针药结合治疗肾虚型偏头痛的临床研究
|
摘要
目的：
本课题采用随机对照研究,观察针药结合疗法治疗肾虚型偏头痛的临床疗效,旨在探讨以本研究选穴捻转补泻手法结合中药大补元煎对肾虚型偏头痛的临床疗效,同时以相同针灸组方的单纯补泻手法以及单纯中药组为对照,以观察患者远期疗效,为针灸疗法治疗偏头痛提供临床依据。
方法：
研究对象选取2011年3月至2012年3月期间在台湾名师中医联合中医诊所的患者为研究的目标人群,将其中符合病例筛选标准的90例偏头痛患者,按1：1：1的比例随机分配至综合疗法组(针药组A组)、捻转补泻组(B组)、中药组(C组),每组各有30例。4周为一疗程,共治疗一个疗程。通过记录两组患者治疗前后头痛症状积分、偏头痛生活质量特异性评分(MSQ)及疼痛问卷SF-MPQ评分,观察本疗法对偏头痛患者的临床疗效。
结果：
本研究采用随机对照试验方法进行临床试验,共有合格受试者90例。随机分为三组,每组各30例患者。三组一般资料检查：年龄、性别、病程、偏头痛类型及治疗前头痛症状评分、MSQ和SF-MPQ评分,差异均无显著性意义,三组间的一般资料具有可比性。
1.治疗前三组患者头痛症状评分比较,差异无统计学意义(P>0.05),具有可比性。经治疗4个疗程后,三组患者头痛症状评分较治疗前均有明显下降,经统计学分析,三组评分差异有统计学意义(P<0.01)。进一步进行两两比较,A组与B组评分差异具有统计学意义(P<0.05)；A组与C组评分差异具有显著统计学意义(P<0.01)；B组与C组评分差异不具有统计学意义(P>0.05)。
2.治疗前三组患者MSQ评分比较,包括功能受限、功能障碍、情感三项差异无统计学意义(P>0.05),具有可比性。经4个疗程治疗后,三组患者MSQ评分较治疗前均有明显增加,经统计学分析,三组各项评分差异有统计学意义(P<0.05)。进一步进行两两比较,A组与B组评分差异具有统计学意义(P<0.05)；A组与C组评分差异具有显著统计学意义(P<0.01)；B组与C组评分差异不具有统计学意义(P>0.05)。在本研究结果中,针药综合疗法可以显著提高患者MSQ量表中功能受限及功能障碍项评分(P<0.01),对于感情项评分也有改善作用(P<0.05),但较其他两项分值提高显著性缺乏。
3.治疗前三组患者SF-MPQ评分比较,差异无统计学意义(P>0.05),具有可比性。经4个疗程治疗后,两组患者头痛症状评分较治疗前均有明显下降,经统计学分析,
三组评分差异有统计学意义(P<0.01)。上述结果提示,进一步进行两两比较,A组与B组评分差异具有统计学意义(P<0.05)；A组与C组评分差异具有显著统计学意义(P<0.01)；B组与C组评分差异不具有统计学意义(P>0.05)。上述结果提示,经不同治疗方案后,针药综合疗法对改善患者SF-MPQ评分具有更显著的临床疗效。4.三组患者临床疗效比较,A组临床痊愈7例、显效13例、有效7例、无效3例；B组临床痊愈4例、显效10例、有效11例、无效5例；C组临床痊愈2例、显效10例、有效10例、无效8例；A组总有效率90.0%,B组总有效率83.3%,C组总有效率73.3%,经Ridit分析,差异有统计学意义(P<0.05)。综合疗法对于肾虚型偏头痛患者具有更好的临床疗效。
结论：
研究数据提示捻转补泻法结合中药能有效控制偏头痛患者的头痛发作次数、减轻头痛程度、缩短头痛持续时间、改善伴随症状。对于MSQ评分各项评分的均有明显改善,从MPQ量表也体现本疗法对偏头痛的镇痛效应。综上所述,针药结合疗法对肾虚型偏头痛患者具有良好的临床疗效,为临床治疗虚证偏头痛提供了依据。
Migraine is a common, often recurrent refractory protracted neurologic illnesses. There is not yet a clear understangding of etiology, pathogenesis of migraine in Modern medicine, although Westren medicine has already carried on an in-depth study on it, but has not find out the miracle drug as yet. Even with ever-renewing medicine, but long-term effects is still unsatisfactory, and the side effects is not conducive to the promotion. WHO consides that migraine is a disease that is seriously harmful for human health and affects the quality of life.
