changes in muscle activity in patients with primary chronic headache

Objective:According to the Global Burden of Disease Study,updated in 2018,headache disorders are the second leading cause in the world and impaired quality of life and lead to reduce daily activity and can be the cause of headache-related disability.So,we desperately need to develop new painless and minimally invasive methods to facilitate diagnosis to improve the quality of headache care.Methods:Our study involved 92 participants over 18 years of age with a diagnosis of primary chronic headache.Among those,36 were with chronic tension type headache,26 were with a chronic migraine,and 30 were healthy participants.All patients were selected according to the criteria of the International Headache Society.Clinical questionnaires,instrumental data,and characteristics of headache episodes were collected from all participants.We evaluated the muscle activity of the pericranial and cervical muscles in patients with chronic headache to compare with healthy participants using Surface electromyography to determine if there is an alteration in muscle activity.Results:Surface electromyography data showed that there was a statistically significant difference in results between the target group and the control group,where patients with primary chronic headache had high amplitude and velocity in the studied muscles on the electromyogram.Among the participants,there was a difference in the intensity of headache attacks on the visual analog scale chronic tension type headache 5.2±1.4,chronic migraine 7.7±1.3,control group 1.6±0.7 and in the frequency of headache attacks per month chronic tension type headache 14.4±1.9,chronic migraine 17.3±2.9,the control group of participants had headache attacks of≤1 per month.Conclusion:We concluded that the patients with primary chronic headaches there are changes in the muscle activity of the pericranial and cervical muscles.In contrast to patients without chronic headaches,which,in turn,the method of surface electromyography may encourage further research in this area.

Genetic Evidence for Causal Association Between Hypertension and Chronic Pain:A Bidirectional Two-Sample Mendelian Randomization Study

Objective The extent to which the association between hypertension and chronic pain in observational studies is either causally linked or influenced by other shared risk factors has not been substantially addressed.In the present study,Mendelian randomization(MR)was employed to examine the potential causal relationship between hypertension and risk of chronic pain.Methods The study data were derived from the pooled dataset of the genome-wide association study(GWAS),enabling the evaluation of the causal effects of hypertension on various types of chronic pain including chronic headache as well as chest,abdominal,joint,back,limb,and multisite chronic pain.We performed a bidirectional two-sample MR analysis using random effect inverse variance weighting(IVW),MR-Egger,weighted median,and weighted mode,quantified by odds ratio(OR).Results Genetically predicted essential hypertension was associated with an increased risk of chronic headache(OR=1.007,95%CI:1.003-1.011,P=0.002)and limb pain(OR=1.219,95%CI:1.033-1.439,P=0.019).No potential causal associations were identified between chronic pain and essential hypertension in the reverse direction MR(P>0.05).In addition,there was no potential causal association between secondary hypertension and chronic pain(P>0.05).Conclusion This study provided genetic evidence that a unidirectional causal relationship exists between essential hypertension and the increased risks of chronic headache and limb pain,and no causal relationship was found between secondary hypertension and chronic pain.These findings offer theoretical underpinnings for future research on managing hypertension and chronic pain.

Central nervous system blastomycosis presenting as a year-long chronic headache

This case describes a posterior fossa mass due to blastomycotic infection in a non-immunocompromised 41-year-old male presenting with a chronic headache for over one year.Given the risk of herniation,no lumbar puncture could be performed.A full work-up found no evidence of systemic infection.Surgical resection helped identify the mass as a blastomycotic abscess.Magnetic resonance imaging characteristics of the mass were helpful in the identification of the mass as a fungal abscess.

Research progress of chronic cervicogenic headache based on the concept of muscular dural bridge complex

Since it was put forward in 1995,musculo-dural bridge has been widely concerned.With the deepening of research,the structure,shape and physiological functions of musculo-dural bridge are gradually known.Previous studies have found that the musculo-dural bridge between muscle and dura mater can not only transfer proprioception,prevent the rupture of dura mater and ensure the normal flow of cerebrospinal fluid,but also be related to chronic cervicogenic headache.Therefore,this article mainly discusses the composition of musculo-dural bridge complex and its relationship with chronic cervicogenic headache,so as to provide a new diagnosis and treatment idea for the occurrence,development and treatment of related diseases in clinic.

Disease-Related Factors Associated with Acupuncture Response in Patients with Chronic Tension-Type Headache:A Secondary Analysis of A Randomized Controlled Trial

