improvement in her symptoms. She reported a sustained decrease in pain scores when followed up in the pain clinic at six and twelve weeks respectively. To the best of our knowledge this is the first application of ultrasound-guided hydrodissection of the GON for cervicogenic headache. It offers a novel, safe and effective technique to aid in the diagnosis and treatment of a common pain condition.展开更多
Introduction: Headaches are a common symptom affecting individuals worldwide, including in the tropical zone, and have been extensively studied in Togo. Phosphodiesterase-5 inhibitors, commonly prescribed for erectile...Introduction: Headaches are a common symptom affecting individuals worldwide, including in the tropical zone, and have been extensively studied in Togo. Phosphodiesterase-5 inhibitors, commonly prescribed for erectile dysfunction, are known to induce headaches, yet there is a lack of research on this topic in sub-Saharan Africa and Togo. Methods: A cross-sectional study conducted from February 1st to June 30th, 2023, including adult patients seeking erectile dysfunction treatment and prescribed PDE-5 inhibitors. Results: A total of 28 patients were included in the study, with an average age of 34.46 ± 7.5 years. The age group of 30 - 39 years was the most represented (53.57%). Among the participants, 67.86% had a history of chronic headaches. During the intake of PDE-5 inhibitors, 71.43% reported the onset of headaches. Among the 19 patients with chronic headaches, 68.42% developed headaches following PDE-5 inhibitor use (RR = 0.88, 95% CI: 0.55 - 1.40, p = 0.484). The characteristics of the induced headaches were similar to the patients’ pre-existing headaches in 78.95% of cases. Additional symptoms included nasal congestion (36.84%) and an urge to have a bowel movement (26.32%). Sildenafil (75.00%) and Tadalafil (25.00%) were the primarily prescribed PDE-5 inhibitors. The incidence of headaches did not significantly differ between the two groups (RR = 1.33, 95% CI: 0.67 - 2.64, p = 0.306). Treatment for the induced headaches involved self-medication with paracetamol (65.00%) and nonsteroidal anti-inflammatory drugs (NSAIDs) (35.00%). Conclusion: Headaches induced by PDE-5 inhibitors are a well-established reality, emphasizing the need for caution and warning in patients with pre-existing headache conditions, while individualized approaches are necessary to address the potential interplay between migraine medications and erectile dysfunction treatments.展开更多
Background:The aim of this study is to explore the mechanism by which Wuzhuyu Decoction treats vascular headache.Methods:We utilized the TCMSP database to identify active ingredients and targets of the Chinese herbal ...Background:The aim of this study is to explore the mechanism by which Wuzhuyu Decoction treats vascular headache.Methods:We utilized the TCMSP database to identify active ingredients and targets of the Chinese herbal medicine,and the Gendcars,OMIM,PharmGKB,TTD,and DrugBank databases were used to screen for disease targets.We constructed the PPI network of targets by utilizing the String database,and GO and KEGG analyses were performed.The"drug-ingredient-target-disease"network diagram was constructed using Cytoscape 3.8.0 software.We analyzed the topological parameters to identify the primary active ingredients and targets of Wuzhuyu Decoction,and subsequently confirmed the findings via molecular docking.Results:A total of 86 active ingredients were obtained,including Quercetin,Kaempferol,Beta-sitosterol,Stigmasterol,and Nuciferin.Fourteen core targets were identified,including JUN,TP53,AKT1,RELA,MAPK1,MAPK14,MYC,MAPK8,CCND1,ESR1,CTNNB1,FOS,NR3C1,and RB1.GO enrichment analysis involved biological processes such as response to drug,response to lipopolysaccharide,and response to molecule of bacterial origin.The cellular components were membrane raft and membrane microdomain,and the molecular functions were catecholamine binding and nuclear receptor activity.The KEGG pathway enrichment analysis demonstrated the potential regulation of 171 pathways by Wuzhuyu Decoction.including the Lipid and atherosclerosis signaling pathway,the Fluid shear stress and atherosclerosis signaling pathway,and the PI3K-AKT signaling pathway.Molecular docking showed that Nuciferin had good binding activity with AKT1(-9.9 kJ/mol),as did Quercetin with AKT1(-9.8 kJ/mol),Stigmasterol with MAPK1(-9.7 kJ/mol),and Kaempferol with AKT1(-9.5 kJ/mol).Conclusion:Wuzhuyu Decoction may exert its therapeutic effect on vascular headache by inhibiting neurogenic inflammation,providing analgesia,and modulating the immune system.展开更多
BACKGROUND Cluster headache(CH)is a severe incapacitating headache disorder.By definition,its diagnosis must exclude possible underlying structural conditions.AIM To review available information on CLH caused by struc...BACKGROUND Cluster headache(CH)is a severe incapacitating headache disorder.By definition,its diagnosis must exclude possible underlying structural conditions.AIM To review available information on CLH caused by structural lesions and to provide better guides in the distinguishing process and to ensure that there is not a potentially treatable structural lesion.METHODS We conducted a systematic review of 77 published cases of symptomatic CH and cluster-like headache(CLH)in PubMed and Google Scholar databases.RESULTS Structural pathologies associated with CH were vascular(37.7%),tumoral(32.5%)and inflammatory(27.2%).Brain mass-like lesions(tumoural and inflammatory)were the most common diseases(28.6%),among which 77.3%lesions were at the suprasellar(pituitary)region.Cases of secondary CH related to sinusitis rose dramatically,occupying 19.5%.The third most common disease was internal carotid artery dissection,accounting for 14.3%.Atypical clinical features raise an early suspicion of a secondary cause:Late age at onset and eye and retroorbital pains were common conditions requiring careful evaluation and were present in at least one-third of cases.Abnormal neurological examination was the most significant red flag for impaired cranial nerves.CLH patients may be responsive to typical CH treatments;therefore,the treatment response is not specific.CLH can be triggered by contralateral structural pathologies.CLH associated with sinusitis and cerebral venous thrombosis required more attention.CONCLUSION Since secondary headache could perfectly mimick primary CH,neuroimaging should be conducted in patients in whom primary and secondary headaches are suspected.Cerebral magnetic resonance imaging scans is the diagnostic management of choice,and further examinations include vessel imaging with contrast agents and dedicated scans focusing on specific cerebral areas(sinuses,ocular and sellar regions).Neuroimaging is as necessary at follow-up visits as at the first observation.展开更多
