Assignment of a diagnosis of migraine has been formalized in diagnostic criteria proposed by the International Headache Society. The objective of the present study is to determine the reproductibility of the formal di...Assignment of a diagnosis of migraine has been formalized in diagnostic criteria proposed by the International Headache Society. The objective of the present study is to determine the reproductibility of the formal diagnosis of migraine in a cohort of headache sufferers over a one- year period. The study was performed in a community cohort taking part in a long- term prospective health survey, the GAZEL study. Two thousand five hundred individuals reporting headache in the GAZEL cohort were sent two postal questionnaires concerning headache symptoms and features at 12- monthly intervals. Replies to the questions allowed a migraine diagnosis to be attributed retrospectively using an algorithm based on the IHS classification scheme. The response rate was 82% for the first questionnaire and 69% for both questionnaires. Of the 1733 subjects providing information at both time- points, the agreement rate for the diagnosis of strict migraine (IHS categories 1.1 or 1.2) was 77.7% (kappa = 0.48), with 62.2% of the patients with this diagnosis (IHS categories 1.1 or 1.2) at Month 0 retaining the same diagnosis at Month 12. When diagnostic criteria were widened to include IHS category 1.7 (migrainous disorder), the agreement rate of the diagnosis was similar at 77.6% (kappa = 0.52), but 82% of the patients with this diagnosis (IHS categories 1.1 or 1.2 or 1.7) at Month 0 now retained the same diagnosis at Month 12. In conclusion, the one- year reproducibility of reporting of migraine headache symptoms is only moderate, varies between symptoms, and leads to instability in the formal assignment of a migraine headache diagnosis and to diagnostic drift between headache types. This finding is compatible with the continuum model of headache, where headache attacks can vary along a severity continuum from episodic tension- type headaches to full- blown migraine attacks.展开更多
Objectives. To describe a method for quantifying headache symptoms/features in family practice charts for patients diagnosed with headache NOS (not otherwis e specified, IGD 9: 784) and to determine the share of NOS h...Objectives. To describe a method for quantifying headache symptoms/features in family practice charts for patients diagnosed with headache NOS (not otherwis e specified, IGD 9: 784) and to determine the share of NOS headache diagnoses w ith clinical data strongly suggestive of migraine or probable migraine headache. Background. Headache is one of the most common pain symptoms that brings pati ents to a family physician. However, the majority of headache sufferers do not r eceive a specific headache diagnosis when they visit physicians. Methods. We e xamined the chart notes of 454 patients exclusively diagnosed with one or more I CD 9 coded headache NOS diagnoses from July 1, 1995 through December 31,1999 at a large suburban, university affiliated practice. We developed a template cont aining 20 headache items combining International Headache Society diagnostic cri teria and additional headache symptoms/features, and decision rules for coding s ymptom s/features and collected data from patient charts. We then developed dec ision rules and reclassified NOS headaches into categories strongly suggestive o f migraine, probable migraine headache, or other diagnosis. Our main outcome mea sure is the consistency in the application of decision rules and diagnostic crit eria. Results. With this method we estimate 3 in 10 (29%) headache NOS patien ts may have had migraine (8%) or probable migraine headache (21%). Reclassifi ed migraine visits averaged 6.5 migraine symptoms and reclassified probable migr aine headache visits 4.7 migraine symptoms. Logistic regression analysis support s the consistency of diagnostic criteria for classifying headache based on coded symptoms/features our model correctly predicted 96%of visits. Evidence of ph ysical examination was recorded at 75%of visits suggesting that physician atten tion is focused on elimination of secondary headache. Conclusions. We think th e use of our rigorous procedures reveals that a substantial amount of migraine a nd probable migraine headache may be missed in everyday practice. We hope our fi ndings will provide a basis for the development of diagnostic methods more close ly suited to the needs of nonspecialists, and contribute to a better standard of care for headache patients seen in primary care practice. Finally, we are hopef ul that other researchers will consider using our template and guideline procedu res in their efforts to identify diagnostic patterns and study headache and othe r health problems.展开更多
