【摘要】 目的 探讨颈源性头痛的特点、病因及治疗效果。 方法 2005年1月-2009年1月收治颈源性头痛患者153例，经X线平片、CT和MRI检查，病变位于上颈椎23例，下颈椎130例，其中上颈椎先天畸形11例，类风湿3例，肿瘤2例，结核3例，陈旧性骨折脱位4例，颈椎管狭窄23例，C4-5椎间盘突出35例，C5-6椎间盘突出22例，C6-7椎间盘突出6例。手术治疗129例，非手术治疗24例。随访3个月～4年，平均2.1年。 结果 手术治疗组129例中91例头痛明显好转，36例头痛部分好转，2例缓解不明显。非手术治疗组24例中11例头痛部分缓解，13例无效。 结论 上颈椎病变所致头痛主要表现为枕部疼痛，部分患者同时伴有前额及眼眶胀痛，可伴有颈部旋转活动受限。下颈椎病变所致头痛表现多样化，无明显的特点，可表现为枕颈部、头顶、额部疼痛或一侧的偏头痛，多伴肩部疼痛,部分有脊髓及神经根受压表现。颈源性头痛保守治疗效果不佳，手术治疗效果较好。【Abstract】 Objective To explore the causes, characteristics and therapeutic effeets of cervicogenic headache. Methods A total of 153 patients with cervicogenic headache from January 2005 to January 2009 were examined by X-ray, CT, and MRI. The focus was located in upper cervical vertebra in 23 cases, and in lower cervical vertebra in 130 cases. In the 153 patients, there were 11 had congenital deformity, 3 had rheumatoid, 2 had tumor, 3 had tuberculosis, 4 had fracture dislocation, 23 had cervical stenosis, 35 had C4-5 DH, 22 had C5-6 DH, and 6 had C6-7 DH. A total of 129 patients underwent operations, and 24 received expectant treatment. Results All the patients were followed up from 3 months to 4 years, averaging 2.1 years. Among 129 cases in the operation group, 91 patients’ headache disappeared completely, 36 disappeared partly, and 2 didn’t disappear. Among 24 cases in the expectant treatment group, 11 patients’ headache disappeared partly,13 didn’t disappeare. Conclusions The headache from upper cervical changing mainly appears pain in occiput; part of them combind pain in forehead or fossa orbitalis, accompanying limitation of neck rotation. Headache from lower cervical changing appears varied, having no feature, and appearing pain in cervical part, corona capitis, forehead or one lateral; many of them combind pain of shoulder, partly showing appearance from spinal cord or root compression. The efficacy of expectant treatment is bad and the efficacy of operation is good.
ObjectiveTo summarize the clinical features of and prognosis factors for spontaneous intracranial hypotension (SIH). MethodsWe continuously registered hospitalized patients diagnosed with SIH from December 1st, 2010 to February 1st, 2014. Etiology information and clinical features were collected at the first day of admission. Routine blood test and lumbar puncture were done as soon as possible. Every patient got position and fluid infusion therapy. During the one-week follow-up, headache level was evaluated with Visual Analogue Scale (VAS). ResultsThere were 110 patients included, and among them, 39(35.5%) were male and 71(64.55%) were female. The age of onset was between 17 and 91 years old with a mean onset age of (42.0±12.4). Besides postural headache, common signs were nausea (68 cases, 61.8%), vomiting (63 cases, 57.3%), dizziness (40 cases, 36.4%), neck pain (27 cases, 24.5%), and tinnitus (23 cases, 20.9%). VAS at baseline was (7.46±0.86), and at the last follow-up, VAS was (3.45±2.17), with an average improvement of 53.75%. Patients with ANA marker positive had better prognosis. ConclusionSIH can accompany serious brain stem and cerebellum signs, and even meningeal irritation. Cerebrospinal fluid (CSF) changes are similar to virus infection with negative serum virus screening. If CSF leak cannot be found on imaging, patients can improve through fluid infusion therapy and postural treatment.
ObjectivesTo evaluate the methodological quality of guidelines for pharmacological intervention of migraine in adults, to compare and analyze the differences in first-line drug recommendations in different regions and quality levels, so as to explore the evidence of drug recommendations, and provide a basis for clinical decision-making.MethodsPubMed, The Cochrane Library, EMbase, SinoMed, CNKI, VIP, and WanFang Data databases, Up To Date, as well as the related books, Yimaitong, Guideline Central, Guidelines International Network (GIN) and National Institute for Health and Clinical Excellence (NICE) were systematically searched to collect pharmacological intervention guidelines of migraine in adults from inception to January 12th, 2020. The methodological quality of the guidelines was evaluated by Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ).ResultsA total of 25 guidelines were included (including 22 evidence-based guidelines), covering 10 countries on 4 continents and World Health Organization (WHO) with a time span of 1997 to 2019. According to AGREE Ⅱ, 5 were A-level guidelines, 18 were B-level guidelines, and 2 were C-level guidelines. Scope and purpose, rigour of development, clarity of presentations and editorial independence obtained high average scores (more than 60%) among all 25 guidelines. The average scores of guidelines in different domains of AGREE Ⅱ varied with regions and countries. Triptans and NSAIDs were the most frequently recommended as first-line drugs for the acute management; beta-blockers and antiepileptic drugs were recommended for the first-line prevention drugs of migraine in adults. There were 2 guidelines that recommended complementary treatments, one recommended traditional Chinese medicine and another recommended herbal butterbur.ConclusionsThe methodological quality of the pharmacological intervention guidelines of migraine in adults is suboptimal among different regions or countries. The quality of evidence-based guidelines is superior to that established by consensus. The consistency of first-line drug recommendations is strong, but there are still regional differences. The therapeutic effect of traditional Chinese medicine requires further verification.
Objective To assess the quality of randomized controlled trials (RCTs) on acupuncture for treating acute migraine attacks. Methods With the searching terms of acupuncture and migraine, the Cochrane Controlled Trials Register (CCTR), PubMed, MEDLINE, EMbase, CBM, CMCC, CNKI and VIP were searched. The reports quality of the included trials, including the quality of methodology, diagnostic criteria, inclusion/exclusion criteria, acupuncture/control interventions, outcome measures, observing time, and adverse effects reports, was evaluated. Results A total 23 RCTs involving 2645 patients were included, of which only 3 RCTs were of high quality with Jadad scores equal to or more than 4. At present, only a few high quality trials on treating acute attacks of migraine with acupuncture had been reported at home and abroad. The international recognized diagnostic criteria and common evaluation methods had not been used generally, and the design of control was kind of irrational. Conclusion Based on current clinical reports, acupuncture may be effective in the management of acute migraine attacks, but some relevant proof is still required. The further domestic studies should be designed strictly following the international recommended diagnosis and evaluation criteria of migraine, and rational control methods as well.
China Association of Chinese Medicine officially issued the Guidelines for Diagnosis and Treatment of Common Internal Diseases in Chinese Medicine-Headache (T/CACM 1271-2019) on January 30th, 2019. The guideline provided 27 recommendations, including clinical diagnosis, treatment, prevention and care of headache. This paper introduces the background of this guideline and interprets its contents of clinical diagnosis, treatment and prevention.