Objective:This observational cohort pilot study aimed to evaluate the effects of the acupuncture methods,Jiu Cang Zhen(JCZ)and Huang Guan(HG),on changes in headache intensity in an inpatient,multimodal Zurzach Headach...Objective:This observational cohort pilot study aimed to evaluate the effects of the acupuncture methods,Jiu Cang Zhen(JCZ)and Huang Guan(HG),on changes in headache intensity in an inpatient,multimodal Zurzach Headache Programme(ZHP).Methods:Study participants consisted of patients diagnosed with chronic headache disorder(headache ds,30 days per month)or daily persistent headache.All patients received conventional therapies with active and passive approaches.The patient group was treated with JCZ and HG acupuncture methods,receiving a total of six to eight acupuncture sessions of 50 to 60 minutes each,during a 3–4-week multimodal ZHP at the RehaClinic Bad Zurzach.Pain intensity was quantified using a Numerical Rating Scale(NRS)before and after each acupuncture therapy session.Results:Ten patients were recruited,six women and four men,with a mean age of 41.7(standard deviation,[SD]=13.9).A reduction in headache intensity was reported by all patients in each of the sessions.The average NRS for pain was 4.21(SD=1.44)before acupuncture and 1.24(SD=0.93)after acupuncture(means first by number of sessions,then per n=10 patients).This resulted in a mean difference of 2.97(SD=1.04),corresponding to a standardized response mean of 2.85(95%confidence interval:2.11–3.60,one-tailed P<0.001),meaning there was a large effect.Conclusions:This pilot study shows that JCZ and HG are suitable acupuncture methods for reducing headache intensity in the treatment of headaches.A comparison with the conventional classical acupuncture methods from the acupuncture textbook for traditional Chinese medicine students in China,exploration with a larger patient group,and prolonged monitoring of pain behavior could be foci of follow-up investigations.展开更多
Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be fa...Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be familiar with a novel treatment option. Background: Post-dural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal and/or occipital region, worsened in the upright position and refractory to routine analgesia. The syndrome incidence was reported to be approximately 1% with typical obstetric anesthesiology practice which reflects more than 20,000 cases per 2014 in the US. Two possible mechanisms are hypothesized as responsible for this syndrome;cerebrospinal fluid leakage and pneumocephalus. Multiple methods of treatment have been applied with wide-ranging results. Design or Methods: Review article with introduction of a novel treatment option. Results: We postulate that Hyperbaric Oxygen Therapy can be used to treat post-dural puncture headache. The rationale for treatment is dual: enhancement of fibroblast proliferation at the site of dural puncture to facilitate faster closure of the tear and compression of air bubbles in case of pneumocephalus according to Boyle’s law. We also claim that hyperbaric oxygen therapy should be considered a prophylactic treatment, if a dural tear is suspected.展开更多
Cervicogenic headache(CEH)has been recognized as a unique category of headache that can be difficult to diagnose and treat.In China,CEH patients are managed by many different specialties,and the treatment plans remain...Cervicogenic headache(CEH)has been recognized as a unique category of headache that can be difficult to diagnose and treat.In China,CEH patients are managed by many different specialties,and the treatment plans remain controversial.Therefore,there is a great need for comprehensive evidence-based Chinese experts’recommendations for the management of CEH.The Chinese Association for the Study of Pain asked an expert panel to develop recommendations for a series of questions that are essential for daily clinical management of patients with CEH.A group of multidisciplinary Chinese Association for the Study of Pain experts identified the clinically relevant topics in CEH.A systematic review of the literature was performed,and evidence supporting the benefits and harms for the management of CEH was summarized.Twenty-four recommendations were finally developed through expert consensus voting for evidence quality and recommendation strength.We hope this guideline provides direction for clinicians and patients making treatment decisions for the management of CEH.展开更多
INTRODUCTION Patients with headache constitute up to 4.5%of emergency department(ED)visits.[1]Cerebral venous thrombosis(CVT)is an important cause of the headache that is more common than once suspected.The diagnosis ...INTRODUCTION Patients with headache constitute up to 4.5%of emergency department(ED)visits.[1]Cerebral venous thrombosis(CVT)is an important cause of the headache that is more common than once suspected.The diagnosis of CVT is often missed or delayed because of non-展开更多
Patients with chronic headache were offered treatment by acupuncture or massage with relaxation instead of a change in their prescribed medication. They were randomly allocated to either treatment. There was a signifi...Patients with chronic headache were offered treatment by acupuncture or massage with relaxation instead of a change in their prescribed medication. They were randomly allocated to either treatment. There was a significant improvement in pain ratings with both treatment types. Specifically a greater effect was seen in migraine patients treated by massage with relaxation when compared to acupuncture. No psychological factors were found to predict response to either treatment. At the end of the study, 13% of patients were significantly more worried that there may be a more serious cause underlying their headache despite reassurance and an improvement in their headache scores.展开更多
AIM: To establish seroprevalence and provide characteristics of Toxoplasma gondii(TG) infection in children with recurrent headaches. METHODS: The study was performed in 178 children aged 7-17 years admitted consecuti...AIM: To establish seroprevalence and provide characteristics of Toxoplasma gondii(TG) infection in children with recurrent headaches. METHODS: The study was performed in 178 children aged 7-17 years admitted consecutively to the Department of Pediatric Neurology from November 2009 to July 2011. The children were surveyed with a questionnaire with the help and assistance of their parents and blood samples taken on admission were studied for the presence of specific anti-TG Ig M, Ig G antibodies and Ig G avidity using enzyme immunoassay Platelia Toxo Ig M, Ig G. RESULTS: The study showed that 19 children(8 boys, 11 girls; 8-17 years old, mean age 14.36 years) hadhigh serum anti-TG Ig G antibody levels(range: 32.2 > 240 UI/m L, mean 120.18 UI/m L; positive value for Ig G was ≥ 9 UI/m L). The avidity index(AI) ranged from 0.202 to 0.925(scale: ≥ 0.5 high AI). The results for Ig M antibodies were all negative and the obtained results ranged from 0.113 to 0.25 U/m L(mean = 0.191 IU/m L) and all values below 0.8 IU/m L were considered negative. The most frequent complaints found in the seropositive patients were headaches that affected the frontal(13 children), occipital(4) and parietal areas(5). Headaches usually had a pulsating(in 7 patients) and squeezing(6) character and rarely were piercing, dull or expanding. Interestingly, 8 children did not feel discomfort during the headaches, probably because they did not have sufficiently increased intracranial pressure yet. The headaches usually appeared 1-2 times/mo, lasted for 2-6 h, and had a mean intensity of 5.5 points in a 10 point subjective scale. The comorbidities included epilepsy(5 patients), various infections in 3 children(chronic eustachitis, chronic rhinitis, chronic purulent tonsillitis, streptococcal pharyngitis, meningitis, allergic diseases), disturbances of behavior, deficits of attention, and ocular and motor concentration disorders in 1 child. The electroencephalographic and neuroimaging studies performed in our patients had a very limited value in establishing cerebral toxoplasmosis.CONCLUSION: Ten point six seven percent of the studied children had markedly increased serum anti-TG Ig G antibodies and high AI indicated chronic infestation. It is suggested that tests for TG infection should be introduced to routine diagnostics in patients with recurrent headaches.展开更多