目的探讨通督调神法针刺联合刺络放血治疗无先兆型偏头痛的疗效。方法将95例无先兆型偏头痛患者随机分为对照组47例和治疗组48例。对照组给予氟桂利嗪治疗,共纳入47例,脱落2例(1例发生严重不良事件,1例失访),最终完成45例。治疗组给予...目的探讨通督调神法针刺联合刺络放血治疗无先兆型偏头痛的疗效。方法将95例无先兆型偏头痛患者随机分为对照组47例和治疗组48例。对照组给予氟桂利嗪治疗,共纳入47例,脱落2例(1例发生严重不良事件,1例失访),最终完成45例。治疗组给予通督调神法针刺联合刺络放血治疗,共纳入48例,脱落3例(1例依从性差,1例要求退出,1例资料不全),最终完成45例。患者完成4周治疗后统计临床疗效。记录患者就诊当日(治疗前)和治疗4周后的次日(治疗后)的偏头痛频次、持续时间评分、疼痛程度、伴随症状评分。测定血清中正五聚蛋白3(pentraxin-3,PTX3)、内皮素1(endothelin-1,ET-1)、环氧合酶-2(cyclooxygenase-2,COX-2)的水平。以偏头痛特异性生活质量(migraine specific quality of life,MSQOL)评估生活质量。结果治疗组患者经4周治疗后总有效43例,总有效率为95.56%,对照组总有效37例,总有效率为82.22%,组间差异显著(P<0.05)。治疗后,两组的偏头痛频次、持续时间评分、数字疼痛量表、伴随症状评分均比治疗前降低(P<0.05);治疗组治疗后的偏头痛频次、持续时间评分、数字疼痛量表、伴随症状评分比对照组低(P<0.05)。治疗后,两组血清PTX3、ET-1、COX-2的水平均明显降低(P<0.05);治疗组治疗后血清PTX3、ET-1、COX-2的水平均比对照组低(P<0.05)。治疗后,两组的大脑前、中、后动脉的平均血流速度均低于治疗前(P<0.05);治疗组治疗后的大脑前、中、后动脉的平均血流速度低于对照组(P<0.05)。两组治疗后的MSQOL各维度评分明显升高,且治疗组较对照组升高更明显,组间差异显著(P<0.05)。结论通督调神法针刺联合刺络放血可提高无先兆型偏头痛的治疗效果,进一步减轻偏头痛症状,改善患者生活质量和血流动力学,与减轻炎性损伤有关。展开更多
文摘目的探讨成人非偏头痛症状与卵圆孔未闭(patent foramen ovale,PFO)的相关性。方法回顾分析我院心血管内科超声心动图室2024年2~12月经胸超声心动图右心声学造影(contrast transthoracic echocardiography,cTTE)检查患者的临床资料,根据症状分为偏头痛症状组(n=527)、非偏头痛症状组(包括不明原因的头晕、耳鸣、一过性听力减退、晕厥、肢体麻木、一过性视野缺损症状,n=144)和无症状对照组(n=87)。比较3组PFO阳性率、PFO阳性患者右向左分流(right to left shunt,RLS)的差异;多因素logistic回归分析PFO阳性的独立相关因素。结果偏头痛症状组、非偏头痛症状组和无症状对照组PFO阳性率分别为85.0%(448/527)、84.0%(121/144)和26.4%(23/87),3组差异有显著性(χ^(2)=153.434,P=0.000),偏头痛症状组和非偏头痛症状组PFO阳性率显著高于无症状对照组(均P=0.000)。592例诊断PFO,3组RLS分级差异有显著性(H=18.762,P=0.000),偏头痛症状组和非偏头痛症状组RLS分级显著高于无症状对照组(均P=0.000)。多因素logistic回归分析显示,年龄≤40岁(OR=2.221,95%CI:1.515~3.256,P=0.000)、偏头痛(OR=3.373,95%CI:2.322~4.899,P=0.000)、头晕(OR=2.499,95%CI:1.694~3.685,P=0.000)和肢体麻木(OR=1.981,95%CI:1.052~3.729,P=0.034)与PFO阳性独立相关。结论头晕、肢体麻木等非偏头痛症状与成人PFO相关,对这些症状的患者进行cTTE检查是必要的。
文摘Assignment of a diagnosis of migraine has been formalized in diagnostic criteria proposed by the International Headache Society. The objective of the present study is to determine the reproductibility of the formal diagnosis of migraine in a cohort of headache sufferers over a one- year period. The study was performed in a community cohort taking part in a long- term prospective health survey, the GAZEL study. Two thousand five hundred individuals reporting headache in the GAZEL cohort were sent two postal questionnaires concerning headache symptoms and features at 12- monthly intervals. Replies to the questions allowed a migraine diagnosis to be attributed retrospectively using an algorithm based on the IHS classification scheme. The response rate was 82% for the first questionnaire and 69% for both questionnaires. Of the 1733 subjects providing information at both time- points, the agreement rate for the diagnosis of strict migraine (IHS categories 1.1 or 1.2) was 77.7% (kappa = 0.48), with 62.2% of the patients with this diagnosis (IHS categories 1.1 or 1.2) at Month 0 retaining the same diagnosis at Month 12. When diagnostic criteria were widened to include IHS category 1.7 (migrainous disorder), the agreement rate of the diagnosis was similar at 77.6% (kappa = 0.52), but 82% of the patients with this diagnosis (IHS categories 1.1 or 1.2 or 1.7) at Month 0 now retained the same diagnosis at Month 12. In conclusion, the one- year reproducibility of reporting of migraine headache symptoms is only moderate, varies between symptoms, and leads to instability in the formal assignment of a migraine headache diagnosis and to diagnostic drift between headache types. This finding is compatible with the continuum model of headache, where headache attacks can vary along a severity continuum from episodic tension- type headaches to full- blown migraine attacks.