Objective: To explore the demographic and disease-related factors associated with acupuncture response in patients with chronic tension-type headache(CTTH). Methods: Using data from the randomized clinical trial(218 cases) consisting of 4 weeks of baseline assessment, 8 weeks of treatment, and 24 weeks of follow-up, participants were regrouped into responders(at least a 50% reduction in monthly headache days at week 16 compared with baseline) and non-responders. Twenty-three demographic and disease-related factors associated with acupuncture response in 183 participants were analyzed by multivariable logistic regression. Results: One hundred and nineteen(65.0%) participants were classified as responders. Four factors were significantly independently associated with acupuncture response, including treatment assignment, headache intensity at baseline, and 2 domains [general health(GH) and social functioning(SF)] from the 36-Item Short Form Health Survey quality of life questionnaire. Treatment assignment was associated with nonresponse: participants receiving true acupuncture were 3-time more likely to achieve a CTTH response than those receiving superficial acupuncture [odds ratio(OR) 0.322, 95% confidence interval(CI) 0.162 to 0.625, P=0.001]. Compared with patients with mild-intensity headache, patients with moderate-intensity headache were twice as likely to respond to acupuncture(OR 2.001, 95% CI 1.020 to 4.011, P=0.046). The likelihood of non-response increased by 4.5% with each unit increase in the GH grade(OR 0.955, 95% CI 0.917 to 0.993, P=0.024) while decreased by 3.8% with each unit increase in the SF grade(OR 1.038, 95% CI 1.009 to 1.069, P=0.011). Conclusions: Greater headache intensity, lower GH score, and higher SF score were associated with better acupuncture responses in CTTH patients. These 3 factors require independent validation as predictors of acupuncture effectiveness in CTTH.

A New Point of Consideration for the Definition of Minor Ischemic Stroke: Review

Stroke is the second highest cause of death globally and a leading cause of not only physical disability but also cognitive. Approximately two-thirds of Ischemic Stroke patients, who represent the most common type of stroke are found to have mild deficits. Minor stroke, sometimes also referred to as “mild stroke”, is often defined in research studies as a National Institute of Health Stroke Scale (NIHSS) score of 5 or less, although, the cut point for NIHSS score or standardized criterion to define minor stroke has not been established. In the past, many studies have been focusing on the definition of the minor stroke to better stabilize the acute treatment guidelines, to predict the functional outcome, and also for early risk factors stratification. Different studies use different criteria or different cut-points of NIHSS scores to define minor stroke. Aside from indecision of acute management of minor stroke, many other questions have been raised regarding minor strokes, for example, the interaction of large vessel occlusion with minor stroke, the prevalence rate of depression, anxiety, cognitive dysfunction, chronic head after minor stroke, and so on. Finding a universal definition for minor stroke is the key to establish the guideline for management for this group of patients. However, the guidance of treatment of minor stroke is not the focus of this review. The review will focus on the deep comprehension of minor stroke characteristics, summarizing the new findings related to minor stroke, and highlight the essential points to consider for characterizing mild stroke symptoms for a new direction guide for future studies.

Acupuncture for chronic daily headache:based on muscular fascia theory

Objective To observe the efficacy of acupuncture in treatment of chronic daily headache（CDH） based on muscular fascia theory.Methods Sixty patients were randomly divided into group A（30 cases） and group B（30 cases）.In group A,based on muscular fascia theory combined with the anatomical position of injection site of kreotoxin in treatment of chronic headache,10-16 acupoints were selected on frontal muscle,occipital muscle,temporal muscle,splenius capitis,semispinalis capitis,suboccipital muscle and sternocleidomastoid muscle.0.25 mm×30 mm acupuncture needles were adopted for acupuncture.After acupuncture,2-3 groups of acupoints were selected for electroacupuncture device.In group B,Neiguan（内关 PC 6）,Shulgou（水沟 GV26）,Hegu（合谷 LI 4）,Taichong（太冲 LR 3）,Baihui（百会 GV 20）,Sishencong（四神聪 EX-HN 1）,Fengchi（风池 GB 20）,Wangu（完骨 GB 12） and Tianzhu（天柱 BL 10） were selected for acupuncture.After acupuncture,2-3 groups of acupoints were selected for electroacupuncture device.Acupuncture was conducted once a day in the two groups,five days were one course of treatment,and two days were free from treatment between two courses.The treatment lasted for eight weeks.Daily headache record was considered as efficacy index,and VAS score and the number of days of headache in each month were observed.Results After treatment for eight weeks and follow-up visit for three months,the efficacy of acupuncture treatment for CDH based on muscular fascia theory（group A） was superior to conventional acupuncture（group B）,and the comparison result between the two groups was statistically significant（VAS score between two groups,after treatment：t=2.2864,P=0.0259,follow-up：r=2.6735,P=0.0097;the frequency of attack between the two groups after treatment：t=2.1520,P=0.0364）.Conclusion CDH may be related with muscular fascia dysfunction of head and neck,and the efficacy of acupuncture treatment based on muscular fascia theory was significant.

Two hundred and fifty-three cases of headache treated by acupuncture

Objective To explore the treatment of chronic headaches which are unmanageable to conventional occidental treatments.Methods Traditional Chinese acupuncture on the basis of syndrome differentiation was applied to 253 patients.The observation and efficacy evaluation criteria were related to the lowering of pain and the diminution in the use of painkillers,antiinflammatories and sedatives.Results For 220(87%) patients,the pain stopped in a permanent way,the remaining 33(13%) patients presented temporary relapses and needed extra treatment or simple pain relievers for their resolution.Conclusion Traditional Chinese Medicine is an efficient method in chronic headaches' treatment.