BACKGROUND Sick sinus syndrome is a common disease in cardiology.Typical symptoms include palpitations,dizziness,shortness of breath,chest tightness,and amaurosis.However,to date,there are no known reports of sick sin...BACKGROUND Sick sinus syndrome is a common disease in cardiology.Typical symptoms include palpitations,dizziness,shortness of breath,chest tightness,and amaurosis.However,to date,there are no known reports of sick sinus syndrome presenting with headache.Whether there is a correlation between headache and sick sinus syndrome merits further research.In this report,we describe a case of headache induced by sick sinus syndrome.CASE SUMMARY A 73-year-old female patient presented to our department with the chief complaint of recurrent paroxysmal headache for more than 7 years.The patient described paroxysmal palpations,usually headache occurring after palpitation.Her blood pressure was normal when the most recent headache occurred.A magnetic resonance imaging study and magnetic resonance angiography of the head at another center were normal.A clinical neurological examination was negative.A 24-h Holter electrocardiogram monitoring study showed sick sinus syndrome.The patient received dual chamber pacing implantation and was administered drug therapy to control ventricular rate.The patient’s paroxysmal headaches and palpitations had resolved within 1 year,confirmed via a follow-up telephone call.CONCLUSION After dual-chamber pacing implantation and drug therapy administration to control the ventricular rate,the patient’s paroxysmal headaches and palpitations had resolved within 1 year,confirmed via a follow-up telephone call.We believe that the headaches were related to the patient’s sick sinus syndrome.展开更多
BACKGROUND Accidental dural puncture(ADP)and subsequent post-dural puncture headache(PDPH)remain common complications of epidural procedures for obstetric anesthesia and analgesia.No clear consensus exists on the best...BACKGROUND Accidental dural puncture(ADP)and subsequent post-dural puncture headache(PDPH)remain common complications of epidural procedures for obstetric anesthesia and analgesia.No clear consensus exists on the best way to prevent PDPH after ADP.CASE SUMMARY We report our findings in twenty parturients who underwent an incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch(HES)to prevent PDPH after ADP with a 16-gauge Tuohy needle during epidural procedures.ADP with a 16-gauge Tuohy needle occurred in nine parturients undergoing a cesarean section(CS)and in eleven parturients receiving labor analgesia.An epidural catheter was re-sited at the same or adjacent intervertebral space in all patients.After CS,the epidural catheter was used for postoperative pain relief over a 48-h period.After delivery in eleven cases,epidural infusion was maintained for 24 h.Thereafter,15 mL of 6%HES 130/0.4 was administered via the epidural catheter immediately prior to catheter removal.None of the parturients developed PDPH or neurologic deficits over a follow-up period of at least two months to up to one year postpartum.CONCLUSION An incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch may have great efficacy in preventing PDPH after ADP.展开更多
Chuanxiong Rhizoma is the dry rhizome of Ligusticum chuanxiong in the umbelliferae family.Chuanxiong Rhizoma pungent,warm,go to liver,gallbladder and pericardium.Effective in promoting blood circulation,promoting Qi,d...Chuanxiong Rhizoma is the dry rhizome of Ligusticum chuanxiong in the umbelliferae family.Chuanxiong Rhizoma pungent,warm,go to liver,gallbladder and pericardium.Effective in promoting blood circulation,promoting Qi,dispelling wind and relieving pain,it could treat chest pain,tingling pain in chest and flank,lump,irregular menstruation,amenorrhea,symptomatic abdominal pain,headache and rheumatic pain.Neurovascular headache is a primary disease caused by dysregulation of intracranial vascular movement and nerve function.It has the characteristics of long course,intermittent recurrent attacks,lingering and difficult to heal.Attacks are often accompanied by many plant nervous system symptoms,such as rapid breathing,accelerated heart rate,vomiting,and gastrointestinal dysfunction.Vascular nerve headache is a common clinical disease,frequently bidity.Studies have shown that Chuanxiong Rhizoma has good pharmacological effects in the treatment of vascular neuropathic headache.①The action of Qi and blood circulation:vascular and neurovascular headache is caused by the evil of external wind and cold and damp heat,which leads to the disconnection of the veins,the disorder of Qi and blood,the obstruction of Qi and blood channels,the loss of brain collateral,and finally causes migraine.Modern Chinese medicine points out that"wind,blood stasis,deficiency,phlegm"are the key factors of the disease.Chuanxiong Rhizoma is the medicine of Qi in the blood.It is pungent and warm.It is good at activating blood and promoting Qi,dispelling wind,relieving pain and dispelling cold,so as to achieve the effect of treating vascular headaches.②Improve brain circulation:angioneurotic headache is caused by dysfunction of the central nervous system related to the regulation of vascular movement,which causes vasospasm or extreme vasodilation,and the decrease of intracranial blood flow causes cerebral ischemia and hypoxia.Sodium ferulate is a chemical component in Chuanxiong Rhizoma.It has a relatively good inhibitory effect on platelet aggregation and the release of 5-HT from platelets.It can ensure the normal contraction of intracranial and extracranial blood vessels,improve the patient′s brain circulation and nerve function,so as to achieve the effect of treating angioneurotic headaches.③Sedative and analgesic effect:the volatile oil and water decoction of Chuanxiong Rhizoma have sedative and analgesic effects,and the water decoction can counteract the excitatory effect of caffeine.Studies have shown that the ATP activation current of rat dorsal root ganglion neurons can be inhibited by ligustrazine in a non-competitive way,which also indicates that Chuanxiong Rhizoma has a good analgesic effect.In this study,the effects of Chuanxiong Rhizoma on angoneeurotic headache were reviewed,and the pharmacological effects of Chuanxiong Rhizoma were further elucidated,providing basis for clinical application and new drug development of Chuanxiong Rhizoma in the treatment of angoneeurotic headache.展开更多
