Research On Features Of TCM Constitution In Patients With Migraine

Background:Headache is a common clinical disease which almost everyone experiences in one’s life. Tension-type headache and migraine are the most popular ones. The prevalence rate of migraine is an upward trend accompanied by the development of social economy as well as the increase of overwhelming force. Approximately6-7%of men and up to20%of women worldwide are suffer from migraine, a chronic, recurrent, disabling, neurovascular and familial disorder. Around a third (31%) of these people report frequent migraines defined as three or more attacks a month. Migraine causes severe impairment or bed rest in more than half(53%) of affected people, markedly impairs quality of life both during and between attacks, More than half (53%) of migraineurs reported severe impairment in activity or the requirement for bed rest with severe headaches. Work or school productivity was reduced by at least50%among half (51%) of migraineurs. Increases absenteeism and reduces productivity at work, and is associated with increased healthcare costs. Most academics reckon on that migraine is a multi-genetic and factors condition associated with the interaction of various environmental and genetic factors, however a number of precipitating factors have been identified in85%sufferers including altered mood and weather, somnipathy and so forth. Western medical diagnosis and treatment can’t be optimistic. Recent pharmacologic treatment options are still far from optimum, leaving many patients with high recurrences or with unpleasant side effects, and ultimately can lead to drug dependence headache. WHO oriented the server migraine to the refractory one and which is referred to the TCM.The ancient Traditional Chinese Medicine has a long history of headaches, which is named "Brain wind, Head wind" cause by mind attacked by the wind. The items of Zhong Jing’s<treatise on febrile diseases> have the sun, Yang, Yang genre, less Yin headache,<Dong Yuan ten book> pointed that the causes were due to exogenous and internal injuries. There are typhoid headache, migraine headache, faint headache damp and hot inverse headache, etc according to different causes and symptoms, also added a little cloudy and the lunar headache. Thus the foundation of drugs with different types was laid. Zhang Jingyue points out that the diagnosis should identify the length of a headache, disease a list, evil is the actual and be dialectical therapy.Objective:Modern studies have shown that an increased incidence rate of Migraine is ongoing. The traditional Chinese Medicine (TCM) theory of constitution has long been playing an important part on the stage of history for the prevention and treatment of diseases. At present, there has not been any research on the relationship between Migraine and TCM constitution, and this study aims to implement a preliminary research on the correlation of Migraine and TCM constitution to provide new ideas for the prevention and treatment of to the disease in Hongkong.Purpose:In this study, to explore the relevance of TCM constitution and Migraine and its impact factors by further research and clinical study based on the overview of TCM constitution and Migraine epidemiology research, as well as Migraine systematic review of rick factors.Method: 1.1Migraine influencing factors surveyThe preparation of migraine impact factor survey, and pre-survey. In the pre-investigation process, by Cronbach’s coefficient, the coefficient of the test-retest and construct validity evaluation questionnaire reliability and validity.35entries, according to their contents,35entry of four theoretical factors, they are:(1) In general:including age, gender, marital status, by the situation of education, occupation, family economic status and body;(2):Family history:family history, including family history, hypertension, neurological disorders and cerebrovascular disease, migraine;(3) headache:including headache incentives, location, nature, extent, and its accompanying symptoms;(4)17relevant factors child:self-evaluation form for constitution of TCM-related factors from the17"enough money","sleep" factor subentry constitute the entries required to fill in, and occasionally, sometimes, oftenalways5(1-5) Likert scale to choose the most appropriate answer to their own situation, the entry for the1-5scoring method.1.2TCM constitution ScaleSubject by the National Key Basic Research Development Program (973Program) based on the cornerstone of the Department of attention to people should be thinking of TCM constitution theory "group.TCM constitution scale by the gentleness, the quality of yang, yin deficiency, qi deficiency, phlegm, damp-heat, blood stasis mass, qi quality of special intrinsic quality of the nine subscales of the evaluation of the60entriestables.Each sub-scale contains7-8items. The entry or not, rarely, sometimes, often, always to paragraph5Likert scale, choose the answer. Each entry is a1-5paragraph5of the points system. Each entry in the original lowest score is1point, the highest score is5points, most of the entries for the1-5forward scored a few entries to a5-1reverse scoring.In addition, in both physical type, the part of the entry points, such as "easy fatigue" in the gentleness (reverse scored) and Qi deficiency in the two subscales (positive score) scoring.