穴位热痛刺激治疗无先兆偏头痛患者的即时镇痛疗效观察

Painful heat stimulation of acupoints can relieve the pain of migraine headaches

目的观察穴位热痛刺激治疗急性发作期无先兆偏头痛患者的即时镇痛疗效。方法采用随机数字表法将120例急性发作期无先兆偏头痛患者分为治疗组及对照组，2组患者均VI服舒马曲坦（50mg），治疗组患者在此基础上同步辅以穴位热痛刺激，作用穴位包括风池、率谷、阳陵泉、外关、太阳、印堂等，热刺激温度设定为54．5℃，每个穴位连续刺激5次，各个穴位交替刺激，共治疗20min。记录穴位热痛治疗后2h各组患者头痛缓解率≥50％的人数；于治疗前、治疗后0．5，1，2，4h分别采用视觉模拟评分法（VAS）对各组患者疼痛程度进行评定；记录分析治疗前、治疗后2h各组患者头痛伴随症状计分以及治疗后24h头痛完全缓解率。结果治疗后2h治疗组头痛缓解率≥50％的患者数量（52例）较对照组（39例）显著增多（P〈0．05）；治疗后0．5，1，2，4h治疗组疼痛VAS评分[分别为（4．86±0．72）分、（3．85±0．33）分、（2．91±0．25）分和（1．82±0．16）分]均较对照组[分别为（5．01±0．50）分、（4．66±0．42）分、（4．03±0．38）分和（2．67±0．02）分]显著降低（均P〈0．05）；治疗后2h治疗组患者头痛伴随症状计分[（0．41±0．29）分]较治疗前[（1．85±0．60）分]及对照组[（0．73±0．46）分]均显著降低（均P〈0．05）；治疗后24h治疗组头痛完全缓解率（87．9％）明显高于对照组水平（70．0％），组间差异具有统计学意义（P〈0．05）。在观察期间所有患者心率、血压均未出现不良反应，热痛刺激部位无感染、红肿等表现。结论在常规药物治疗无先兆偏头痛患者基础上辅以穴位热痛刺激，能获得较好的即时镇痛疗效，该疗法值得临床进一步推广、应用。

Objective To observe any analgesic effect of painful heat stimulation of acupuncture points in the treatment of acute migraine without aura. Methods One hundred and twenty patients subject to migraine headaches without aura were randomly divided into a treatment group and a control group, each of 60. Both groups were treated with 50 mg doses of oral sumatriptan, while the treatment group was additionally provided with painful heat stimulation of acupoints. The heat was applied at 54.5 ℃ to the Fengchi, Shuaigu, Yan- gliquan, Waiguan, Taiyang and Yintang points in turn, 40 sec each for a total of 20 minutes all together, with each acupoint heated 5 times. The patients reported their level of discomfort using a visual analogue scale （VAS） before the treatment and 0.5, 1, 2 and 4 hours later. The number of participants reporting that their pain was re- duced by half or more after 2 hours was recorded, as well as the rate of complete remission at 24 h after treat- ment. Results Significantly more patients in the treatment group （52） reported pain relief two hours after the treatment than among the control group （39）. The average VAS scores at 0.5, 1, 2 and 4 hours after treatment were all significantly lower in the treatment group than in the control group. Two hours after treatment, the aver- age accompanying symptoms score of the treatment group was significantly lower than before treatment, and lower than the control group＇s average. After 24 hours the complete remission rate in the treatment group （ 87.9% ） was significantly higher than in the control group （ 70% ）. No subject reported any adverse heart rate or blood pressure effects after the treatment, and there were no infections at the stimulation sites. Conclusion Painful heat stimulation of acupoints is a safe and effective supplement to routine drug treatment in treating acute mi- graine without aura. It is worthy of clinical application.