AIM To report the effects of greater occipital nerve(GON) blocks on refractory chronic migraine headache.METHODS Nine patients who were receiving the conventionally accepted preventive therapies underwent treatment wi...AIM To report the effects of greater occipital nerve(GON) blocks on refractory chronic migraine headache.METHODS Nine patients who were receiving the conventionally accepted preventive therapies underwent treatment with repeated GON block to control chronic migraine resistant to other treatments. GON blocking with lidocaine and normal saline mixture was administered by the same physician at hospital once a month(for three times in total). Patients were assessed before the injection and every month thereafter for pain frequency and severity, number of times analgesics were used and any appearant side effects during a 6 mo follow-up.RESULTS Eight of nine patients reported a marked decrease in frequency and severity of migraine attacks in comparison to their baseline symptoms; one reported no significant change(not more than 50%) from baseline and did not accept the second injection. GON block resulted in considerable reduction in pain frequency and severity and need to use analgesics up to three months after the injection in the present cases. The patients did not report any adverse effects. CONCLUSION Hereby we noticed a remarkable success with refractory chronic migraine patients. We believe that this intervention can result in rapid relief of pain with the effects lasting for perhaps several weeks or even months. Further controlled clinical trials are warranted to evaluate the effect of GON block in the treatment of refractory migraine cases.展开更多
Aim: To assess the lifetime prevalence of tension-type headache, migraine and chronic daily headache, including the primary headaches in a student population. Methods: This is a cross-sectional descriptive study. Data...Aim: To assess the lifetime prevalence of tension-type headache, migraine and chronic daily headache, including the primary headaches in a student population. Methods: This is a cross-sectional descriptive study. Data were collected from consecutive consenting students by means of a semi-structured questionnaire. The questionnaire was designed to assess demographic data, headache profiles and medical consultation. Results: Four hundred and forty-nine (89.8%) out of 500 students who were interviewed were analyzed. The lifetime prevalence of primary headache was 89.8%;it 90.5% and 88.6% in females and males respectively. The overall prevalence of migraine was 8.9%, with a prevalence of 10.6% in females and 6.5% in males. Migraine without aura was most commonly seen at 73%. The prevalence of migraine without aura was 7.6% in females and 4.9% in males. Tension type headache (TTH) had an overall prevalence of 22.9%, with a prevalence of 28.4% in females and 15.1% in males. Migraine and tension type headache co-existed in 5.8% of the students. About 8.5% suffered from chronic daily headache: chronic migraine 2.9%, chronic tension headache 3.1%. The rate of medical consultation was 54.8% (males 49.7%, females 58.3%). Conclusions: Headache is a common health problem among medical and nursing students in Enugu South East Nigeria where 89.8% of respondents have had primary headaches. The prevalence of migraine, TTH and chronic daily headache was 8.9%, 22.9% and 8.5% respectively. Headaches therefore, represent one of the most challenging neurological disorders in Sub-Saharan Africa where most sufferers do not have access to specialist care.展开更多
Objective: We conducted a prospective trial of oscillating mechanical stimulation (OS) of the craniocervical region as treatment for drug-refractory chronic migraine (CM). Methods: Ten patients (8 women, 2 men;mean ag...Objective: We conducted a prospective trial of oscillating mechanical stimulation (OS) of the craniocervical region as treatment for drug-refractory chronic migraine (CM). Methods: Ten patients (8 women, 2 men;mean age 47.0 ±15.1 years) were enrolled. The treatment was administered over an 8-week period to 13, 4, and 9 sites on the face and head, neck, and upper back, respectively, at 5- to 15-pound intensity. The primary outcome measure was the number of days patients suffered a migraine (hereafter “number of migraine days”), and the secondary outcome measures were the six-item Headache Impact Test (HIT-6) and Visual Analog Scale (VAS) scores for migraine pain intensity and the nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalized Anxiety Disorder (GAD-7) scale scores. Results: Nine patients completed treatment. The number of migraine days remained unchanged, from a mean 21.7 ±11.6 days/month before treatment to 19.3 ±7.3 days/month upon completion of treatment. However, the HIT-6 scores improved from 67.0 ±8.2 to 61.4 ±7.1 (p = 0.007) after 3 weeks, 61.1 ±11.5 (p = 0.01) after 6 weeks, and 59.9 ±11.6 (p = 0.035) upon completion of treatment. Similarly, the VAS scores improved significantly from 7.3 ±1.7 to 5.7 ±3.1 (p = 0.018) at 6 weeks and 4.8 ±2.8 (p = 0.011) upon completion of treatment. The GAD-7, PHQ-9, and allodynia scale scores remained unchanged. Conclusion: Our data suggest that OS is well tolerated and may become a feasible form of treatment for drug-resistant CM.展开更多