(2) The object of studyUsing hospital-based case-control study, patient selection, and cluster sampling method by the researchers of Applied Statistics Survey (TCM constitution Scale and migraine impact factor questionnaire) of270patients with migraine and269to investigate cases in the control group, the collection of epidemiological data, and then using the method of logistic regression, analysis of survey data to explore the Chinese constitution and the relationship between migraine impact factors.2.2.1Migraine group inclusion criteria and exclusion criteria:Inclusion criteria:(1) conform to the International Headache Society (HIS)2004, migraine headache classification criteria;(2) Eligible patients must be resident of Hong Kong residents;(3) Limited to gender, the age of18years to75years old;(4) Exclusion ophthalmoplegic migraine, retinal migraine, children with periodic syndrome (possibly migraine prodromal migraine:benign childhood paroxysmal vertigo, alternating hemiplegia of childhood), migraine coexist disorders(migraine last migrainous cerebral infarction);(5) Agreed to participate in the survey respondents.Exclusion criteria(1) does not comply with the above diagnosis;(2) mental disorder or is otherwise unable to complete the survey.2.2in the control groupExclude migraine Usual Residents in Hong Kong; limited to gender, age, the age of18to75years; agreed to participate in the survey respondents.3. statistical methods3.1General characterizationUsed in forming the data than the description of the migraine group with the control group the main features of the subject of the investigation, including age, gender, body size and reflect the community’s demographic characteristics, etc., the comparison between the two sets of measurement data were analyzed by two independent sample t-test; the use of ranked datanon-parametric Wilcoxon rank sum test, non-hierarchical count data using the chi-square test; and to prepare two sets of each variable frequency distribution table.3.2Chinese medicine constitution and migraine impact factors logistic regression analysis3.2.1The single-factor analysisThe migraine group and the control group, the type of physical data fitting unconditional logistic regression model:variables migraine group and control group assignment for one of the migraine group, control group2. The independent variable of nine kinds of physical type, a value of0=No,1=yes, the variables one by one to introduce non-conditional logistic regression model for univariate analysis.Do the constitution of the risk of migraine and migraine risk factors by logistic regression analysis, the independent variable (migraine influencing factors) are more the first screening of the independent variables on univariate analysis, then for the risk of physical and screeninglogistic regression analysis of risk factors for migraine. The measurement data were analyzed by two independent sample t-test; ranked data using non-parametric Wilcoxon rank sum test, non-hierarchical count data using the chi-square test.3.2.2Multi-factor analysisThe migraine group and the control group, the type of physical data fitting unconditional logistic regression model:variables migraine group and control group assignment for one of the migraine group, control group2.Independent variables of nine kinds of physical type, a value of0=No,1=yes, stepwise forward likelihood method (of Forward:The Conditional), set the SPSS default to the introduction of (Entry), and removed the inspection standards (Removal) variables were0.05and0.10.Dangerous physical and screening migraine impact factors non-conditional logistic regression analysis:the risk of physical data as the dependent variable, migraine headaches affect factors as independent variables, since the variable assignment, please refer to Table13, using the SPSS default to introduce (the Entry)and inspection levels removed (Removal) variables were0.05and0.10.Results:Investigated a total of270case group and control group of269people. The recovery of the number of copies of the questionnaire539, the recovery was100%. Which questionnaire to537268cases (migraine group and control group of269cases), the effective rate of99.63%.I.A letter to the questionnaire reliability and validity analysis:reliability analysis of test-retest reliability and internal consistency test, the general correlation coefficient R=1.000, P=0.000<0.001, a family history of the correlation coefficient R=0.987,P=0.000<0.001, correlation coefficient of the degree of migraine P=0.988, P=0.000<0.001,17factor correlation coefficient R=0.996, P=0.000<0.001. The overall Cronbach’s alpha coefficient of0.799entries as calculated by the standardized reliability as0.890, can be used for a formal investigation. Validity Analysis:In accordance with the contribution rate, the minimum extraction of10common factor is more appropriate, but according to the first division of the field, extract the common factor of3.2.The average age of the patient group was45.64±13.14years old, the average age of the control group was42.05±13.68years old, two sets of two independent samples t-test, two groups of age difference was statistically significant (t=3.098, P=0.002). The gender of the two groups, the chi-square test to get the difference was statistically significant (χ2=15.258, P=0.000﹤0.001) difference not statistically significant. Level of education and economic level data, so the use of non-parametric Wilcoxon rank sum test, the results show that the economic situation of the difference between two groups was statistically significant (Z=-3.690, P=0.000﹤0.001).3.migraine family history in the normal population and migraine population difference was statistically significant (Z=-13.383, P=0.000﹤0.001), family history of migraine headache in the migraine population accounted for73.88%of the normal populationmigraine family history accounted for16.36%, indicating that migraine is a familial