| Background:Migraine is a disease with high morbidity and disability rate,ranking second among central nervous system diseases with high economic burden.The Migraine without aura(Mwoa)is usually a unilateral throbbing headache,each attack lasting 4-72 hours and often accompanied by nausea,vomiting,photophobia,and photophobia.In a few patients,other neurological symptoms such as vertigo,tinnitus,anxiety and depression may also occur.The development of neuroimaging technology has extended the research on the mechanism of migraine to the central nervous system.Among them,functional Magnetic Resonance Imaging(fMRI)technology has advantages of non-invasive,non-radiation and high accuracy.It has been widely used to study the clinical mechanism of migraine.GB44 is the Jing-Well point of Gallbladder Meridian of Foot Shaoyang,and also the root of Gallbladder Meridian of Foot Shaoyang in the Root-knot theory.A large number of previous clinical studies have proved that acupuncture has a positive clinical effect in treating migraine without aura,but its central effect mechanism is rarely studied at home and abroad.This study will take the root knot theory as the theoretical basis for selecting acupoints to study the central effect mechanism of acupuncture at GB44 in treating migraine without aura with Shaoyang meridian.Objective:In this study,patients with Shaoyang meridian type migraine without aura were selected as the research object.Based on the comprehensive evaluation of pain degree,quality of life and reliability and validity evaluation of acupuncture at GB44 on patients with migraine without aura,the mechanism of central effect of acupuncture at GB44 on the treatment of migraine without aura was explored by using the low-frequency oscillation amplitude analysis method combined with the resting state functional MRI technology.Methods:A total of 22 patients with migraine without aura who met the diagnosis and inclusion criteria and were admitted to the acupuncture clinic of Dongzhimen Hospital of Beijing University of Chinese Medicine were included in this study.13 cases in the experimental group and 9 cases in the control group were randomly divided into 4 weeks,3 times in the first 2 weeks,and 2 times in the last 2 weeks.The experimental group performed acupuncture intervention at GB44,and the control group selected the midpoint of ST40 and BL57 as nonmeridian point for acupuncture intervention.After 4 weeks of acupuncture,a resting brain functional magnetic resonance scanning was performed.amplitude of low frequency fluctuation(ALFF)was analyzed to observe the functional changes of brain area before and after acupuncture for 4 weeks.The migraine attack information recorded in headache diaries before and after acupuncture for 4 weeks was collected,including the number of headache attacks,Visual Analogue Scale(VAS)score and headache attack days to evaluate the effect of acupuncture on headache symptoms.The score of Migraine Specific Quality of Life Questionnaire,Headache Impact Test(MSQ)and Headache Impact Test(HIT-6)were collected to evaluate the effect of acupuncture on quality of life.Finally,the collected data were statistically analyzed and compared before and after acupuncture and between the two groups,and a conclusion was drawn.Results:1.Baseline data of the two groups were balanced.Gender,age,weight,height,education level,headache course,headache days in the past 4 weeks,average VAS in the past 4 weeks,headache frequency in the past 4 weeks,the score of HIT-6 in the past 4 weeks,the score of MSQ-E,MSQ-P,MSQ-R before acupuncture,acupuncture credibility score and expected evaluation had no significant differences(P>0.05),and were comparable.2.After statistical analysis,headache days,average VAS and frequency of headache before and after acupuncture in experimental group were significantly different(P<0.05);There were no significant differences in headache days,average VAS and frequency of headache in control group before and after acupuncture at 4 weeks(P>0.05).3.After statistical analysis,there were significant differences in HIT-6 and MSQ scores before and after 4-week acupuncture in experimental group(P<0.05);There were no significant differences in MSQ-E and MSQ-P of the control group before and after 4 weeks of acupuncture(P>0.05),but there were significant differences in HIT-6 and MSQ-R(P<0.05).4.Compared with before acupuncture,In the experimental group,fractional lowfrequency amplitude(fALFF)values before and after 4 weeks of acupuncture showed increased in brain areas including left cerebellar 8 area,middle frontal gyrus,right inferior temporal gyrus,superior temporal gyrus,middle frontal gyrus and precuneus.The brain regions with decreased fALFF values were the bilateral thalamus,left posterior central gyrus,and left anterior cuneus.The difference was statistically significant(P<0.05).In the control group,fALFF value of left superior frontal gyrus increased before and after acupuncture at 4 weeks.The difference was statistically significant(P<0.05).Conclusion:1.Acupuncture at GB44 can significantly improve the clinical symptoms of Shaoyang meridian type migraineurs without aura,including reducing the number of headache days,the number of headache attacks,and the degree of pain during migraine attacks.Acupuncture did not relieve the above clinical symptoms.2.Acupuncture at GB44 can improve the quality of life of Shaoyang meridian type migraineurs without aura in many ways,including emotion restrictive and preventive function,etc.Acupuncture at non-meridian and non-acupoint could only improve the quality of life of migraine patients in terms of restrictive function,but had no effect on the quality of life of patients in terms of emotion and preventive function.3.Acupuncture at GB44 can enhance the nerve activity of the left cerebellar area 8,middle frontal gyrus,right inferior temporal gyrus,superior temporal gyrus,superior frontal gyrus,middle frontal gyrus and precuneus,while reduce the nerve activity of the bilateral thalamus,left posterior central gyrus and left precuneus.Acupuncture at non-meridian and non-acupoint only enhanced the nerve activity of left superior frontal gyrus.The comparative analysis showed that acupuncture at GB44 could regulate the pain,cognition and emotion center,which may be one of the central effect mechanisms of acupuncture at GB44 in the treatment of Shaoyang meridian type migraine without aura. |
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