The aim of this study was to evaluate the prevalence of chronic pain (CP) and the relationship between CP, especially headache adjusted for CP at other sites, and health-related quality of life (HRQoL) in middle-aged ...The aim of this study was to evaluate the prevalence of chronic pain (CP) and the relationship between CP, especially headache adjusted for CP at other sites, and health-related quality of life (HRQoL) in middle-aged Japanese residents. We examined the prevalence of CP (defined as pain persisting for 3 months or more) and HRQoL (SF-36) in 1117 middle-aged residents of Japan. We assessed the eight dimensions of health status and the 3 component SF-36 summary score to evaluate HRQoL. The prevalence of CP was 15.3% among men and 15.1% among women. Multiple linear regression analysis demonstrated that lumbar pain (p β = -0.132), knee pain (p β = -0.115), foot pain (p = 0.042, β = -0.065), and age (p β = -0.154) were independently correlated with a lower physical component score (PCS). Older age (ppβ = -0.096), knee pain (p β = -0.109), upper limb pain (p β = -0.098), and lumbar pain (p = 0.022, β = -0.077) all showed a significant negative correlation with MCS. The presence of chronic headache (p = 0.011, β = -0.082) was the only factor significantly correlated with a lower role component score (RCS). We identified a negative correlation between chronic headache and RCS, unlike the relation between musculoskeletal pain and PCS or MCS, suggesting that RCS was an independently influenced by CP differently from PCS or MCS in Japanese residents.展开更多
Post-dural puncture headache continues to be a significant cause of morbidity in parturients. Despite being a common complication faced by many anesthesiologists, there is a lack of consensus regarding its management....Post-dural puncture headache continues to be a significant cause of morbidity in parturients. Despite being a common complication faced by many anesthesiologists, there is a lack of consensus regarding its management. Many still use traditionally taught treatments such as strict bed rest and aggressive hydration despite lack of evidence for their usage. Few are using newly tested treatments such as gabapentin and ACTH despite being proven effective in randomized controlled trials. Furthermore, when and how the epidural blood patch should be used is contentious between different practitioners. This review aims at answering what is the best strategy to manage post-dural puncture headache and proposes an evidence-based practice guideline.展开更多
Headache associated with Carotid Endarterectomy (CEA) is a known condition;however, its incidence and etiology are not well defined. In this study, we determined the incidence and evaluated the characteristics of head...Headache associated with Carotid Endarterectomy (CEA) is a known condition;however, its incidence and etiology are not well defined. In this study, we determined the incidence and evaluated the characteristics of headache following CEA. This prospective study was conducted between January and July 2009, in 32 patients submitted to CEA. 68.7% of patients were male;mean age was 67.3 years-old. Headache incidence was 37.5%, ipsilateral to the CEA in 91% of patients;pressure was the most common pain quality (81.2%) and affected the frontal region alone in 37.5% of headache episodes. All headache episodes were of mild intensity. No correlation (p > 0.05) was found between sexes and no significant value (p > 0.05) was determined between the presence of headache and the mean degree of stenosis in the ipsilateral and contralateral carotid operated. Headache following CEA is a common condition;in most cases it is ipsilateral to the procedure, pressure type, mild and self-limiting.展开更多
Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or th...Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves;to review outcomes including duration and degree of pain relief;to evaluate procedure’s complication rate and patient’s willingness to repeat the procedure;to compare effectiveness of the most recent RF ablation to patient’s first RF ablation. Methods: This is a single-center retrospective observational study of 23 patients with recurrent cervicogenic headaches and/or occipital neuralgia treated with repeated RF ablation of the C2 dorsal root ganglion and/or third occipital nerves. All patients receiving treatment from January 2010 to July 2014 are included in this single site retrospective study. This is an IRB approved medical chart review study. Results: 22 of 23 patients underwent follow-up. An average of 86.5% of participants reported pain relief on average of 25.4 weeks at time of follow-up. 41% reported side effects including suboccipital hyperesthesia and/or ear discomfort, 95% reported willingness to repeat the procedure again if severe symptoms recurred, 59% of patients reported the most recent RF ablation had the same results as the first, 32% reported the most recent RF was the most effective, and 9% reported that the first RF was the most effective. Conclusion: Repeated RF ablation is a feasible option for recurrent cervicogenic headaches and/or occipital neuralgia. Effectiveness of repeat intervention is the same or better than the first ablation. Though there was a higher likelihood of side effects including suboccipital neuralgia and/or ear discomfort on repeat treatment, the side effects were generally well tolerated.展开更多
文摘BACKGROUND Patients with proteinase 3-antineutrophil cytoplasmic antibody associated vasculitis(AAV)experience different manifestations at the initial onset and relapse.However,such cases of different initial and relapse manifestations have not been reported in myeloperoxidase(MPO)-AAV patients.CASE SUMMARY A 52-year-old woman was admitted to our hospital because of headache.Laboratory findings indicated nephrotic range proteinuria and microscopic hematuria,serum creatinine of 243μmol/L,anti-MPO antibody titer of>400 RU/mL,and positive perinuclearantineutrophil cytoplasmic antibody.Renal biopsy showed pauci-immune crescentic glomerulonephritis.The cerebrospinal fluid examination and brain magnetic resonance imaging did not show any abnormality.Therefore,MPO-AAV was diagnosed.Corticosteroids,plasmapheresis,and cyclophosphamide as induction therapy and mycophenolate mofetil(MMF)as maintenance therapy were administered.The patient’s headache disappeared;serum creatinine returned to normal;complete remission of microscopic hematuria and proteinuria was observed.Anti-MPO antibody titer reached normal limits after immunosuppressive treatment.Twenty-five months after stopping the immunosuppressive treatment,the patient relapsed with arthralgia,without neurological or renal involvement.The patient’s arthralgia improved after treatment with prednisone and MMF.CONCLUSION We have reported a rare case of MPO-AAV who initially presented with headache and kidney involvement.However,relapse presented with only arthralgia,which was completely different from the initial manifestations.This case suggests that AAV relapse should be highly suspected in MPO-AAV patients after remission,when clinical manifestations at relapse are different from those at onset.Prednisone and MMF may provide a good choice for refractory arthralgia during relapse in MPO-AAV patients.
