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头痛预防的预后与体重指数

世界核心医学期刊文摘(神经病学分册) 2006年第8期 9-10页

作者： bigal m.e. Gironda m. Tepper S.J. 刘凯 Department of Neurology Albert Einstein College of Medicine 1165 Morris Park Avenue Bronx NY United States Dr.

A population- based longitudinal study suggests that obesity is a strong risk factor for the development of headaches on 15 or more days per month. Little is know about the influence of weight on the response to headache preventive treatment. Herein we prospectively assessed the influence of the baseline body mass index (BmI) on the response to headache preventive treatment. We included adults with episodic or chronic migraine (ICHD- 2), or transformed migraine (Silberstein and Lipton criteria) that sought care in a headache clinic. BmI was assessed in the first visit. Baseline information included headache frequency, num.e. of days with severe headache (prospectively obtained over 1 month), and headache- related disability (HIT- 6). The same information was obtained after 3 months of preventive treatment. Subjects were categorized based on BmI in: normal weight (≤ 24.9), overweight (25- 29.9), or obese (≥ 30). We contrasted the headache end- points using anova with post- test and Kruskal- Wallis with post- test. We used logistic regression to model BmI and headache parameters adjusting for covariates. Our sample consisted of 176 subjects (79.5% women, mean of 44.4 years). At baseline 40.9% had normal weight, 29.5% were overweight and 27.3% were obese. No significant differences were observed in the num.e. of headache days at baseline. After treatment, frequency declined in the entire population, but no significant differences were found by BmI group. Regarding the num.e. of days with severe pain per month, there were also no significant differences at baseline (normal = 6.1, overweight = 6.5, obese = 6.7), and improvement overall (P = 0.01). However, changes were greater in the obese (reduction in 2.7 days with treatment) and overweight (3.9) vs. normal (1.5, P es at baseline did not differ by BmI group (normal weight = 63.8, overweight = 64.1, obese = 63.6). However, compared with the normal weighted group, change in HIT scores (follow- u

关键词：头痛头疼疼痛体重指数正常体重头痛发作

比较第2版头痛疾病国际分类和选择性诊断标准对青少年慢性每日头痛分类的差异

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世界核心医学期刊文摘（神经病学分册） 2005年第10期1卷 20-21页

作者： bigal m.e. Rapoport A.m. Tepper S.J. 袁海峰 New england Cent er for Headache 778 Long Ridge Road Stamford CT 06902 United States Dr.

Objectives.- To compare the second edition of the International Classificati on of Headache Disorders (ICHD- 2) and the Silberstein- Lipton (S- L) criteri a in the classification of adolescents with chronic daily headache (CDH). method s.- We reviewed the clinical records and the headache diaries of 170 adolescent s (13 to 17 years) seen between 1998 and 2003 at a headache center. Relevant inf ormation was transferred to a standardized form that included operational criter ia for the ICHD- 2. CDH subtypes were classified according the criteria propose d by S- L into transformed migraine (Tm) with (Tm+ ) and without medication ov eruse (Tm- ), chronic tension- type headache (C- TTH), new daily persistent h eadache (NDPH), and he micrania continua (HC). Results.- From the 69 patients with Tm- according t he S- L criteria, most (71% ) could be classified as chronic migraine (Cm), wh ile a minority of patients required a combination of diagnosis, mainly migraine and CTTH (14.4% ). Of the patients with Tm+ , just 39.6% met the criteria fo r probable Cm (PCm) with probable medication overuse (PmO). If instead of 15 mig raine days per month, we considered 15 or more days of migraine or probable migr aine, 84% of the subjects with Tm- and 68.7% of those with Tm+ could be classified. Of the 27 subjects classified as NDPH without medication overuse acc ording to the S- L system, the majority (51.2% ) were also classified as NDPH according the ICHD- 2. Interestingly, three (11.1% of the subjects with NDPH without medication overuse) were classified as Cm in the ICHD- 2 because these patients had an abrupt onset of 15 or more days of migraine per month. All patie nts with NDPH with medication overuse according to the S- L criteria required a combination of diagnoses in the ICHD- 2. All subjects with CTTH received a sin gle diagnosis in both classification systems. Conclusions.- (i) Among adolescen ts with Tm, the majority (58.1% ) could be classified as Cm, according to the I C

