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ABSTRACT: BACKGROUND: In order to know the status quo of health care for primary headache disorders in China, questions about headache consultation and diagnosis were included in a nationwide population-based survey initiated by Lifting The Burden: the Global Campaign against Headache. METHODS: Throughout China, 5,041 unrelated respondents aged 18--65 years were randomly sampled from the general population and visited unannounced at their homes. After basic sociodemographic and headache diagnostic questions, respondents with headache answered further questions about health-care utilization in the previous year. RESULTS: Significantly higher proportions of respondents with migraine (239/452; 52.9%) or headache on >=15 days per month (23/48; 47.9%) had consulted a physician for headache than of those with tension-type headache (TTH) (218/531; 41.1%; P < 0.05). Multivariate analysis showed associations between disability and probability of consultation in those with migraine (mild vs. minimal: AOR 3.4, 95% CI: 1.6--7.4; moderate vs. minimal: 2.5, 1.2--5.4; severe vs. minimal: 3.9, 1.9--8.1) and between rural habitation and probability of consulting in those with TTH (AOR: 3.5; 95% CI: 1.9--6.3, P < 0.001). Married respondents with TTH were less likely than unmarried to have consulted (AOR: 0.26; 95% CI: 0.07--0.93; P = 0.038). About half of consultations (47.8--56.5%) for each of the headache disorders were at clinic level in the health system. Consultations in level-3 hospitals were relatively few for migraine (5.9%) but more likely for headache on >=15 days/month (8.7%) and, surprisingly, for TTH (13.3%). Under-diagnosis and misdiagnosis were common in consulters. More than half with migraine (52.7%) or headache on >=15 days/month (51.2%), and almost two thirds (63.7%) with TTH, reported no previous diagnosis. Consulters with migraine were as likely (13.8%) to have been diagnosed with "nervous headache" as with migraine. "Nervous headache" (9.8%) and "vascular headache" (7.6%) were the most likely diagnoses in those with TTH, of whom only 5.6% had previously been correctly diagnosed. These were also the most likely diagnoses (14.0% each) in consulters with headache on >=15 days/month. CONCLUSIONS: This picture of the status quo shows limited reach of headache services in China, and high rates of under-diagnosis and misdiagnosis in those who achieve access to them. This is not a picture of an efficient or cost-effective response to major causes of public ill-health and disability.
The Journal of Headache and Pain 06/2013; 14(1):47. · 2.43 Impact Factor
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ABSTRACT: BACKGROUND/AIMS: Vascular dysfunction is implied in migraine. Endothelin type A receptor (EDNRA) is a receptor for endothelin-1, a potent vasoconstrictor. Several studies have investigated the association between EDNRA -231G>A SNP and migraine, but showed conflicting results. This study aimed to evaluate the association between EDNRA -231A allele and migraine by meta-analysis. METHODS: Relevant databases were searched to identify eligible studies published in English from 2000 to 2012. Data were extracted using standardized forms. The association was assessed by relative risk (RR) with 95% confidence intervals (CIs) using a fixed or random effects model to determine the strength of the genetic association. RESULTS: Three studies comprising 440 migraineurs, 222 subjects with tension-type headaches (TTHs) and 1323 controls were included in the meta-analysis. A significant difference was found between migraineurs and controls with AA genotype vs. AG+GG, and pooled RR with fixed effect was 4.04 (95% CI 1.173, 1.585; p=0.000, I(2)=15.1%). However, there was no statistically significant difference between TTH and controls (p=0.774). CONCLUSIONS: This meta-analysis provides evidence suggesting a significant association between EDNRA -231G>A polymorphism and migraine.
Journal of the neurological sciences 10/2012; · 2.32 Impact Factor
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ABSTRACT: The objective of this study was to observe the efficacy, safety, and side effects of a combination of flunarizine plus topiramate compared with either flunarizine and or toparamate alone for migraine prophylaxis.
Out of 150 patients with migraine recruited into the study and randomly assigned to one of three conditions, 126 completed the trial in their group: flunarizine (39), topiramate (44), and flunarizine plus topiramate (43). Patient information was assessed at enrollment and at follow-up visits at the end of months 1-3, 6, 9, and 12. The primary measure of efficacy reduction in mean monthly migraine frequency of at least 50% as compared with baseline. Secondary efficacy parameters included reduction in mean monthly migraine days and severity of headache. Side effects were compared in the three groups by recording adverse reactions and weight changes.
