A Retrospective Study On The Treatment Of MwoA Patients Based On The Method Of Activating Blood Circulation And Removing Blood Stasis Based On Rs-fMRI

BackgroundMigraine,as a common chronic nervous system disease,is characterized by severe pain,bilateral recurrent attacks and obvious pulsation,often dominated by hemiplegic head[1].Epidemiological survey data show that the annual prevalence rate of migraine in China is 9.3%[2].At present,the focus of research on migraine at home and abroad is mainly in the pathogenesis and drug treatment of migraine.Functional magnetic resonance imaging((fMRI))has been widely used in the study of brain function.MRI is an imaging technique that reconstructs the signals generated by nuclear resonance in the magnetic field without radiation and other side effects[3].Resting state mode and task state mode are usually used to study the pathogenesis of migraine center based on fMRI.Resting state fMRI has become a research hotspot at home and abroad because of its simple experimental procedure,non-invasive and single intervention conditions.Ni Jinjun[5]studied the distribution of TCM syndromes of 300 patients with migraine.The results showed that most of the symptoms of migraine during attack were internal stagnation of blood stasis.Cao Jin[6]et al studied the TCM syndrome of 303 patients with migraine,in which the number of cases of blood stasis syndrome was the most.The search of the literature shows that there is no functional imaging study on migraine related to activating blood circulation and removing blood stasis.Some studies have shown that after acupuncture[7]and auricular point[8]treatment,the abnormal brain function of migraine patients has been improved.This study will evaluate the clinical efficacy of the method of activating blood circulation and removing blood stasis in the treatment of migraine,and explore the central mechanism of activating blood circulation and removing blood stasis in the treatment of migraine by resting fMRI technique.ObjectiveTo explore the clinical efficacy and brain functional magnetic resonance imaging(fMRI)features of patients with non-premonitory migraine(blood stasis blocking collaterals)treated with traditional Chinese medicine for promoting blood circulation and removing blood stasis,so as to provide evidence-based medical evidence for promoting blood circulation and removing blood stasis in the treatment of migraine.to help us better understand the pathogenesis of migraine.MethodsIn this study,a retrospective case study was used to collect patients without premonitory migraine(blood stasis type)and healthy controls who met the inclusion criteria in the headache clinic of Guangdong Hospital of traditional Chinese Medicine from January 2018 to December 2019.All patients were treated with the method of promoting blood circulation,removing blood stasis and dredging collaterals and relieving pain.traditional Chinese medicine granules(self-made prescription Ligusticum chuanxiong,Yuanhu,etc.)were given orally for 2-4 weeks.Basic treatment:according to the condition,flunarizine hydrochloride or acupuncture and auricular point treatment were used.The general data,clinical data,epidemiological data,headache diary,VAS,MSQ,SAS,SDS and the results of brain resting state functional magnetic resonance imaging(fMRI)were collected and analyzed.Brain functional magnetic resonance imaging(fMRI)analysis(local consistency method,low frequency oscillation amplitude)was used to observe the difference of brain fMRI between patients with non-premonitory migraine(blood stasis blocking collaterals)and healthy controls.At the same time,the clinical efficacy of traditional Chinese medicine for promoting blood circulation and removing blood stasis and the difference of brain functional magnetic resonance imaging were observed.Results1.There were significant differences in VAS mean score,VAS maximum score,monthly headache duration and migraine sPecific quality of life questionnaire scores among migraine Patients after treatment.2.Compared with the healthy group,the ALFF values of left superior temporal gyrus,left anterior wedge lobe,left posterior cingulate gyrus,right superior parietal gyrus,left temporal pole,left inferior parietal angular gyrus and right wedge anterior lobe were higher in the non-aura migraine group(GRF correction,voxel level P<0.005,cluster level P<0.05,P<0.05 62).The ALFF value of right dorsolateral superior frontal gyrus and right superior orbital frontal gyrus decreased in non-aura migraine group(GRF correction,voxel level P<0.005,cluster level P<0.05,P<0.0562).3.Compared with those before treatment,the ALFF values of left anterior cingulate gyrus,left peritalar fissure cortex,left lingual gyrus,left superior parietal gyrus,left middle frontal gyrus and left orbital middle frontal gyrus increased after treatment(GRF correction,voxel level P<0.05,cluster level P<0.05 329).After treatment,the ALFF values of left middle temporal gyrus,right middle temporal gyrus,right superior temporal gyrus,right inferior temporal gyrus,left superior temporal gyrus and left inferior temporal gyrus decreased(GRF correction,voxel level P<0.05,cluster level P<0.05 329).4.Compared with the healthy group,the right fusiform gyrus,right middle temporal gyrus and right inferior temporal gyrus in the non-aura migraine group were higher than those in the healthy group(FDR correction,voxel level P<0.005,cluster level P<0.05 84).The ReHo values of left fusiform gyrus,left dorsolateral superior frontal gyrus,right middle frontal gyrus,left middle frontal gyrus,right dorsolateral superior frontal gyrus,right caudate nucleus and right thalamus in the migraine without aura group were lower than those in the healthy group(FDR correction,voxel level P<0.005,cluster level P<0.05,P<0.05 84).5.After treatment,the ReHo values of right middle temporal gyrus,right inferior temporal gyrus and right superior temporal gyrus were lower than those of the healthy group(FDR correction,voxel level P<0.05,cluster level P<0.05 809).After treatment,the ReHo values of left anterior cingulate gyrus,left orbital middle frontal gyrus,left inferior orbital frontal gyrus,left superior orbital frontal gyrus and left caudate nucleus were higher than those of the healthy group(FDR correction,voxel level P<0.05,cluster level P<0.05 809).Conclusion1.The treatment of migraine with the method of activating blood circulation and removing blood stasis with traditional Chinese medicine can not only effectively relieve the headache degree of migraine,reduce the time of headache attack,but also improve the quality of life of migraine patients.The middle temporal gyrus may be an important damaged area of migraine without aura,and it is an important target for the treatment of traditional Chinese medicine by activating blood circulation and removing blood stasis.2.The default network(anterior lobe,prefrontal cortex)may be an important brain functional network without premonitory migraine(syndrome of blood stasis blocking collaterals).3.The therapy of promoting blood circulation and removing blood stasis may achieve the theraPeutic effect by adjusting the function of the default network.