Background: The treatments suggested for chronic migraine (CM) include: 1) intramuscular (im) botulinum toxin (BTX) every 12 weeks, and 2) blockade of peripheral nerves of the head. The present study evaluated the eff...Background: The treatments suggested for chronic migraine (CM) include: 1) intramuscular (im) botulinum toxin (BTX) every 12 weeks, and 2) blockade of peripheral nerves of the head. The present study evaluated the efficacy of facial nerve blockade in combination with a single administration of different low BTX. Methods: Forty patients with CM submitted to unilateral facial nerve blockade (supraorbital, supratrochlear and auriculotemporal) were divided into 4 randomized groups in a double-blind manner in order to receiveim, after 7 days: 25 IU Botox®(Botox group), 25 IU Prosigne®(25-Pro group), 33.3 IU Prosigne®(33-Pro group) or saline (control group), with the dose divided for application to 10 sites in the frontal and bilateral temporal regions. Analgesia and adverse effects were evaluated: 1) before blockade of the facial nerves and 2) 4 weeks, 3) 8 weeks and 4) 12 weeks after BTX-A or saline application (HC clinical trial no. 12465). Results: Botox®(25 IU) or Prosigne®(33.3 IU) resulted in at least seven-day intervals between headache attacks associated with 70% reduction in frequency and intensity of crises over 12 weeks (P ®resulted in 8 weeks of analgesia. The conversion factor between Botox®and Prosigne®was 1:1.3. Conclusions: Im application of Botox®(25 IU) or Prosigne®(33.3 IU) one week after nerve blockade on the painful side was equally effective for 12 weeks in patients with chronic daily headache, with the conversion factor between Botox®and Prosigne®being 1:1.3.展开更多
The pathophysiology of migraine is complex.Neuroimaging studies reveal functional and structural changes in the brains of migraine patients.We sought to explore regional volume differences in intracranial structures i...The pathophysiology of migraine is complex.Neuroimaging studies reveal functional and structural changes in the brains of migraine patients.We sought to explore regional volume differences in intracranial structures in patients with episodic and chronic migraine.Sixteen episodic migraine patients,16 chronic migraine patients,and 24 normal controls were recruited and underwent 3.0 T MRI scanning.The volumes of 142 brain regions were calculated by an automatic volumetric algorithm and compared with clinical variables.Results demonstrated that the volumes of specific regions in the frontal and occipital lobes,and the right putamen,were increased and the volume of the fourth ventricle was decreased in the episodic migraine patients compared with controls.The volumes of the left basal forebrain,optic chiasm,and,the fourth ventricle were decreased in the chronic migraine patients,while the occipital cortex and the right putamen were larger.Compared to episodic migraine patiants,chronic migraine patients displayed larger left thalamus and smaller frontal regions.Correlation analysis showed that headache frequency was negatively correlated with the volume of the right frontal pole,right lateral orbital gyrus,and medial frontal lobes and positively correlated with the volume of the left thalamus.The sleep disturbance score was negatively correlated with the volume of the left basal forebrain.This suggests that migraine patients have structural changes in regions associated with pain processing and modulation,affective and cognitive processing,and visual perception.The remodeling of selective intracranial structures may be involved in migraine attacks.This study was approved by the Ethics Committee of Chinese PLA General Hospital(approval No.S2018-027-02)on May 31,2018.展开更多
Objectives: Aging workforces with increasing numbers of chronic conditions require health initiatives with greater workplace focus. A regional pension insurance introduced a Return To Work (RTW) strategy for insurants...Objectives: Aging workforces with increasing numbers of chronic conditions require health initiatives with greater workplace focus. A regional pension insurance introduced a Return To Work (RTW) strategy for insurants with chronic conditions. The objective was to identify the degree of implementation of work related measures in medical rehabilitation and the extent of RTW outcomes. Methods: 5883 insurants were considered. Severe Restriction of Work Ability (SRWA), Work-related Medical Rehabilitation (WMR), and Case Management (CM) were examined for 2008 and 2012. An Index of Employment status (IoE) was used in a logistic regression. Results: Utilization of WMR raised from 12.3% in 2008 to 66.1% in 2012. The proportion of insurants with SRWA and WMR grew from 8% up to 40.1%. In 2008, 14.7% of insurants with SRWA received WMR;in 2012, it grew to 76.6%. On the other hand, in 2012 26% got WMR without SRWA and 12.2% had SRWA and got no WMR. CM was not conducted in 2008 but reached 20.2% in 2012. Across all indications, WMR resulted in positive RTW as measured by IoE: OR = 0.75 (KI-95%: 0.67 - 0.86). Conclusion: WMR was successfully implemented according to the German guideline. There is a need to optimize the linkage between SRWA and WMR and CM to provide need-based care.展开更多