The proportion whose monthly headache frequency decreased more than 50% was 66.7% (26/39) in the flunarizine group, 72.7% (32/44) in the topiramate group and 76.7% (33/43) in the combination group, respectively (P=0.593). The mean monthly days and severity of headache in the three groups also declined and was more significant in the flunarizine plus topiramate group than in the flunarizine group and the topiramate group (P<0.05). In the flunarizine group, the average weight change was 0.6kg. Topiramate was associated with a mean weight loss was of -0.9kg in the topiramate group and -0.2kg in the flunarizine plus topiramate group.
Flunarizine, topiramate, and the combination of flunarizine with topiramate are all effective and have good tolerability in migraine prophylaxis. Adding topiramate to flunarizine may reduce the latter's impact on body weight.
Pain Medicine 01/2012; 13(1):80-6. · 2.35 Impact Factor
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Ning Luo, Yannan Fang,
Feng Tan,
Qian Zhang,
Daliang Zou,
Xiutang Cao,
Xuehua Xu,
Hua Bai,
Jiangang Ou,
Haike Wu,
Zilong Chen,
Yane Zhou,
Saiying Wan,
Yan Hong,
Jingliang Wang,
Minghui Ding,
Aiwu Zhang,
Daoyuan Zhu,
Jun Dun
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ABSTRACT: Background.— Since the early 1990s, no study has been undertaken examining the prevalence and burden of headache disorders in China.Objective.— We conducted a one-year survey on the prevalence and burden of primary headache in the Chinese provinces of Guangdong and Guangxi. Our study also evaluated the factors behind similarities and differences affecting prevalence in the 2 regions of study.Methods.— Random samples of 372 local residents in Guangdong and 182 local residents in Guangxi aged 18-65 years were invited to a face-to-face interview.Results.— The one-year prevalence of primary headache was 22.6% (84/372) in Guangdong and 41.2% (75/182) in Guangxi. The prevalence of migraine (14.3%, n = 26) in Guangxi was higher than prevalence of migraine (8.3%, n = 31) in Guangdong (P = .03). The ratio of headache cost and household income was 2.1% in Guangdong and 3.7% in Guangxi, the ratio in Guangdong was less than that in Guangxi (P = .001). The diagnostic confirmation rate of migraine was low. No migraineur used triptans drugs to treat migraine in either region.Conclusion.— Migraine prevalence was higher in the lower-income region that also contains a higher proportion of ethnic minorities. Although there was no difference of headache cost between the 2 regions, the headache populations in the lower-income region would relatively suffer a greater financial burden if taking the economic differences between the 2 regions into account. The improvement of diagnostic and therapeutic levels for the treatment of headache, especially migraine, in the 2 regions may be a matter of urgency.
Headache The Journal of Head and Face Pain 11/2010; · 2.52 Impact Factor
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ABSTRACT: To investigate the role of 5-HT(7) receptors on the release of calcitonin gene-related peptide (CGRP) in an animal model of migraine.
Calcitonin gene-related peptide has been identified as a key neuropeptide in the pathophysiology of migraine. It is elevated in the external jugular vein during migraine attacks in humans and after stimulation of the trigeminal ganglion in animal models of migraine. This can be treated with the 5-HT(1B/1D) receptor agonist sumatriptan concomitant with headache relief. Nevertheless, triptans, the most effective agents for the treatment of acute migraine attacks, are not effective in more than 1/3 of migraineurs and less than 50% of migraineurs achieve complete pain freedom. This indicates other serotonin receptors may be involved in the pathophysiology of migraine. Increasing evidence has shown that 5-HT(7) receptors may be involved in migraine pathogenesis. However, direct evidence for the role of 5-HT(7) receptors in migraine is still lacking.
Unilateral electrical stimulation of the trigeminal ganglion (TGES) was performed in anesthetized male Sprague-Dawley rats. Animals were pretreated with sumatriptan (300 microg/kg, i.v.), selective 5-HT(7) receptor antagonist SB269970 (5, 10 mg/kg, s.c.), potential 5-HT(7) receptor agonist AS19 (5, 10 mg/kg, s.c.) or co-administration of SB269970 and AS19 (10 mg/kg, s.c.). Serum CGRP concentrations in the ipsilateral jugular vein were determined before and at 2 and 5 minutes after the start of TGES.
