Background： Histopathology identified the anatomical and molecular abnormalities ofbrainstem nuclei in migraine patients. However, the exact whole brainstem structural changes in vivo have not yet been identified in ...Background： Histopathology identified the anatomical and molecular abnormalities ofbrainstem nuclei in migraine patients. However, the exact whole brainstem structural changes in vivo have not yet been identified in medication-overuse headache （MOH） transformed from migraine. The aim of this study was to investigate the regional volume changes over the whole brainstem in the MOH patients using voxel-based morphometry （VBM） in vivo.Methods： High-resolution three-dimensional structural images were obtained using a 3.0-Tesla magnetic resonance system from 36 MOH patients and 32 normal controls （NCs） who were consecutively recruited from the International Headache Center, Chinese People＇s Liberation Army General Hospital, from March 2013 to June 2016. VBM was used to assess the brainstem structural alteration in the MOH patients, and voxel-wise correlation was performed to evaluate the relationship with the clinical characteristics.Results： The brainstem region with increased volume located in the left ventrolateral periaqueductal gray （MNI coordinate： -1, -33, -8）, ventral tegmental area （MNI coordinate： 0, -22, - 12）, bilateral substantia nigra （MNI coordinate： -8, - 16, - 12, 9, - 16, - 12）, and trigeminal root entry zone （MNI coordinate： -19, -29, -31; 19, -32, -29） in MOH patients compared with NCs. The headache visual analog scale score was positively related with the left rostral ventromedial medulla （RVM） （MNI coordinate： -1, -37, -56; cluster size： 20; r = 0.602） in the MOH patients.Conclusions： The regional volume gain ofbrainstem could underlie the neuromechanism of impaired ascending and descending pathway in the MOH patients, and the left RVM volume alteration could imply the impaired tolerance ofnociceptive pain input and could be used to assess the headache disability in the MOH patients.展开更多
Objective:This observational cohort pilot study aimed to evaluate the effects of the acupuncture methods,Jiu Cang Zhen(JCZ)and Huang Guan(HG),on changes in headache intensity in an inpatient,multimodal Zurzach Headach...Objective:This observational cohort pilot study aimed to evaluate the effects of the acupuncture methods,Jiu Cang Zhen(JCZ)and Huang Guan(HG),on changes in headache intensity in an inpatient,multimodal Zurzach Headache Programme(ZHP).Methods:Study participants consisted of patients diagnosed with chronic headache disorder(headache ds,30 days per month)or daily persistent headache.All patients received conventional therapies with active and passive approaches.The patient group was treated with JCZ and HG acupuncture methods,receiving a total of six to eight acupuncture sessions of 50 to 60 minutes each,during a 3–4-week multimodal ZHP at the RehaClinic Bad Zurzach.Pain intensity was quantified using a Numerical Rating Scale(NRS)before and after each acupuncture therapy session.Results:Ten patients were recruited,six women and four men,with a mean age of 41.7(standard deviation,[SD]=13.9).A reduction in headache intensity was reported by all patients in each of the sessions.The average NRS for pain was 4.21(SD=1.44)before acupuncture and 1.24(SD=0.93)after acupuncture(means first by number of sessions,then per n=10 patients).This resulted in a mean difference of 2.97(SD=1.04),corresponding to a standardized response mean of 2.85(95%confidence interval:2.11–3.60,one-tailed P<0.001),meaning there was a large effect.Conclusions:This pilot study shows that JCZ and HG are suitable acupuncture methods for reducing headache intensity in the treatment of headaches.A comparison with the conventional classical acupuncture methods from the acupuncture textbook for traditional Chinese medicine students in China,exploration with a larger patient group,and prolonged monitoring of pain behavior could be foci of follow-up investigations.展开更多
基金This work was supported by grants from Hainan Provincial Natural Science Foundation of China （No. 818MS153）, Special Financial Grant from the China Postdoctoral Science Foundation （No. 2014T70960）, and Foundation for Medical and Health Science and Technology Innovation Project of Sanya （No. 2016YW37）.
文摘Background： Histopathology identified the anatomical and molecular abnormalities ofbrainstem nuclei in migraine patients. However, the exact whole brainstem structural changes in vivo have not yet been identified in medication-overuse headache （MOH） transformed from migraine. The aim of this study was to investigate the regional volume changes over the whole brainstem in the MOH patients using voxel-based morphometry （VBM） in vivo.Methods： High-resolution three-dimensional structural images were obtained using a 3.0-Tesla magnetic resonance system from 36 MOH patients and 32 normal controls （NCs） who were consecutively recruited from the International Headache Center, Chinese People＇s Liberation Army General Hospital, from March 2013 to June 2016. VBM was used to assess the brainstem structural alteration in the MOH patients, and voxel-wise correlation was performed to evaluate the relationship with the clinical characteristics.Results： The brainstem region with increased volume located in the left ventrolateral periaqueductal gray （MNI coordinate： -1, -33, -8）, ventral tegmental area （MNI coordinate： 0, -22, - 12）, bilateral substantia nigra （MNI coordinate： -8, - 16, - 12, 9, - 16, - 12）, and trigeminal root entry zone （MNI coordinate： -19, -29, -31; 19, -32, -29） in MOH patients compared with NCs. The headache visual analog scale score was positively related with the left rostral ventromedial medulla （RVM） （MNI coordinate： -1, -37, -56; cluster size： 20; r = 0.602） in the MOH patients.Conclusions： The regional volume gain ofbrainstem could underlie the neuromechanism of impaired ascending and descending pathway in the MOH patients, and the left RVM volume alteration could imply the impaired tolerance ofnociceptive pain input and could be used to assess the headache disability in the MOH patients.
基金supported by Zurzach Rehabilitation Foundation SPA and Swiss Traditional Chinese Medicine Academy(STA)。
文摘Objective:This observational cohort pilot study aimed to evaluate the effects of the acupuncture methods,Jiu Cang Zhen(JCZ)and Huang Guan(HG),on changes in headache intensity in an inpatient,multimodal Zurzach Headache Programme(ZHP).Methods:Study participants consisted of patients diagnosed with chronic headache disorder(headache ds,30 days per month)or daily persistent headache.All patients received conventional therapies with active and passive approaches.The patient group was treated with JCZ and HG acupuncture methods,receiving a total of six to eight acupuncture sessions of 50 to 60 minutes each,during a 3–4-week multimodal ZHP at the RehaClinic Bad Zurzach.Pain intensity was quantified using a Numerical Rating Scale(NRS)before and after each acupuncture therapy session.Results:Ten patients were recruited,six women and four men,with a mean age of 41.7(standard deviation,[SD]=13.9).A reduction in headache intensity was reported by all patients in each of the sessions.The average NRS for pain was 4.21(SD=1.44)before acupuncture and 1.24(SD=0.93)after acupuncture(means first by number of sessions,then per n=10 patients).This resulted in a mean difference of 2.97(SD=1.04),corresponding to a standardized response mean of 2.85(95%confidence interval:2.11–3.60,one-tailed P<0.001),meaning there was a large effect.Conclusions:This pilot study shows that JCZ and HG are suitable acupuncture methods for reducing headache intensity in the treatment of headaches.A comparison with the conventional classical acupuncture methods from the acupuncture textbook for traditional Chinese medicine students in China,exploration with a larger patient group,and prolonged monitoring of pain behavior could be foci of follow-up investigations.