文摘AIM To report the effects of greater occipital nerve(GON) blocks on refractory chronic migraine headache.METHODS Nine patients who were receiving the conventionally accepted preventive therapies underwent treatment with repeated GON block to control chronic migraine resistant to other treatments. GON blocking with lidocaine and normal saline mixture was administered by the same physician at hospital once a month(for three times in total). Patients were assessed before the injection and every month thereafter for pain frequency and severity, number of times analgesics were used and any appearant side effects during a 6 mo follow-up.RESULTS Eight of nine patients reported a marked decrease in frequency and severity of migraine attacks in comparison to their baseline symptoms; one reported no significant change(not more than 50%) from baseline and did not accept the second injection. GON block resulted in considerable reduction in pain frequency and severity and need to use analgesics up to three months after the injection in the present cases. The patients did not report any adverse effects. CONCLUSION Hereby we noticed a remarkable success with refractory chronic migraine patients. We believe that this intervention can result in rapid relief of pain with the effects lasting for perhaps several weeks or even months. Further controlled clinical trials are warranted to evaluate the effect of GON block in the treatment of refractory migraine cases.
文摘Aim: To assess the lifetime prevalence of tension-type headache, migraine and chronic daily headache, including the primary headaches in a student population. Methods: This is a cross-sectional descriptive study. Data were collected from consecutive consenting students by means of a semi-structured questionnaire. The questionnaire was designed to assess demographic data, headache profiles and medical consultation. Results: Four hundred and forty-nine (89.8%) out of 500 students who were interviewed were analyzed. The lifetime prevalence of primary headache was 89.8%;it 90.5% and 88.6% in females and males respectively. The overall prevalence of migraine was 8.9%, with a prevalence of 10.6% in females and 6.5% in males. Migraine without aura was most commonly seen at 73%. The prevalence of migraine without aura was 7.6% in females and 4.9% in males. Tension type headache (TTH) had an overall prevalence of 22.9%, with a prevalence of 28.4% in females and 15.1% in males. Migraine and tension type headache co-existed in 5.8% of the students. About 8.5% suffered from chronic daily headache: chronic migraine 2.9%, chronic tension headache 3.1%. The rate of medical consultation was 54.8% (males 49.7%, females 58.3%). Conclusions: Headache is a common health problem among medical and nursing students in Enugu South East Nigeria where 89.8% of respondents have had primary headaches. The prevalence of migraine, TTH and chronic daily headache was 8.9%, 22.9% and 8.5% respectively. Headaches therefore, represent one of the most challenging neurological disorders in Sub-Saharan Africa where most sufferers do not have access to specialist care.
文摘Objective: We conducted a prospective trial of oscillating mechanical stimulation (OS) of the craniocervical region as treatment for drug-refractory chronic migraine (CM). Methods: Ten patients (8 women, 2 men;mean age 47.0 ±15.1 years) were enrolled. The treatment was administered over an 8-week period to 13, 4, and 9 sites on the face and head, neck, and upper back, respectively, at 5- to 15-pound intensity. The primary outcome measure was the number of days patients suffered a migraine (hereafter “number of migraine days”), and the secondary outcome measures were the six-item Headache Impact Test (HIT-6) and Visual Analog Scale (VAS) scores for migraine pain intensity and the nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalized Anxiety Disorder (GAD-7) scale scores. Results: Nine patients completed treatment. The number of migraine days remained unchanged, from a mean 21.7 ±11.6 days/month before treatment to 19.3 ±7.3 days/month upon completion of treatment. However, the HIT-6 scores improved from 67.0 ±8.2 to 61.4 ±7.1 (p = 0.007) after 3 weeks, 61.1 ±11.5 (p = 0.01) after 6 weeks, and 59.9 ±11.6 (p = 0.035) upon completion of treatment. Similarly, the VAS scores improved significantly from 7.3 ±1.7 to 5.7 ±3.1 (p = 0.018) at 6 weeks and 4.8 ±2.8 (p = 0.011) upon completion of treatment. The GAD-7, PHQ-9, and allodynia scale scores remained unchanged. Conclusion: Our data suggest that OS is well tolerated and may become a feasible form of treatment for drug-resistant CM.