Objective
In this study, we designed a randomized, controlled trial. To observed the clinical effect of acupuncture and Chinese drugs in the threatment of kidney deficient type migranine. The aim of this paper is to probe the mechanism of the treatment that strengthening and reducing rotaing needles combined Chinese medicine decoction Da Bu Yuan Jian for kidney deficient type migranine, and want to provide thinking and evidence for experiment study and clinical usage.
Methods
we selected90insomnia patients who accepted treatment in TaiWan MingShi Traditional Chinese medicine clinic, duiring the period of2011/2to2012/3. we randomly divided the cases into three groups, a intergration therapeutics group、a strengthening and reducing rotaing needles group and a Chinese medicine group.30cases in each group. The intergration therapeutics group treated with acupuncture combined Chinese medicine decoction Da Bu Yuan Jian, and compared with the other two groups, A4weeks course of treatment, and then recorded the migranin symptom-sing scores, MSQ scores, SF-MPQ scores. We assessed the difference of the treatment effect of the three groups by SPSS software statistics.
Results
1according to migranin symptom-sing scores, the three groups before treatmen was no significant difference (P>0.05). After the treatment, the symptom-sing scores of the three groups were decreased. And the difference was significant (P<0.01). the multiple comparisons showed that, there was significant difference between A and B group, A and C groups (P<0.05). But B and C groups had no statistical significance (P>0.05). it showed that the intergration therapeutics group was more effective than the other two groups in decreasing the migranin symptom-sing scores.
2according to migranin MSQ scores, The MSQ scale included three items: function limitation. Function obstacle and emotion, the three groups before treatmen was no significant difference (P>0.05). After the treatment, each item of the three groups were changed. And the difference was significant (P<0.05). the multiple comparisons showed that, there was significant difference between A and B group, A and C groups (P<0.01P<0.05). But B and C groups had no statistical significance (P>0.05). it showed that the intergration therapeutics group was supper to the other two groups in improving the MSQ scores.
3according to the SF-MPQ scores, the three groups before treatmen was no significant difference (P>0.05). After the treatment, the symptom-sing scores of the three groups were decreased. And the difference was significant (P<0.01). the multiple comparisons showed that, there was significant difference between A and B group, A and C groups (P<0.05P<0.01). But B and C groups had no statistical significance (P>0.05). it showed that the intergration therapeutics group was more effective than the other two groups in decreasing the SF-MPQ scores.
4the clinical efficacy, intergration therapeutics group, the clinical recovery was7, markedly effective3cases, effective7cases, inefficacy3cases, the effective rate was90.0%, while in other two groups, clinical recovery was4, markedly effective10cases, effective11cases, inefficacy
5cases, the effective rate was83.3%, and clinical recovery was2, markedly effective10cases, effective10cases, inefficacy8cases, the effective rate was73.3%, the curative effect of the treatment group was better than others (P<0.05).
Conclusion
In the study, the treatment of strengthening and reducing rotaing needles combined Chinese medicine decoction Da Bu Yuan Jian for kidney deficient type migranine can effectively control attack times, lasting time and accompanied symptoms. And alleviate pain of patients, improve quality of life. Its method is simple, practical, safe and worthy of clinical use.