关键词：慢性每日头痛国际分类诊断标准慢性紧张型头痛持续状态持续头痛操作标准转换型标化诊断系统

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偏头痛患病率和临床特征的年龄依赖性

世界核心医学期刊文摘(神经病学分册) 2006年第12期 25-26页

作者： bigal m.e. Liberman J.N. Lipton R.B. 郭俊 Dr.Department of Neurology Albert Einstein College of Medicine1165 Morris Park Ave.BronxNYUnited States

BACKGROUND:Available data suggest two seemingly opposite trends with regard to the natural history of *** prevalence decreases with *** some individuals,migraine progresses to chronic daily ***:To contrast the clinical features of migraine across the life ***:A validated computer-assisted telephone interview(CATI)was used to identify a population sample in three urban centers in the United *** participants were older than 18 *** CATI covered the International Classification of Headache Disorders criteria for migraine and Probable migraine(Pm).Prevalence and clinical features of migraine and Pm were examined by ***:This sample consists of 145,335 *** overall prevalence of migraine was 15%,whereas the overall prevalence of Pm was 14.6%.migraine prevalence was highest between ages 30 and 39 *** older ages,Pm was more prevalent than *** those with migraine,the prevalence of unilateral and throbbing pain peaked at intermediate ages and declined after *** prevalence of photophobia and phonophobia related to the attacks declined with ages,whereas the prevalence of aura *** proportion of those with 10 to 14 headache days per month also increased,from 12.5%in those ages 18 to 29 to 41.0%(odds ratio = 4.8,95%CI = 3.9 to 7.1)in those older than ***:The profile of migraine changes over the life span and suggests three nonexclusive *** many,migraine *** some patients with migraine,attacks get less typical,resembling probable migraine instead of full *** some,migraine progresses.

关键词：偏头痛患者脑病患病率临床特征

偏头痛的家族风险:先证者发病年龄与头痛严重程度的变异

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世界核心医学期刊文摘(神经病学分册) 2006年第10期 30-31页

作者： Stewart W.F. bigal m.e. Kolodner K. 赵天智 Albert einstein College of medicine 1300 Morris Park Ave. Bronx NY 10461 United States Dr.

Background: It is well established that migraine aggregates within families. Less is known about the influence of proband characteristics (e.g., age at onset, headache severity) on familial aggregation. Objective: To examine the association between the proband' s migraine severity and age at migraine onset and familial aggregation of migraine. methods: The authors investigated the migraine prevalence in first- degree relatives of 532 persons with migraine and control subjects in a population study. Familial aggregation was expressed as the risk of migraine in family mem.e.s of probands divided by risk in control family mem.e.s. Results: The relative risk (RR) of migraine in first- degree relatives of migraine probands was elevated compared with family mem.e.s of controls (RR = 1.88; 95% CI: 1.30 to 2.72). The RR was also significantly higher for relatives of probands reporting onset of migraine before age 16 (2.50; 95% CI: 1.65 to 3.79) compared with those with onset at age 16 or older (1.44; 95% CI: 0.93 to 2.23). Among probands with very severe average pain scores (i.e., 9 to 10 on a 0 to 10 scale), the RR of migraine in family mem.e.s was 2.38 (95% CI: 1.56 to 3.62) compared with 1.52 (0.99 to 2.34) for less severe pain (p early onset of migraine in the proband as well as the severity of migraines are associated with higher levels of family aggregation.

关键词：发病年龄严重程度先证者年龄因素偏头痛脑病家族

鼻内接触点头痛和难治性偏头痛患者的外科治疗

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世界核心医学期刊文摘（神经病学分册） 2005年第9期1卷 40-41页

作者： Behin F. Behin B. bigal m.e. Lipton R.B. 周永 142 Palisade Avenue Jersey City NJ 07306 United StatesDr.