文摘Background: The treatments suggested for chronic migraine (CM) include: 1) intramuscular (im) botulinum toxin (BTX) every 12 weeks, and 2) blockade of peripheral nerves of the head. The present study evaluated the efficacy of facial nerve blockade in combination with a single administration of different low BTX. Methods: Forty patients with CM submitted to unilateral facial nerve blockade (supraorbital, supratrochlear and auriculotemporal) were divided into 4 randomized groups in a double-blind manner in order to receiveim, after 7 days: 25 IU Botox®(Botox group), 25 IU Prosigne®(25-Pro group), 33.3 IU Prosigne®(33-Pro group) or saline (control group), with the dose divided for application to 10 sites in the frontal and bilateral temporal regions. Analgesia and adverse effects were evaluated: 1) before blockade of the facial nerves and 2) 4 weeks, 3) 8 weeks and 4) 12 weeks after BTX-A or saline application (HC clinical trial no. 12465). Results: Botox®(25 IU) or Prosigne®(33.3 IU) resulted in at least seven-day intervals between headache attacks associated with 70% reduction in frequency and intensity of crises over 12 weeks (P ®resulted in 8 weeks of analgesia. The conversion factor between Botox®and Prosigne®was 1:1.3. Conclusions: Im application of Botox®(25 IU) or Prosigne®(33.3 IU) one week after nerve blockade on the painful side was equally effective for 12 weeks in patients with chronic daily headache, with the conversion factor between Botox®and Prosigne®being 1:1.3.
基金supported by the Natural Science Foundation of Hainan Province of China,No.818MS153(to ZYC)the National Natural Science Foundation of China,No.81771200(to ZD)+2 种基金the National Key Research and Development Projects of Beijing Science and Technology Plan of China,No.Z161100002616013(to SYY)the Special Financial Grant from the China Postdoctoral Science Foundation,No.2014T70960(to ZYC)the Nursery Technology Innovation Fund of Chinese PLA General Hospital,No.12KMM39(to XYC)
文摘The pathophysiology of migraine is complex.Neuroimaging studies reveal functional and structural changes in the brains of migraine patients.We sought to explore regional volume differences in intracranial structures in patients with episodic and chronic migraine.Sixteen episodic migraine patients,16 chronic migraine patients,and 24 normal controls were recruited and underwent 3.0 T MRI scanning.The volumes of 142 brain regions were calculated by an automatic volumetric algorithm and compared with clinical variables.Results demonstrated that the volumes of specific regions in the frontal and occipital lobes,and the right putamen,were increased and the volume of the fourth ventricle was decreased in the episodic migraine patients compared with controls.The volumes of the left basal forebrain,optic chiasm,and,the fourth ventricle were decreased in the chronic migraine patients,while the occipital cortex and the right putamen were larger.Compared to episodic migraine patiants,chronic migraine patients displayed larger left thalamus and smaller frontal regions.Correlation analysis showed that headache frequency was negatively correlated with the volume of the right frontal pole,right lateral orbital gyrus,and medial frontal lobes and positively correlated with the volume of the left thalamus.The sleep disturbance score was negatively correlated with the volume of the left basal forebrain.This suggests that migraine patients have structural changes in regions associated with pain processing and modulation,affective and cognitive processing,and visual perception.The remodeling of selective intracranial structures may be involved in migraine attacks.This study was approved by the Ethics Committee of Chinese PLA General Hospital(approval No.S2018-027-02)on May 31,2018.
文摘Objectives: Aging workforces with increasing numbers of chronic conditions require health initiatives with greater workplace focus. A regional pension insurance introduced a Return To Work (RTW) strategy for insurants with chronic conditions. The objective was to identify the degree of implementation of work related measures in medical rehabilitation and the extent of RTW outcomes. Methods: 5883 insurants were considered. Severe Restriction of Work Ability (SRWA), Work-related Medical Rehabilitation (WMR), and Case Management (CM) were examined for 2008 and 2012. An Index of Employment status (IoE) was used in a logistic regression. Results: Utilization of WMR raised from 12.3% in 2008 to 66.1% in 2012. The proportion of insurants with SRWA and WMR grew from 8% up to 40.1%. In 2008, 14.7% of insurants with SRWA received WMR;in 2012, it grew to 76.6%. On the other hand, in 2012 26% got WMR without SRWA and 12.2% had SRWA and got no WMR. CM was not conducted in 2008 but reached 20.2% in 2012. Across all indications, WMR resulted in positive RTW as measured by IoE: OR = 0.75 (KI-95%: 0.67 - 0.86). Conclusion: WMR was successfully implemented according to the German guideline. There is a need to optimize the linkage between SRWA and WMR and CM to provide need-based care.