基金Supported by Research Project for TCM Excellent Talents of Shaanxi Province(Shaan Zhong Yi Yao Han[2020]112)Project of Shaanxi Administration of Traditional Chinese Medicine(2021-ZZ-LC016)Key Project of Shaanxi Provincial Department of Science and Technology(2022ZDLSF03-09).
文摘The clinical effect of acupuncture on vascular headache caused by hyperactivity of liver-yang has been shown, but the specific mechanism is not yet clear. This paper is intended to discuss the etiology and pathogenesis of vascular headache caused by hyperactivity of liver-yang and the mechanism of acupuncture, so as to provide a certain reference for clinical diagnosis and treatment of scalp acupuncture treatment of vascular headache caused by hyperactivity of liver-yang.
文摘Aims: To evaluate the association between bruxism, headaches, and temporomandibular disorder (TMD). Methods: A keyword search of the clinical notes of patients’ charts in AxiUm<sup>TM</sup> was performed using the search terms “TMD”, “headache”, and “sleep bruxism” to identify these patients. The inclusion criteria were patients with partial of full dentition, aged 18 to 65 years old who attended the UNLV School of Dental Medicine clinics between January 2014 and September 2018. Patients with incomplete records and those who were completely edentulous formed the exclusion criteria. Data were analyzed using the Pearson Correlation Coefficient. Results: The final sample was made up of 529 patients. The highest percentage of study subjects were in the age range of 29 - 34 (17.9%), with a statistically significant correlation to pain on opening (P = 0.0403). Females showed a statistically significant correlation to TMJ clicking (P = 0.0033). Caucasians also had a statistically significant correlation to TMJ clicking (P = 0.0001). In addition, a statistically significant correlation between pain on opening or chewing and headaches was also observed (P = 0.0081). Conclusion: Within the limitations of the present study, Caucasians, and females presented with more TMJ clicking than the other study subjects. Young adults, in particular, experienced more pain on opening or chewing.
文摘We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodissection for treatment of cervicogenic headache and occipital neuralgia. A 35-year-old female presented to the pain clinic with severe chronic cervicogenic headache impacting her sleep, work and activities of daily living. Conservative management had failed to adequately resolve her pain. Ultrasound-guided suboccipital hydrodissection of the greater occipital nerve was performed with the patient in the prone position. After skin sterilization, the linear ultrasound transducer was oriented in a transverse orientation at the level of the C2-C3 vertebrae. The needle was advanced from medial to lateral “in-plane” under direct ultrasound visualization, until the needle was positioned at the C2 lamina. After confirming the needle tip position, 10 ml of hydrodissection fluid was injected with good visualization of distribution of the solution. The patient described immediate and significant improvement in her symptoms. She reported a sustained decrease in pain scores when followed up in the pain clinic at six and twelve weeks respectively. To the best of our knowledge this is the first application of ultrasound-guided hydrodissection of the GON for cervicogenic headache. It offers a novel, safe and effective technique to aid in the diagnosis and treatment of a common pain condition.
文摘Introduction: Headaches are a common symptom affecting individuals worldwide, including in the tropical zone, and have been extensively studied in Togo. Phosphodiesterase-5 inhibitors, commonly prescribed for erectile dysfunction, are known to induce headaches, yet there is a lack of research on this topic in sub-Saharan Africa and Togo. Methods: A cross-sectional study conducted from February 1st to June 30th, 2023, including adult patients seeking erectile dysfunction treatment and prescribed PDE-5 inhibitors. Results: A total of 28 patients were included in the study, with an average age of 34.46 ± 7.5 years. The age group of 30 - 39 years was the most represented (53.57%). Among the participants, 67.86% had a history of chronic headaches. During the intake of PDE-5 inhibitors, 71.43% reported the onset of headaches. Among the 19 patients with chronic headaches, 68.42% developed headaches following PDE-5 inhibitor use (RR = 0.88, 95% CI: 0.55 - 1.40, p = 0.484). The characteristics of the induced headaches were similar to the patients’ pre-existing headaches in 78.95% of cases. Additional symptoms included nasal congestion (36.84%) and an urge to have a bowel movement (26.32%). Sildenafil (75.00%) and Tadalafil (25.00%) were the primarily prescribed PDE-5 inhibitors. The incidence of headaches did not significantly differ between the two groups (RR = 1.33, 95% CI: 0.67 - 2.64, p = 0.306). Treatment for the induced headaches involved self-medication with paracetamol (65.00%) and nonsteroidal anti-inflammatory drugs (NSAIDs) (35.00%). Conclusion: Headaches induced by PDE-5 inhibitors are a well-established reality, emphasizing the need for caution and warning in patients with pre-existing headache conditions, while individualized approaches are necessary to address the potential interplay between migraine medications and erectile dysfunction treatments.
基金supported by the China Natural Science Foundation(No.81973811).