文摘Objectives. To describe a method for quantifying headache symptoms/features in family practice charts for patients diagnosed with headache NOS (not otherwis e specified, IGD 9: 784) and to determine the share of NOS headache diagnoses w ith clinical data strongly suggestive of migraine or probable migraine headache. Background. Headache is one of the most common pain symptoms that brings pati ents to a family physician. However, the majority of headache sufferers do not r eceive a specific headache diagnosis when they visit physicians. Methods. We e xamined the chart notes of 454 patients exclusively diagnosed with one or more I CD 9 coded headache NOS diagnoses from July 1, 1995 through December 31,1999 at a large suburban, university affiliated practice. We developed a template cont aining 20 headache items combining International Headache Society diagnostic cri teria and additional headache symptoms/features, and decision rules for coding s ymptom s/features and collected data from patient charts. We then developed dec ision rules and reclassified NOS headaches into categories strongly suggestive o f migraine, probable migraine headache, or other diagnosis. Our main outcome mea sure is the consistency in the application of decision rules and diagnostic crit eria. Results. With this method we estimate 3 in 10 (29%) headache NOS patien ts may have had migraine (8%) or probable migraine headache (21%). Reclassifi ed migraine visits averaged 6.5 migraine symptoms and reclassified probable migr aine headache visits 4.7 migraine symptoms. Logistic regression analysis support s the consistency of diagnostic criteria for classifying headache based on coded symptoms/features our model correctly predicted 96%of visits. Evidence of ph ysical examination was recorded at 75%of visits suggesting that physician atten tion is focused on elimination of secondary headache. Conclusions. We think th e use of our rigorous procedures reveals that a substantial amount of migraine a nd probable migraine headache may be missed in everyday practice. We hope our fi ndings will provide a basis for the development of diagnostic methods more close ly suited to the needs of nonspecialists, and contribute to a better standard of care for headache patients seen in primary care practice. Finally, we are hopef ul that other researchers will consider using our template and guideline procedu res in their efforts to identify diagnostic patterns and study headache and othe r health problems.
文摘目的探讨通督调神法针刺联合刺络放血治疗无先兆型偏头痛的疗效。方法将95例无先兆型偏头痛患者随机分为对照组47例和治疗组48例。对照组给予氟桂利嗪治疗,共纳入47例,脱落2例(1例发生严重不良事件,1例失访),最终完成45例。治疗组给予通督调神法针刺联合刺络放血治疗,共纳入48例,脱落3例(1例依从性差,1例要求退出,1例资料不全),最终完成45例。患者完成4周治疗后统计临床疗效。记录患者就诊当日(治疗前)和治疗4周后的次日(治疗后)的偏头痛频次、持续时间评分、疼痛程度、伴随症状评分。测定血清中正五聚蛋白3(pentraxin-3,PTX3)、内皮素1(endothelin-1,ET-1)、环氧合酶-2(cyclooxygenase-2,COX-2)的水平。以偏头痛特异性生活质量(migraine specific quality of life,MSQOL)评估生活质量。结果治疗组患者经4周治疗后总有效43例,总有效率为95.56%,对照组总有效37例,总有效率为82.22%,组间差异显著(P<0.05)。治疗后,两组的偏头痛频次、持续时间评分、数字疼痛量表、伴随症状评分均比治疗前降低(P<0.05);治疗组治疗后的偏头痛频次、持续时间评分、数字疼痛量表、伴随症状评分比对照组低(P<0.05)。治疗后,两组血清PTX3、ET-1、COX-2的水平均明显降低(P<0.05);治疗组治疗后血清PTX3、ET-1、COX-2的水平均比对照组低(P<0.05)。治疗后,两组的大脑前、中、后动脉的平均血流速度均低于治疗前(P<0.05);治疗组治疗后的大脑前、中、后动脉的平均血流速度低于对照组(P<0.05)。两组治疗后的MSQOL各维度评分明显升高,且治疗组较对照组升高更明显,组间差异显著(P<0.05)。结论通督调神法针刺联合刺络放血可提高无先兆型偏头痛的治疗效果,进一步减轻偏头痛症状,改善患者生活质量和血流动力学,与减轻炎性损伤有关。