Contact point headaches have been attributed to intranasal contact between opp osing mucosal surfaces, resulting in referred pain in the distribution of the tr igeminal nerve. In subjects with primary headaches, contact points may be associ ated with treatment refractoriness. We aimed to assess the benefits of surgical correction in patients with refractory migraine or transformed migraine, and rad iographic evidence of contact points in the sinonasal area. We reviewed charts o f patients who underwent endoscopic sinus surgery and septoplasty for contact po int in the same surgical facility, from October 1998 through August 2003. Subjec ts eligible for surgery had: (i) refractory migraine (failed to standard pharmac ological headache treatments) or refractory transformed migraine; (ii) contact p oints demonstrated by computed tomography scan; (iii) reported significant heada che improvement after topical anaesthesia to the contact area. Headache characte ristics were assessed preoperatively and at follow-up (6-62 months after surge ry) using a standardized questionnaire. A total of 21 subjects (72.5%women) wer e assessed. mean headache frequency was reduced from 17.7 to 7.7 headache days p er month (P=0.003). mean headache severity was reduced from 7.8 to 3.6 on a 0-1 0 scale (P=0.0001). Headache-related disability was reduced from 5.6 (10-point scale) to 1.8 (P ects (76.2%) had their headache scores improved by 50%or more; nine (42.9%) were pain free at the last follow -up. A total of 18 (95.8%) had at least a 25%reduction in their headache scor es. Two patients (9.5%) had increase in their headache score by less than 25%. For selected patients with refractory headaches, demonstrable contact points, a nd positive response after topical anaesthesia, surgical approach toward the tri ggering factor may be useful. Prospective studies are necessary to confirm our r esults.

关键词：难治性偏头痛接触点黏膜接触神经分布区内窥镜鼻窦手术鼻中隔成形术放射影像学局部麻醉转换性分量表

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1例三氯蔗糖诱发的偏头痛报道

世界核心医学期刊文摘(神经病学分册) 2006年第8期 15-15页

作者： bigal m.e. Krymchantowski A.V. 陈孝东 Department of Neurology Albert Einstein College of Medicine 1165 Morris Park Avenue Bronx NY 10461 United States

Sucralose is the active compound of the most commonly sold sweetener in the United States. Different than aspartame, sucralose is not considered to be a migraine trigger. Herein we report a patient with attacks of migraine consistently triggered by sucralose. She also suffers from menstrually related migraine that had been well- controlled for several months since she switched her contraceptive from fixed estrogen to triphasic contraceptive pills. Some attacks triggered by sucralose were preceded by aura, and she had never experienced migraine with aura before. Withdrawal of the compound was associated with complete resolution of the attacks. Single- blind exposure (vs. sugar) triggered the attacks, after an attack- free period.

关键词：偏头痛患者脑病三氯蔗糖

利扎曲坦与利扎曲坦加曲美布汀用于偏头痛急性治疗的比较:一项双盲、随机、交叉、安慰剂对照研究

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世界核心医学期刊文摘(神经病学分册) 2006年第10期 20-20页

作者： Krymchantowski A.V. Filho P.F.m. bigal m.e. 刘凯 Rua Siqueira Campos 43/1002 Copacabana Rio de Janeiro Brazil Dr.