文摘Background:The aim of this study is to explore the mechanism by which Wuzhuyu Decoction treats vascular headache.Methods:We utilized the TCMSP database to identify active ingredients and targets of the Chinese herbal medicine,and the Gendcars,OMIM,PharmGKB,TTD,and DrugBank databases were used to screen for disease targets.We constructed the PPI network of targets by utilizing the String database,and GO and KEGG analyses were performed.The"drug-ingredient-target-disease"network diagram was constructed using Cytoscape 3.8.0 software.We analyzed the topological parameters to identify the primary active ingredients and targets of Wuzhuyu Decoction,and subsequently confirmed the findings via molecular docking.Results:A total of 86 active ingredients were obtained,including Quercetin,Kaempferol,Beta-sitosterol,Stigmasterol,and Nuciferin.Fourteen core targets were identified,including JUN,TP53,AKT1,RELA,MAPK1,MAPK14,MYC,MAPK8,CCND1,ESR1,CTNNB1,FOS,NR3C1,and RB1.GO enrichment analysis involved biological processes such as response to drug,response to lipopolysaccharide,and response to molecule of bacterial origin.The cellular components were membrane raft and membrane microdomain,and the molecular functions were catecholamine binding and nuclear receptor activity.The KEGG pathway enrichment analysis demonstrated the potential regulation of 171 pathways by Wuzhuyu Decoction.including the Lipid and atherosclerosis signaling pathway,the Fluid shear stress and atherosclerosis signaling pathway,and the PI3K-AKT signaling pathway.Molecular docking showed that Nuciferin had good binding activity with AKT1(-9.9 kJ/mol),as did Quercetin with AKT1(-9.8 kJ/mol),Stigmasterol with MAPK1(-9.7 kJ/mol),and Kaempferol with AKT1(-9.5 kJ/mol).Conclusion:Wuzhuyu Decoction may exert its therapeutic effect on vascular headache by inhibiting neurogenic inflammation,providing analgesia,and modulating the immune system.
文摘BACKGROUND Cluster headache(CH)is a severe incapacitating headache disorder.By definition,its diagnosis must exclude possible underlying structural conditions.AIM To review available information on CLH caused by structural lesions and to provide better guides in the distinguishing process and to ensure that there is not a potentially treatable structural lesion.METHODS We conducted a systematic review of 77 published cases of symptomatic CH and cluster-like headache(CLH)in PubMed and Google Scholar databases.RESULTS Structural pathologies associated with CH were vascular(37.7%),tumoral(32.5%)and inflammatory(27.2%).Brain mass-like lesions(tumoural and inflammatory)were the most common diseases(28.6%),among which 77.3%lesions were at the suprasellar(pituitary)region.Cases of secondary CH related to sinusitis rose dramatically,occupying 19.5%.The third most common disease was internal carotid artery dissection,accounting for 14.3%.Atypical clinical features raise an early suspicion of a secondary cause:Late age at onset and eye and retroorbital pains were common conditions requiring careful evaluation and were present in at least one-third of cases.Abnormal neurological examination was the most significant red flag for impaired cranial nerves.CLH patients may be responsive to typical CH treatments;therefore,the treatment response is not specific.CLH can be triggered by contralateral structural pathologies.CLH associated with sinusitis and cerebral venous thrombosis required more attention.CONCLUSION Since secondary headache could perfectly mimick primary CH,neuroimaging should be conducted in patients in whom primary and secondary headaches are suspected.Cerebral magnetic resonance imaging scans is the diagnostic management of choice,and further examinations include vessel imaging with contrast agents and dedicated scans focusing on specific cerebral areas(sinuses,ocular and sellar regions).Neuroimaging is as necessary at follow-up visits as at the first observation.
基金supported by Zurzach Rehabilitation Foundation SPA and Swiss Traditional Chinese Medicine Academy(STA)。
文摘Objective:This observational cohort pilot study aimed to evaluate the effects of the acupuncture methods,Jiu Cang Zhen(JCZ)and Huang Guan(HG),on changes in headache intensity in an inpatient,multimodal Zurzach Headache Programme(ZHP).Methods:Study participants consisted of patients diagnosed with chronic headache disorder(headache ds,30 days per month)or daily persistent headache.All patients received conventional therapies with active and passive approaches.The patient group was treated with JCZ and HG acupuncture methods,receiving a total of six to eight acupuncture sessions of 50 to 60 minutes each,during a 3–4-week multimodal ZHP at the RehaClinic Bad Zurzach.Pain intensity was quantified using a Numerical Rating Scale(NRS)before and after each acupuncture therapy session.Results:Ten patients were recruited,six women and four men,with a mean age of 41.7(standard deviation,[SD]=13.9).A reduction in headache intensity was reported by all patients in each of the sessions.The average NRS for pain was 4.21(SD=1.44)before acupuncture and 1.24(SD=0.93)after acupuncture(means first by number of sessions,then per n=10 patients).This resulted in a mean difference of 2.97(SD=1.04),corresponding to a standardized response mean of 2.85(95%confidence interval:2.11–3.60,one-tailed P<0.001),meaning there was a large effect.Conclusions:This pilot study shows that JCZ and HG are suitable acupuncture methods for reducing headache intensity in the treatment of headaches.A comparison with the conventional classical acupuncture methods from the acupuncture textbook for traditional Chinese medicine students in China,exploration with a larger patient group,and prolonged monitoring of pain behavior could be foci of follow-up investigations.
文摘Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be familiar with a novel treatment option. Background: Post-dural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal and/or occipital region, worsened in the upright position and refractory to routine analgesia. The syndrome incidence was reported to be approximately 1% with typical obstetric anesthesiology practice which reflects more than 20,000 cases per 2014 in the US. Two possible mechanisms are hypothesized as responsible for this syndrome;cerebrospinal fluid leakage and pneumocephalus. Multiple methods of treatment have been applied with wide-ranging results. Design or Methods: Review article with introduction of a novel treatment option. Results: We postulate that Hyperbaric Oxygen Therapy can be used to treat post-dural puncture headache. The rationale for treatment is dual: enhancement of fibroblast proliferation at the site of dural puncture to facilitate faster closure of the tear and compression of air bubbles in case of pneumocephalus according to Boyle’s law. We also claim that hyperbaric oxygen therapy should be considered a prophylactic treatment, if a dural tear is suspected.
文摘Cervicogenic headache(CEH)has been recognized as a unique category of headache that can be difficult to diagnose and treat.In China,CEH patients are managed by many different specialties,and the treatment plans remain controversial.Therefore,there is a great need for comprehensive evidence-based Chinese experts’recommendations for the management of CEH.The Chinese Association for the Study of Pain asked an expert panel to develop recommendations for a series of questions that are essential for daily clinical management of patients with CEH.A group of multidisciplinary Chinese Association for the Study of Pain experts identified the clinically relevant topics in CEH.A systematic review of the literature was performed,and evidence supporting the benefits and harms for the management of CEH was summarized.Twenty-four recommendations were finally developed through expert consensus voting for evidence quality and recommendation strength.We hope this guideline provides direction for clinicians and patients making treatment decisions for the management of CEH.
