| BackgroundMigraine is a common chronic idiopathic neurovascular dysfunction disorders. World Health Organization(WHO) defined the most serious headache as the most disabling chronic disease, similar to dementia, quadriplegia and severe mental illness, whatsmore, chronic migraine (CM) is the most common disabling complication of migraine, it brings to the community and patients more serious burden, the International Headache Society(IHS) also defines it as an independent disease, caused the majority of academic researches and attentions.About the diagnosis of CM is not unchangeable, just a process of continuous improvement.2004 International Classification of Headache Disorders Second Edition (ICHD-Ⅱ) divided migraine into six subtypes,such as migraine without aura, migraine with aura, often a precursor of migraine children periodic syndrome, retinal migraine, complications of migraine and probable migraine.CM is defined as a kind of complication among these. Diagnosis requirements, migraine without aura> 15 days per month, continual duration= 3 months, and the exclusion of medication-over use headache(MOH). Chronic headache patients, especially in patients with CM has lost its typical clinical features, which brought great difficulties to clinicians for the clear diagnosis, but also stimulate researchers to improve the diagnosis of CM constantly. Silberstein,etc,divided the chronic daily headache(CDH) into four subtypes:chronic migraine, chronic tension-type headache, new daily persistent headache and made continuous unilateral headache, defined CM is a separate disease entity, one subtype of CHD, and also redefined the diagnosis of CM.International Classification of Headache Disorders the second revised edition (ICHD-2R) in CM diagnostic criteria proposed: ① headache days per month≥15 days, duration≥3 months;② average headache duration≥4h /d,≥8 days linked to the migraine without aura; ③with or without medication overuse.It is currently being applied by the majority of clinicians.Continuously improving the diagnosis is the progress of a better understanding of the didease, which not only recognized the changes in chronic process of migraine, but also continue to emphasize its features and medication overuse is an important intervention factor.Natoli, etc., according to Silberstein-Lipton standard,research show that the world is about 0.9%～5.1% of the prevelance of CM, which has the typical symptoms of 1.4%-2.2%.Stovner,etc, reported,it is about 3% to 4% CM in Europe, 4.1% in USA,2% in France.A Western studies in different regions of the country population sample survey of Taipei show that the CM prevalence rates were 1.7% and 0.98%.CM total annual incidence is about 14% of the migraine population, some European surveies show that, it is about 2.5% of episodic migraine (EM) developed into CM each year.EM risk factors for chronic conversion can be summarized as a control risk factor and uncontrol risk factors. The uncontrol risk factors included gender, age, genetic history of migraine, education, low socio-economic status. Control risk factors include stressful life events, obesity, infrastructure headache frequency, pain medication overuse, sleep disorders, psychiatric comorbidties,etc. Second, chronic headaches, always result in sleep disorders, while increase anxiety, depression and other psychiatric comorbid disease indicience, the three often influence each other, reinforce each other, aggravating headache. Research found that 74% of CM patients and 26% of EM patients with depression,80% of CM patients and 36% EM patients had anxiety, CM is more common with anxiety, depression, compared with EM.The pathogenesis of CM is complexy, there is no unified conclusion, it may be associated with the following theory:(1) The impact of the cerebral cortex, cortical hyperexcitability may be a major factor underlying EM converted to the CM.(2) magnetic suppression of perceptual accuracy (MPSA), the impact can be detected by transcranial magnetic stimulation on visual perception, migraine patients cortical excitability such indicators compared with an index,CM is higher than EM and normol person.(3)Brainstem disorders pain modulation systems, the current study shows that, CM pain pathways in patients with brain stem there is a structural and functional disorders, chronic changes in the system can lead to increased frequency of headaches.(4) sensitized trigeminal vascular system, cutaneous allodynia may be one of the factors of chronic migraine headache. Cutaneous allodynia of CM patients is more severe than EM. Migraine cutaneous allodynia is the result by the second level brainstem’s central sensitization of trigeminal neurons. CM may be caused by central sensitization for the recurrent migraine pathways leading to chronic pain.According to Chinese Medicine, migraine and CM belong to the same category of "headache" disease, the cause is nothing less than the two sides of exogenous and internal injuries.Headache’s disease -bit is head, and blood, meridians, liver, spleen, kidney are closely related. Exogenous headache, each caused more due to pathogenic wind, with cold, dampness, heat.The internal injurieshe is divided into over and deficiency two situations,the deficiency often as a result of the blood, liver, spleen, kidney’s unfunction; blood stasis and phlegm infestation mostly lead to the over disease, it is mixed for the long duration.Currently, did not achieve a breakthrough on CM treatment. Related to the traditional treatment of acute migraine pain medications, research indicates that it is prone