tendency of the disease. In the migraine population with the normal population, cerebrovascular disease family history (Z=-4.014, P=0.000﹤0.001) and family history of hypertension (Z=-4.617, P=0.000﹤0.001) difference was statistically significant. the clinical description of cerebrovascular disease and high blood pressure can also affect the occurrence of migraine.4.The two groups of17related to physical factors, in addition to the daily diet with dietary preferences, and working hours fixed factors are ranked data, using non-parametric Wilcoxon rank sum test. The test results showed that daily diet with (χ2=11.950, P=0.018), dietary preferences (χ2=17.982, P=0.001), sleep in satisfactory condition (Z=-7.026, P=0.000<0.001), alcohol consumption,(Z=-4.074, P-0.000﹤O.001), tea (Z=-2.814, P=0.005), negative feelings (Z=-4.228, P=0.000﹤0.001), sexual satisfaction (Z=-5.119, P=0.000﹤0.001), exercise situation (Z=-4.052, P=0.000﹤0.001), stress conditions (Z=-3.060, P=0.002) and overtime work of (Z=-3.993, P=0.000﹤0.001),10factor difference was statistically significant, the remaining projects difference was not statistically significant.5. of constitutions in Chinese medicine:in the case group (migraine sufferers) to qi deficiency, qi and quality of blood stasis quality more common, while the gentleness, Yang and quality of Qi deficiency is common in healthy people in Hong Kong.6. Headache attack:headache incentives to changes in the weather is more common, emotions and stress headache impact; headache more balanced position, but the right side of the migraine is more common; the nature of the headache to pulsating painis more common; headache accompanied by symptoms of dizziness for outstanding performance; moderate pain embodied in this collection of cases more; three mitigation methods more evenly.7.Migraine risk of physical and protect the physical type:Univariate logistic regression have:qi quality, the stasis quality for migraine risk factors, the impact of migraine according to the quality of the Exp (B) size can be inferred stasistoo large. Gentleness, Yang and quality of yin deficiency migraine protective factors; multivariate logistic regression:after multiple stepwise regression analysis too, gentleness, quality of yang, yin deficiency, qi quality and stasis quality, enter regression model. Model goodness of fit test χ2=6.341, P=0.012, show that the model fit is good; regression model to accurately predict the percentage of72.3%. Quality of qi, blood stasis quality migraine risk factors, the gentleness, the yang quality, yin deficiency migraine protective factors.8.Gentleness and migraine factors:univariate logistic regression of:sex, sleep, drink tea, and sex life satisfaction for the gentleness of risk factors, age, migraine family history, family history of cerebrovascular disease, highblood pressure, family history, negative feelings, physical exercise, there is pressure for the gentleness of protective factors; multivariate logistic regression to get:after multiple stepwise regression analysis too, gender, migraine family history, family history of hypertension, negative feelings and exerciseGo to the regression model. Model goodness of fit test χ2=7.661, P=0.054, indicating that the model fit is not ideal; regression model to accurately predict the percentage of79.1%. With or without sex for peace and qualitative risk factors, migraine, family history, family history of hypertension, negative feelings and regular physical for gentleness protection factors.9.Qi quality and migraine factors:univariate logistic regression have:migraine family history of qi qualitative risk factors, and sex, sleep satisfaction, often drinking, negative feelings qi quality of protective factors. Multivariate logistic regression: after multiple stepwise regression analysis, sex, sleep is entered into the regression model. Model goodness of fit test χ2=9.206, P=0.002, show that the model fit is good; regression model to accurately predict the percentage of86.2%. Sex and sleep quality for qi protective factors.10.Stasis quality and migraine factors:univariate logistic regression have:a family history of migraine, diet preferences for the stasis qualitative risk factors, and tea, sexual satisfaction, overtime stasis quality protectionfactors. Multivariate logistic regression:after multiple stepwise regression analysis have migraine family history, stress and overtime work into the regression model. Model goodness of fit test χ2=4.033, P=0.045, show that the model fit is good; regression model to accurately predict the percentage of84.2%. Migraine family history, pressure stasis qualitative risk factors, overtime work for the protective factors of stasis quality.Conclusion: By.exploring relationship between TCM constitution and Migraine, for the first time the establishment of qi-stagnation and blood-stasis constitution were regarded as risk factors of Migraine, normal constitution, yang deficiency constitution and yin deficiency constitution were found to be the protective factors of Migraine, which enriches the TCM pathogenesis theory of Migraine.By exploring the relationship between TCM constitution and impact factors of Migraine, the research drawer the conclusion that normal constitution-related factors included:gender, sleeping, tea, sex, aging, negative feelings, family history of migraine, family history of cardiovascular and cerebrovascular diseases, family history of hypertension, and exercise; Qi-stagnation constitution-related factors included:gender and sleeping; and Blood-stasis constitution-related factors included: family history of migraine, pressure and overwork time.