【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.
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 evaluate the efficacy of Yangxue Qingnao Grain for migraine. Methods We searched The Cochrane Library (Issue 3, 2007), EMBASE (1974 to June 2007), PubMed (1966 to June 2007), VIP (1989 to June 2007), CNKI (1979 to June 2007) and CBM (1978 to June 2007) to identify randomized controlled trials or quasirandomized controlled trials comparing Yangxue Qingnao Grain versus sibeline for migraine. The quality of included studies was critically assessed and data analyses were performed with The Cochrane Collaboration’s RevMan 4.2.7. Results Eight studies were included, involving 5 randomized trials and 3 quasi-randomized trials. Meta-analyses showed that the total response rate (RR=1.07, 95%CI 1.00 to 1.15, P=0.06), the duration of headache (WMD 1.33, 95%CI – 0.87 to 3.52, P=0.24), and the frequency of headache episodes (WMD 0.93, 95%CI –1.00 to 2.86, P=0.35) were similar between Yangxue Qingnao Grain and sibeline. One study reported that the changes of ACA (WMD 3.70, 95%CI –3.46 to 10.86), MCA (WMD 0.60, 95%CI –10.37 to 11.57), ICA (WMD 3.40, 95%CI –4.35 to 11.15) and DCA (WMD – 2.30, 95%CI –9.52 to 4.92) revealed by transcranial doppler sonography were also comparable between the two groups. Conclusion Yangxue Qingnao Grain is effective in the treatment of migraine, but its superiority over sibeline is not demonstrated. Due to the poor quality and small sample of the included trials, more large-scale multi-center randomized trials are needed.
Objective To evaluate the effects of cold provoca tion on optic dise blood flow and retinal light sensitivity of primary open-angle glaucoma (POAG) patients,and explore the relationship between the changes of optic disc blood flow and retin al light sensitivity. Methods A total 33 POAG patients (33 eyes)and 13 normal controls (13 eyes) were tested by usin g th e Heidelberg retinal flowmetry (HRF) and Topcon automatic perimeter,and the optic disc blood flow and retinal light sensitivity of POAG patients and normal cont rols were measured at normal conditions and after cold provocation. Results The mean optic disc blood flow,volume and the mean retinal light sensitivity of POAG patients decreased significantly (Plt;0.05) after cold provocation.There was a linear and significant relationsh ip between the decrease of mean optic disc blood flow and mean retinal light sen sitivity of POAG patients (r=0.615,P＜0.001). The optic disc blood flow of POAG patients with a history of migraine were more likely to r educe in response to cold provocation and reduced much more than those without such history (Plt;0.05). Conclusion Cold provocation can significantly reduce both the optic disc blood flow and retinal light sensitivity in POAG patients.A close correlation was fo und between the amount of mean optic disc blood flow decrease and the volume of mean retinal light sensitivity decline. (Chin J Ocul Fundus Dis, 2001,17:37-40)