to cause Medication Overuse Headache(MOH), facilitate the process of transformation from EM to CM.The anti-epileptic drugs such as topiramate, valproate,etc.,the therapeutic effects are still some controversy, botulinum toxin-A(BOTOX-A) although can relieve headache symptoms, but has a long treatment period, high cost, and easily repeated.Therefore, western medicine, there are still some limitations in CM treatment. Headache is a symptom of TCM diagnosis, migraine and CM belong to Chinese medicine, "headache" disease areas, consistent with its pathogenesis.TCM therapy follows the principle of treatment determination based on syndrome differentiation. Professor Chen Baotian by long-term clinic treatment of migraine, early proposed etiology of migraine is nothing more than the wind, dampnesss, stasis and deficiency, and pointed without typing and rule on treatment.CM has a long duration, varied syndromes, and often accompanied by emotional disorders, which in turn increase the occurrence and development of headache, so its pathogenesis is more typically manifested as wind, dampness, stasis, depression combined into disease.The treatment should be taking into account of the headache and emotional disorders. In this study, Toutong Xin NO.1(TX1) is applied for treating CM, which has a significant effect on the basis of aggravating the amount of Chuangxiong,white peony root, Bupleurum, Aconite.It strengthen the effectiveness of liver’s functionObjective1. To explore the clinical curative effect of modified TX1 in treating patients with CM.2.To observe and evaluate the improvement of emotionnal disorders treated by modified TX1.3. To explore the etiology and pathogenesis of CM.Methods1.Methods of cases selected:Diagnostic criteria; 2006,ICHD-2R-CM: ① headache days per month≥15 days, duration≥ 3 months; ②average headache duration≥ 4h/d,≥8 days linked to the migraine without aura; ③ with or without medication overuse. Exclusion criteria:(1) CT and MRI imaging examination revealed intracranial organic disease; (2) during pregnancy or breast-feeding women; (3) the combined heart, liver, kidney, hematopoietic system and other serious primary disease, epilepsy, stroke and mental illness.A total of 80 patients with CM is from the clinic and ward of TCM department in Nanfang Hospital, Southern Medical University, from, January,2013 to March, 2014. Treatment group of 40 patients,16 males and 24 females, aged 16 to 53 years (mean 35.2 ±10.8) years, duration of 1 to 30 years (mean 9.3±7.9) years. The control group of 40 patients,12 males and 28 females, aged 17 to 52 years (mean 35.3±10.1) years, duration of 1 to 29 years (mean 8.6±7.4) years.Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were assessed before treatment and after treatment. No significant difference between the two groups (P> 0.05) in terms of gender, age, duration, etc.2. Treatment:Treatment group with modified TX1:Ephedra, Asarum, safflower, habitat, Angelica, Notopterygium, Alisma is lOg respectively, Duhuo,Fangfeng, Astragalus each is 15g, Angelica and Poria are 20g.Keel,Oyster, Uncaria, Millettla is 30g respectively.Aconite is 20-25g, Chuanxiong is 30-35g, white peony root 30g, Bupleurum is 24g. provided by the Chinese herbal pharmacy of the Nanfang Hospital.Usage:one Potion a day.About 2000ml water to cook 2 times of the medicinal herbals, get 400ml medicine, Oral twice a day.The Control group is received Flunarizine Hydrochloride Capsules,5mg,po,l/qn. The total course of treatment is 12 weeks, during which no other treatment.3.Observation indexes:including degree,frequency,duration of headache,scores of SAS,SDS.Headache Level:using VAS (visual analogue scale) measured pain intensity.0 painless,10 into the most severe pain.1-3 is divided into mild pain, moderate pain into 4-6,7-10 points severe pain.Emotional Assessment:SDS standard score 50 points or more for patients with depression, SAS standard score 50 points or more with anxiety.4.Efficacy criteria:Cure:headache and associated symptoms disappeared; markedly:headache and associated symptoms significantly reduced seizure frequency, duration, reduce 2/3; Effective:headache eased, prolonged attack interval, duration reduced by 1/3; invalid:no headache significant changes or increased.5. Statistical methods:It uses SPSS 17.0 to process all data.Difference of measurement data was expressed with mean±tandard deviation (x±s), and compared with analysis of Independent-Sample T Test, Difference of enumeration data was compared with analysis of chi-square test.,P<0.05 means statistically significant.ResultsThe effective rates of clinical effect were 95% and 70% in treatment group and control group respectively, the difference was statistically significant(p<0.05).There were significantly differences between two groups (p<0.05)in degree,frequency,and duration,before and after the therapy.80 cases of CM with SAS score 50 points or more is 52 cases, accounted for 65%, SDS score 50 points or more is 48 cases, accouned for 60%. The comparision of SAS scores between two groups before and after the treatment, and the two groups after treatment were statistically significant difference (p< 0.05). The comparision of SDS scores between two groups before and after the treatment, and the two groups after treatment were statistically significant difference (p< 0.05).ConclusionsThe modified TX1 is Significantly effective in treating CM,and reducing the depression. CM should be treated based on wind, dampness, blood stasis, deficiency,and the depression. |
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