Our results showed that sumatriptan almost completely inhibited the release of CGRP evoked by TGES. Pre-administration of SB269970 (5, 10 mg/kg) caused a significant decrease in serum CGRP concentrations at 2 and 5 minutes following the onset of TGES, with a less inhibitory effect compared with sumatriptan. AS19 had no significant effect on CGRP release, while the SB269970-induced inhibitory effect was reversed by AS19.
Selective inhibition of 5-HT(7) receptors partly reduced CGRP release evoked by TGES. These findings suggest that 5-HT(7) receptors may play a role in the pathophysiology of migraine.
Headache The Journal of Head and Face Pain 03/2010; 50(4):579-87. · 2.52 Impact Factor
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ABSTRACT: Nitroglycerin-induced NF-kappaB activation in trigeminal nucleus caudalis is believed to be partly involved in the pathogenesis of migraine. Atorvastatin, an inhibitor of HMG-CoA reductase, is thought to have pleiotropic effects in various neurologic diseases. Moreover, there are several lines of evidences that atorvastatin inhibits NF-kappaB activation in peripheral blood mononuclear cells. Thus, this study aims to explore whether atorvastatin attenuates NF-kappaB activation in trigeminal nucleus caudalis in a nitroglycerin-induced migraine model. A significant increase in nuclear content of p65, an indicator of NF-kappaB activation, was detected in trigeminal nucleus caudalis in rats following injection with nitroglycerin. However, the nitroglycerin-induced NF-kappaB activation in trigeminal nucleus caudalis was attenuated by pretreatment with atorvastatin in a dose-dependent fashion. These results suggest that atorvastatin may be a novel and promising candidate for future treatment or prophylaxis of migraine via attenuating activation of NF-kappaB in trigeminal nucleus caudalis.
Neuroscience Letters 10/2009; 465(1):61-5. · 2.11 Impact Factor
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ABSTRACT: This study is to report the clinical, neuroimaging and pathological characteristics of patients with primary angiitis of the central nervous system (PACNS) from Southern China.
Eight patients with PACNS admitted between August 1995 and April 2006 were retrospectively studied. Records of clinical features, neuroimaging, brain biopsy and therapy were analyzed.
Primary angiitis of the central nervous system occurred predominantly in youth and middle-aged adults. Headache, hemiplegia and speech disturbance were the most predominant manifestations. The cerebrospinal fluid (CSF) was slightly abnormal in only one case, MRI was abnormal in seven, magnetic resonance angiography in seven, diffusion-weighted imaging in five and digital subtraction angiography in four. Brain biopsy in four cases revealed lymphocytic angiitis. All cases had good outcome with the treatment of single corticoid or cyclophosphamide.
We report eight cases of PACNS from Southern China associated with neurological and neuroimaging abnormalities; these patients presented a mild to moderate inflammatory disease that was correlated with few CSF abnormalities and good response to single steroid or cyclophosphamide treatment without relapses. Although brain biopsy represents the gold standard for diagnosis of PACNS, considering the difficulty and challenge of identification of this disease, combination with other examinations might be necessary to arrive at an early and definitive diagnosis.
European Journal of Neurology 12/2008; 16(1):63-9. · 3.69 Impact Factor
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ABSTRACT: To investigate whether additional early physiotherapy after stroke improved functional recovery in stroke patients.
A prospective, randomized, controlled study.
One stroke ward and an acute stroke unit in a large teaching hospital, southern China.
Patients with first-onset stroke consecutively admitted to the stroke centre.
One group (n = 78) received additional early physiotherapy (AEP) for 45 minutes, five days a week for four weeks starting within the first week since stroke onset; the routine therapy (RT) group (n = 78) received no professional rehabilitation therapy.
Glasgow Coma Scale, Mini-Mental State Examination, Fugl-Meyer Assessment of Motor Recovery, Clinical Neurological Deficit Scale and Modified Barthel Index (MBI).
Patients from the AEP group had a high drop-out rate (n = 28), but those remaining made relatively better functional recovery at 30 days than those from the RT group if measured by MBI. Multiple linear regression analysis revealed that cognitive disturbance, aphasia, double incontinence, site of lesion and sensory impairment might affect functional recovery after stroke.
Additional early physiotherapy might improve independence of patients after stroke but failed to show benefit in other aspects in our study. Cognitive disturbance, aphasia, double incontinence, site of lesion as well as sensory impairment might affect functional outcome after stroke.
Clinical Rehabilitation 10/2003; 17(6):608-17. · 2.12 Impact Factor