文摘INTRODUCTION Patients with headache constitute up to 4.5%of emergency department(ED)visits.[1]Cerebral venous thrombosis(CVT)is an important cause of the headache that is more common than once suspected.The diagnosis of CVT is often missed or delayed because of non-
文摘Patients with chronic headache were offered treatment by acupuncture or massage with relaxation instead of a change in their prescribed medication. They were randomly allocated to either treatment. There was a significant improvement in pain ratings with both treatment types. Specifically a greater effect was seen in migraine patients treated by massage with relaxation when compared to acupuncture. No psychological factors were found to predict response to either treatment. At the end of the study, 13% of patients were significantly more worried that there may be a more serious cause underlying their headache despite reassurance and an improvement in their headache scores.
文摘AIM: To establish seroprevalence and provide characteristics of Toxoplasma gondii(TG) infection in children with recurrent headaches. METHODS: The study was performed in 178 children aged 7-17 years admitted consecutively to the Department of Pediatric Neurology from November 2009 to July 2011. The children were surveyed with a questionnaire with the help and assistance of their parents and blood samples taken on admission were studied for the presence of specific anti-TG Ig M, Ig G antibodies and Ig G avidity using enzyme immunoassay Platelia Toxo Ig M, Ig G. RESULTS: The study showed that 19 children(8 boys, 11 girls; 8-17 years old, mean age 14.36 years) hadhigh serum anti-TG Ig G antibody levels(range: 32.2 > 240 UI/m L, mean 120.18 UI/m L; positive value for Ig G was ≥ 9 UI/m L). The avidity index(AI) ranged from 0.202 to 0.925(scale: ≥ 0.5 high AI). The results for Ig M antibodies were all negative and the obtained results ranged from 0.113 to 0.25 U/m L(mean = 0.191 IU/m L) and all values below 0.8 IU/m L were considered negative. The most frequent complaints found in the seropositive patients were headaches that affected the frontal(13 children), occipital(4) and parietal areas(5). Headaches usually had a pulsating(in 7 patients) and squeezing(6) character and rarely were piercing, dull or expanding. Interestingly, 8 children did not feel discomfort during the headaches, probably because they did not have sufficiently increased intracranial pressure yet. The headaches usually appeared 1-2 times/mo, lasted for 2-6 h, and had a mean intensity of 5.5 points in a 10 point subjective scale. The comorbidities included epilepsy(5 patients), various infections in 3 children(chronic eustachitis, chronic rhinitis, chronic purulent tonsillitis, streptococcal pharyngitis, meningitis, allergic diseases), disturbances of behavior, deficits of attention, and ocular and motor concentration disorders in 1 child. The electroencephalographic and neuroimaging studies performed in our patients had a very limited value in establishing cerebral toxoplasmosis.CONCLUSION: Ten point six seven percent of the studied children had markedly increased serum anti-TG Ig G antibodies and high AI indicated chronic infestation. It is suggested that tests for TG infection should be introduced to routine diagnostics in patients with recurrent headaches.
基金Supported by the Sichuan Science and Technology Program,No.2020YJ0197the Chengdu Medical Research Project,No.2019115.
文摘BACKGROUND Sick sinus syndrome is a common disease in cardiology.Typical symptoms include palpitations,dizziness,shortness of breath,chest tightness,and amaurosis.However,to date,there are no known reports of sick sinus syndrome presenting with headache.Whether there is a correlation between headache and sick sinus syndrome merits further research.In this report,we describe a case of headache induced by sick sinus syndrome.CASE SUMMARY A 73-year-old female patient presented to our department with the chief complaint of recurrent paroxysmal headache for more than 7 years.The patient described paroxysmal palpations,usually headache occurring after palpitation.Her blood pressure was normal when the most recent headache occurred.A magnetic resonance imaging study and magnetic resonance angiography of the head at another center were normal.A clinical neurological examination was negative.A 24-h Holter electrocardiogram monitoring study showed sick sinus syndrome.The patient received dual chamber pacing implantation and was administered drug therapy to control ventricular rate.The patient’s paroxysmal headaches and palpitations had resolved within 1 year,confirmed via a follow-up telephone call.CONCLUSION After dual-chamber pacing implantation and drug therapy administration to control the ventricular rate,the patient’s paroxysmal headaches and palpitations had resolved within 1 year,confirmed via a follow-up telephone call.We believe that the headaches were related to the patient’s sick sinus syndrome.
文摘BACKGROUND Accidental dural puncture(ADP)and subsequent post-dural puncture headache(PDPH)remain common complications of epidural procedures for obstetric anesthesia and analgesia.No clear consensus exists on the best way to prevent PDPH after ADP.CASE SUMMARY We report our findings in twenty parturients who underwent an incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch(HES)to prevent PDPH after ADP with a 16-gauge Tuohy needle during epidural procedures.ADP with a 16-gauge Tuohy needle occurred in nine parturients undergoing a cesarean section(CS)and in eleven parturients receiving labor analgesia.An epidural catheter was re-sited at the same or adjacent intervertebral space in all patients.After CS,the epidural catheter was used for postoperative pain relief over a 48-h period.After delivery in eleven cases,epidural infusion was maintained for 24 h.Thereafter,15 mL of 6%HES 130/0.4 was administered via the epidural catheter immediately prior to catheter removal.None of the parturients developed PDPH or neurologic deficits over a follow-up period of at least two months to up to one year postpartum.CONCLUSION An incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch may have great efficacy in preventing PDPH after ADP.
