个体化治疗方法对颈源性头痛患者镇痛效应分析:盲法评估

Analgesic outcome of individualized treatment for cervicogenic headache:a blind evaluation

目的:由于颈源性头痛病因较多,准确选择个体化治疗方法以期取得更好的镇痛效应。方法:选择2003-08/2004-06在广东省人民医院麻醉科痛症门诊治疗,符合颈源性头痛国际研究组织制定的诊断标准患者27例。根据患者不同的症状体征应用不同的方法:药物治疗、痛点阻滞、手法治疗、小针刀、星状神经节和硬膜外阻滞,治疗前后分别进行视觉镇痛评分,0分为最低分,10分为最高分,治疗后随访半年,按照治疗前后月头痛天数和头痛强度(视觉镇痛评分)的改变来评价治疗效果。结果:按实际处理分析,纳入27例患者,3例未能按要求完成治疗,2例治疗后半年内未能随访到,进入结果分析22例,随访率81%(22/27)。患者治疗后视觉镇痛评分较治疗前明显降低[(2.9±1.7),(6.7±3.8)分,P<0.001]。治疗后头痛月发作次数较治疗前明显减少[(3.5±1.5),(11.1±4.3)d/月(P<0.001)]。结论:针对不同病因采用个体化方法治疗,使患者头痛发作次数减少了68%,视觉镇痛评分降低了57%,说明治疗效果明显。

AIM:To correctly select an individualized treatment for cervical headache to gain better analgesic outcome is important because there are many etiological fa ctors of cervical headache. METHODS:From August 2003 to June 2004,27 patients with cervicogenic headache met the criteria established by the Cervicogenic Headache International Study Gr oup in the pain clinic of Department of Anesthesiology,Guangdong Provincial Peop le's Hospital.Drug,blockage of pain point,maneuver,minineedle- scalpel,stellate ganglion and epidural blocking were applied according to the symptoms and signs in the 27 patients.The visual analogue scale(VAS) was evaluated based on 0 poin t as the lowest and 10 points as the highest before and after treatment.The ther apeutic effect was assessed in terms of the changes of headache degree using VAS and the headache days per month before and after treatment through half- a- y ear follow- up. RESULTS:According to the practical management,among the 27 patients,3 did not finish the treatment according to schedule,2 were not followed up,so 22 finishe d the treatment with the follow- up rate of 81% (22/27).The scores on VAS were significantly increased after treatment,as compared with before treatment[(2.9 ± 1.7) points vs (6.7± 3.8) points,P< 0.001].The headache times after treatmen t were significantly less as compared with those before treatment[(3.5± 1.5) da ys per month vs (11.1± 4.3) days per month,P CONCLUSION:The application of individualized treatment for headache based on different causes decreases the headache times by 68% ,and lowers the VAS scores by 57% ,indicating obvious therapeutic effects.