Gastroparesis frequently happens during migraine attacks, postponing the onset of action of orally administered drugs. Furthermore, triptans seem to work better in the earlier phases of the migraine attacks. Therefore, associating a gastrokinetic drug with a triptan may translate into better efficacy and higher consistency of response. Trimebutine is an opioid derivative with exclusive action on receptors of the meissner and Auerbach plexus throughout the digestive tube. It has no absorption or central penetration. Herein we contrast the combination of rizatriptan plus trimebutine with rizatriptan alone in the acute treatment of migraine. Forty patients with migraine consecutively seen in our clinic were randomized to treat two consecutive moderate or severe attacks with one tablet of 10 mg rizatriptan plus one capsule of 200 mg trimebutine and two attacks with the same triptan and placebo, in counterbalanced order. We collected information on the severity of the attack, as well as presence of nausea and photophobia at the time of drug intake, and after 1, 2 and 4 h. Recurrence and adverse events were also contrasted. Sixty- four attacks were treated with each drug regimen. At 1 h postdose, 30 (46.8% ) of 64 attacks treated with the combination resolved completely, vs. eight (12.5% ) of the rizatriptan- treated attacks, a difference of 34% (P e, 47 (73.4% ) attacks treated with the combination vs. 20 (31.2% ) of those treated with rizatriptan alone resolved completely, a difference of 42% (95% confidence interval 26, 58, P egarding nausea and photophobia, the combination was also associated with significantly better response. Recurrence was similar among the two drug regimens, as well as adverse events. The combination rizatriptan and trimebutine is more effective than rizatriptan alone. The combination does not increase adverse events or recurrence of pain.

关键词：利扎曲坦利扎曲普坦偏头痛脑病曲美布汀安慰剂空白剂

半侧固定性头痛为主诉的眼眶炎性假瘤(肌炎型):1例病例报道

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世界核心医学期刊文摘(神经病学分册) 2006年第8期 25-25页

作者： Krymchantowski A.V. Oliveira T. bigal m.e. 王孝文 Rua Siqueira Campos 43/1002 Copacabana Rio de Janeiro Brazil Dr.

The case of a 38- year- old woman with continuous unilateral side- locked headache is reported. She had continuous right- sided periorbital pain of mild to moderate intensity for the past 5 months. She also reported a few episodes of pain exacerbations every day. She had no autonomic features. Based on a normal CT scan ordered by her general physician, we started indomethacin (150 mg/day) as well as celecoxib (400 mg/day)for 2 weeks, without relief. Oral prednisone for 6 days provided important relief, and she stayed on daily use of steroids, refusing other forms of therapy. After 5 months she developed orbital and eyelid edema, with painful restrictions to eye movement. Orbital mRI and pathological exam demonstrated inflammatory orbital pseudotumor (myositic form).

关键词：眼眶炎性假瘤头痛头疼疼痛肌炎肌肉疾病

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慢性偏头痛是成年转换型偏头痛的早期阶段

世界核心医学期刊文摘（神经病学分册） 2006年第3期2卷 35-35页

作者： bigal m.e. Rapoport A.m Sheftell F.D. 方伯言 Rousso Bldg. Office 334-A 1165 Morris Park Ave. Bronx NY 10461 United States

Background: Chronic migraine (Cm) is characterized by 15 or more migraine days per month. most adults with chronic daily headache (CDH) that evolved from migraine have < 15 days of migraine/month. They are often class... 详细信息

Background: Chronic migraine (Cm) is characterized by 15 or more migraine days per month. most adults with chronic daily headache (CDH) that evolved from migraine have migraine/month. They are often classified as transformed migraine (Tm), a disorder not addressed in the International Headache Society cl assification. Objective: To test the hypothesis that early in the course of migr aine chronification, the frequency of migraine attacks is high and that as illne ss progresses the frequency of nonmigraine headaches increases. methods: Informa tion was collected on 402 adults with Tm and was divided into two groups. Group 1 Tm had a 15 days of migraine/month, whereas Group 2 Tm had migrai ne/month. Risk factors were modeled for num.e. of migraine days per month using logistic regression. Results: Of 402 subjects with Tm, 121 (30.1%) were in Grou p 1. The proportion of Group 1 subjects decreased with age, from 71%below age 3 0 to 22%age 60 or above. The correspondent proportion of Group 2 increased from 29 to 78%. more than 15 days of migraine per month was independently predicted by younger ages ( ears; p = 0.002), shorter interval from.e.isodic to CDH ( ears; p = 0.003), and shorter time since the development of CDH ( e ars; p migraine is an earlier stage of transforme d migraine.

关键词：转换型头痛发作国际头痛协会慢性每日头痛回归模拟间断发作分类组织