文摘Chuanxiong Rhizoma is the dry rhizome of Ligusticum chuanxiong in the umbelliferae family.Chuanxiong Rhizoma pungent,warm,go to liver,gallbladder and pericardium.Effective in promoting blood circulation,promoting Qi,dispelling wind and relieving pain,it could treat chest pain,tingling pain in chest and flank,lump,irregular menstruation,amenorrhea,symptomatic abdominal pain,headache and rheumatic pain.Neurovascular headache is a primary disease caused by dysregulation of intracranial vascular movement and nerve function.It has the characteristics of long course,intermittent recurrent attacks,lingering and difficult to heal.Attacks are often accompanied by many plant nervous system symptoms,such as rapid breathing,accelerated heart rate,vomiting,and gastrointestinal dysfunction.Vascular nerve headache is a common clinical disease,frequently bidity.Studies have shown that Chuanxiong Rhizoma has good pharmacological effects in the treatment of vascular neuropathic headache.①The action of Qi and blood circulation:vascular and neurovascular headache is caused by the evil of external wind and cold and damp heat,which leads to the disconnection of the veins,the disorder of Qi and blood,the obstruction of Qi and blood channels,the loss of brain collateral,and finally causes migraine.Modern Chinese medicine points out that"wind,blood stasis,deficiency,phlegm"are the key factors of the disease.Chuanxiong Rhizoma is the medicine of Qi in the blood.It is pungent and warm.It is good at activating blood and promoting Qi,dispelling wind,relieving pain and dispelling cold,so as to achieve the effect of treating vascular headaches.②Improve brain circulation:angioneurotic headache is caused by dysfunction of the central nervous system related to the regulation of vascular movement,which causes vasospasm or extreme vasodilation,and the decrease of intracranial blood flow causes cerebral ischemia and hypoxia.Sodium ferulate is a chemical component in Chuanxiong Rhizoma.It has a relatively good inhibitory effect on platelet aggregation and the release of 5-HT from platelets.It can ensure the normal contraction of intracranial and extracranial blood vessels,improve the patient′s brain circulation and nerve function,so as to achieve the effect of treating angioneurotic headaches.③Sedative and analgesic effect:the volatile oil and water decoction of Chuanxiong Rhizoma have sedative and analgesic effects,and the water decoction can counteract the excitatory effect of caffeine.Studies have shown that the ATP activation current of rat dorsal root ganglion neurons can be inhibited by ligustrazine in a non-competitive way,which also indicates that Chuanxiong Rhizoma has a good analgesic effect.In this study,the effects of Chuanxiong Rhizoma on angoneeurotic headache were reviewed,and the pharmacological effects of Chuanxiong Rhizoma were further elucidated,providing basis for clinical application and new drug development of Chuanxiong Rhizoma in the treatment of angoneeurotic headache.
文摘The aim of this study was to evaluate the prevalence of chronic pain (CP) and the relationship between CP, especially headache adjusted for CP at other sites, and health-related quality of life (HRQoL) in middle-aged Japanese residents. We examined the prevalence of CP (defined as pain persisting for 3 months or more) and HRQoL (SF-36) in 1117 middle-aged residents of Japan. We assessed the eight dimensions of health status and the 3 component SF-36 summary score to evaluate HRQoL. The prevalence of CP was 15.3% among men and 15.1% among women. Multiple linear regression analysis demonstrated that lumbar pain (p β = -0.132), knee pain (p β = -0.115), foot pain (p = 0.042, β = -0.065), and age (p β = -0.154) were independently correlated with a lower physical component score (PCS). Older age (ppβ = -0.096), knee pain (p β = -0.109), upper limb pain (p β = -0.098), and lumbar pain (p = 0.022, β = -0.077) all showed a significant negative correlation with MCS. The presence of chronic headache (p = 0.011, β = -0.082) was the only factor significantly correlated with a lower role component score (RCS). We identified a negative correlation between chronic headache and RCS, unlike the relation between musculoskeletal pain and PCS or MCS, suggesting that RCS was an independently influenced by CP differently from PCS or MCS in Japanese residents.
文摘Post-dural puncture headache continues to be a significant cause of morbidity in parturients. Despite being a common complication faced by many anesthesiologists, there is a lack of consensus regarding its management. Many still use traditionally taught treatments such as strict bed rest and aggressive hydration despite lack of evidence for their usage. Few are using newly tested treatments such as gabapentin and ACTH despite being proven effective in randomized controlled trials. Furthermore, when and how the epidural blood patch should be used is contentious between different practitioners. This review aims at answering what is the best strategy to manage post-dural puncture headache and proposes an evidence-based practice guideline.
文摘Headache associated with Carotid Endarterectomy (CEA) is a known condition;however, its incidence and etiology are not well defined. In this study, we determined the incidence and evaluated the characteristics of headache following CEA. This prospective study was conducted between January and July 2009, in 32 patients submitted to CEA. 68.7% of patients were male;mean age was 67.3 years-old. Headache incidence was 37.5%, ipsilateral to the CEA in 91% of patients;pressure was the most common pain quality (81.2%) and affected the frontal region alone in 37.5% of headache episodes. All headache episodes were of mild intensity. No correlation (p > 0.05) was found between sexes and no significant value (p > 0.05) was determined between the presence of headache and the mean degree of stenosis in the ipsilateral and contralateral carotid operated. Headache following CEA is a common condition;in most cases it is ipsilateral to the procedure, pressure type, mild and self-limiting.
文摘Objective: To address the degree and duration of pain relief from recurrent cervicogenic headaches and/or occipital neuralgia following retreatment with radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerves;to review outcomes including duration and degree of pain relief;to evaluate procedure’s complication rate and patient’s willingness to repeat the procedure;to compare effectiveness of the most recent RF ablation to patient’s first RF ablation. Methods: This is a single-center retrospective observational study of 23 patients with recurrent cervicogenic headaches and/or occipital neuralgia treated with repeated RF ablation of the C2 dorsal root ganglion and/or third occipital nerves. All patients receiving treatment from January 2010 to July 2014 are included in this single site retrospective study. This is an IRB approved medical chart review study. Results: 22 of 23 patients underwent follow-up. An average of 86.5% of participants reported pain relief on average of 25.4 weeks at time of follow-up. 41% reported side effects including suboccipital hyperesthesia and/or ear discomfort, 95% reported willingness to repeat the procedure again if severe symptoms recurred, 59% of patients reported the most recent RF ablation had the same results as the first, 32% reported the most recent RF was the most effective, and 9% reported that the first RF was the most effective. Conclusion: Repeated RF ablation is a feasible option for recurrent cervicogenic headaches and/or occipital neuralgia. Effectiveness of repeat intervention is the same or better than the first ablation. Though there was a higher likelihood of side effects including suboccipital neuralgia and/or ear discomfort on repeat treatment, the side effects were generally well tolerated.
