| ObjectsIn this study,patients with menstrual migraine(MM)were used as research carriers,using Blood Oxygen Level Dependent-functional Magnetic Resonance Imaging(BOLD-fMRI)technology,Using Regional Homogeneity(ReHo)and Amplitude of Low Frequency Fluctuations(ALFF)analysis methods,to observe the difference in clinical efficacy of acupuncture treatment of menstrual migraine with different distal-proximal points combination,The similarities and differences of functional activities,explore the mechanism of action of distant and near acupoints,provide a scientific basis for the clinical application of far and near acupoints in the treatment of menstrual migraine,and preferably a prescription for acupoints.MethodsA total of 22 menstrual migraine patients and 12 healthy subjects were included in the study.Patients with menstrual migraine were randomly divided into LR3 adjunct acupuncture points group(selected bilateral GB20,GB8 compatibility LR3)and PC6 adjunct acupuncture points group(selected bilateral GB20,GB8 compatibility PC6).Each group of 11 patients underwent acupuncture treatment,starting treatment 1 week before menstruation,once every other day,a total of 3 treatments;1 week for menstrual cramps,2 treatments;the rest of the time,2 treatments per week.Continuous treatment for 3 menstrual cycles,a total of 27 ± 6 times.Healthy subjects underwent resting-state fMRI scans and clinical evaluations at the time of enrollment.Patients with menstrual migraine underwent restive fMRI scans and clinical evaluations before and after treatment,completing the following analysis:1.To compare the differences in headache,quality of life and emotional state of menstrual migraine patients before and after acupuncture treatment by different distalproximal points combination,and to explore the clinical effects of far and near acupoints in the treatment of menstrual migraine.2.To compare the differences in ReHo and ALFF between menstrual migraine patients and healthy subjects in resting state,to explore the characteristics of brain function in patients with menstrual migraine.3.By comparing the changes of ReHo and ALFF before and after acupuncture treatment in LR3 adjunct acupuncture points group and PC6 adjunct acupuncture points group,the correlation between brain function activity value and clinical effect index in normal chemotaxis area was further analyzed,and further exploration of different distal-proximal points combination of mechanism on the regulation of brain function in menstrual migraine.Results1.Baseline data of menstrual migraine patients and healthy subjects were balanced and comparable(P>0.05).The baseline data of the patients in the LR3 adjunct acupuncture points group and PC6 adjunct acupuncture points group were balanced and comparable(P>0.05).2.After acupuncture treatment,the number of headache episodes,headache visual analogue pain score scale(VAS)score,headache intensity grade were significantly improved in the LR3 adjunct acupuncture points group(P<0.05),and the headache patient quality of life questionnaire(MSQ).The scores in the functionally restricted,dysfunctional areas were improved(P<0.05),the self-rating anxiety scale(SAS),and the self-rating depression scale(SDS)scores were improved(P<0.05);the differences in the emotional field in MSQ were not Statistical significance(P>0.05).The number of headache episodes in the PC6 adjunct acupuncture points group was significantly improved(P<0.05),the function in the MSQ was limited,the dysfunction,the score in the emotional field was improved(P<0.05),and the SAS score and SDS score were improved(P<0.05).There was no significant difference in headache VAS score and headache intensity grade(P>0.05).After acupuncture treatment,there was no significant difference in the clinical effect index between the two groups(P>0.05).3.Results of study on resting brain function in patients with menstrual migraine(1)Compared with healthy subjects,the Reho elevated brain area in the LR3 adjunct acupuncture points group included: right middle occipital gyrus,inferior occipital gyrus,superior temporal gyrus,middle temporal gyrus,left lingual gyrus;ReHo reduced brain area Including: bilateral precuneus,right fusiform gyrus,superior anterior gyrus,left anterior cerebellar apex.The brain regions with elevated ALFF include: bilateral middle frontal gyrus,right inferior frontal gyrus,precentral gyrus,cuneus,and left middle occipital gyrus;ALFF reduced brain regions include: left precuneus,postcentral gyrus,right lateral cerebellar tonsils.(2)Compared with healthy subjects,the ReHo elevated brain area in the PC6 adjunct acupuncture points group included: right inferior frontal gyrus,left cerebellar posterior lobe;ReHo reduced brain area included: right anterior cingulate gyrus,superior frontal gyrus,the left cingulate gyrus,postcentral gyrus,precuneus,middle frontal gyrus.The brain regions with elevated ALFF include: right postcentral gyrus,precuneus,anterior cingulate gyrus,superior frontal gyrus,middle frontal gyrus,precentral gyrus,left cingulate gyrus;ALFF reduced brain area including: both sides superior temporal gyrus,the left middle temporal gyrus,cuneus.4.Changes of resting brain function in menstrual migraine after acupuncture treatment with different distal-proximal points combination(1)Compared with before acupuncture,the brain area of Reho increased after acupuncture in the LR3 adjunct acupuncture points group included: bilateral precuneus,superior frontal gyrus,middle frontal gyrus,right subcallosal gyrus;ReHo reduced brain area included: left middle occipital gyrus,inferior occipital gyrus,lingual gyrus.The brain regions with elevated ALFF after acupuncture include: left precuneus,cingulate gyrus,and subcallosal gyrus;brain regions with reduced ALFF include: left middle occipital gyrus,inferior occipital gyrus,lingual gyrus.(2)Compared with before acupuncture,the brain area of ReHo increased after acupuncture in PC6 adjunct acupuncture points group includes: left insula,cingulate gyrus,right cerebellar posterior lobe,and posterior cerebellar cone;ReHo reduced brain area included: the front front buckle back,the right tail core,postcentral gyrus,precentral gyrus,inferior temporal gyrus,middle frontal gyrus.The brain area of the patients with PC6 adjunct acupuncture points group after acupuncture includes: the right posterior cerebellar hillside;the brain region with ALFF reduction includes: bilateral anterior wedge,right central posterior gyrus,suboccipital lobule,and inferior gyrus The hippocampus is back,the pillow is back,the left side is buckled back,and the back buckle is brought back.(3)Correlation analysis between brain function and clinical effect indicators in patients with Taichong acupoint group: ReHo elevation value of right anterior wedge frontal lobe after acupuncture The MSQ function restricted area and the dysfunction field were positively correlated with the rise value,and negatively correlated with the SAS score and the SDS score decrease value.The ALFF elevation of the left anterior wedge after acupuncture was positively correlated with the MSQ function limitation and the dysfunction collar.The SAS score and the SDS score decrease were negatively correlated.(4)Correlation analysis between brain function and clinical effect indicators in PC6 adjunct acupuncture points group: There was a negative correlation between the SAS score and the SDS score decrease,and the left clasp back ALFF decrease was positively correlated with the SAS score and the SDS score decrease.Conclusions1.This study can preliminarily prove that patients with menstrual migraine with different acupuncture points have improved their clinical symptoms,quality of life and emotional state.The LR3 adjunct acupuncture points group was superior to the PC6 adjunct acupuncture points group in improving the patient’s headache VAS score and headache intensity grading.2.The mechanism and pathological changes of anxiety and depression in menstrual migraine patients may be related to precuneus and cingulate gyrus abnormal activity.At the same time,we speculate that the pain and emotional abnormalities of menstrual migraine patients may be related to the brain function activities of the precuneus,cingulate gyrus and frontal lobe.3.The activation of occipital lobe may be the specific brain area of the LR3 adjunct acupuncture points group for the treatment of menstrual migraine.The limbic system may be the key brain area of the PC6 adjunct acupuncture points group involved in pain regulation. |
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