本课题采用随机对照研究,观察针药结合疗法治疗肾虚型偏头痛的临床疗效,旨在探讨以本研究选穴捻转补泻手法结合中药大补元煎对肾虚型偏头痛的临床疗效,同时以相同针灸组方的单纯补泻手法以及单纯中药组为对照,以观察患者远期疗效,为针灸疗法治疗偏头痛提供临床依据。
方法：
研究对象选取2011年3月至2012年3月期间在台湾名师中医联合中医诊所的患者为研究的目标人群,将其中符合病例筛选标准的90例偏头痛患者,按1：1：1的比例随机分配至综合疗法组(针药组A组)、捻转补泻组(B组)、中药组(C组),每组各有30例。4周为一疗程,共治疗一个疗程。通过记录两组患者治疗前后头痛症状积分、偏头痛生活质量特异性评分(MSQ)及疼痛问卷SF-MPQ评分,观察本疗法对偏头痛患者的临床疗效。
结果：
本研究采用随机对照试验方法进行临床试验,共有合格受试者90例。随机分为三组,每组各30例患者。三组一般资料检查：年龄、性别、病程、偏头痛类型及治疗前头痛症状评分、MSQ和SF-MPQ评分,差异均无显著性意义,三组间的一般资料具有可比性。
1.治疗前三组患者头痛症状评分比较,差异无统计学意义(P>0.05),具有可比性。经治疗4个疗程后,三组患者头痛症状评分较治疗前均有明显下降,经统计学分析,三组评分差异有统计学意义(P<0.01)。进一步进行两两比较,A组与B组评分差异具有统计学意义(P<0.05)；A组与C组评分差异具有显著统计学意义(P<0.01)；B组与C组评分差异不具有统计学意义(P>0.05)。
2.治疗前三组患者MSQ评分比较,包括功能受限、功能障碍、情感三项差异无统计学意义(P>0.05),具有可比性。经4个疗程治疗后,三组患者MSQ评分较治疗前均有明显增加,经统计学分析,三组各项评分差异有统计学意义(P<0.05)。进一步进行两两比较,A组与B组评分差异具有统计学意义(P<0.05)；A组与C组评分差异具有显著统计学意义(P<0.01)；B组与C组评分差异不具有统计学意义(P>0.05)。在本研究结果中,针药综合疗法可以显著提高患者MSQ量表中功能受限及功能障碍项评分(P<0.01),对于感情项评分也有改善作用(P<0.05),但较其他两项分值提高显著性缺乏。
3.治疗前三组患者SF-MPQ评分比较,差异无统计学意义(P>0.05),具有可比性。经4个疗程治疗后,两组患者头痛症状评分较治疗前均有明显下降,经统计学分析,
三组评分差异有统计学意义(P<0.01)。上述结果提示,进一步进行两两比较,A组与B组评分差异具有统计学意义(P<0.05)；A组与C组评分差异具有显著统计学意义(P<0.01)；B组与C组评分差异不具有统计学意义(P>0.05)。上述结果提示,经不同治疗方案后,针药综合疗法对改善患者SF-MPQ评分具有更显著的临床疗效。4.三组患者临床疗效比较,A组临床痊愈7例、显效13例、有效7例、无效3例；B组临床痊愈4例、显效10例、有效11例、无效5例；C组临床痊愈2例、显效10例、有效10例、无效8例；A组总有效率90.0%,B组总有效率83.3%,C组总有效率73.3%,经Ridit分析,差异有统计学意义(P<0.05)。综合疗法对于肾虚型偏头痛患者具有更好的临床疗效。
结论：
研究数据提示捻转补泻法结合中药能有效控制偏头痛患者的头痛发作次数、减轻头痛程度、缩短头痛持续时间、改善伴随症状。对于MSQ评分各项评分的均有明显改善,从MPQ量表也体现本疗法对偏头痛的镇痛效应。综上所述,针药结合疗法对肾虚型偏头痛患者具有良好的临床疗效,为临床治疗虚证偏头痛提供了依据。
Migraine is a common, often recurrent refractory protracted neurologic illnesses. There is not yet a clear understangding of etiology, pathogenesis of migraine in Modern medicine, although Westren medicine has already carried on an in-depth study on it, but has not find out the miracle drug as yet. Even with ever-renewing medicine, but long-term effects is still unsatisfactory, and the side effects is not conducive to the promotion. WHO consides that migraine is a disease that is seriously harmful for human health and affects the quality of life.
Objective
In this study, we designed a randomized, controlled trial. To observed the clinical effect of acupuncture and Chinese drugs in the threatment of kidney deficient type migranine. The aim of this paper is to probe the mechanism of the treatment that strengthening and reducing rotaing needles combined Chinese medicine decoction Da Bu Yuan Jian for kidney deficient type migranine, and want to provide thinking and evidence for experiment study and clinical usage.
Methods
we selected90insomnia patients who accepted treatment in TaiWan MingShi Traditional Chinese medicine clinic, duiring the period of2011/2to2012/3. we randomly divided the cases into three groups, a intergration therapeutics group、a strengthening and reducing rotaing needles group and a Chinese medicine group.30cases in each group. The intergration therapeutics group treated with acupuncture combined Chinese medicine decoction Da Bu Yuan Jian, and compared with the other two groups, A4weeks course of treatment, and then recorded the migranin symptom-sing scores, MSQ scores, SF-MPQ scores. We assessed the difference of the treatment effect of the three groups by SPSS software statistics.
Results
1according to migranin symptom-sing scores, the three groups before treatmen was no significant difference (P>0.05). After the treatment, the symptom-sing scores of the three groups were decreased. And the difference was significant (P<0.01). the multiple comparisons showed that, there was significant difference between A and B group, A and C groups (P<0.05). But B and C groups had no statistical significance (P>0.05). it showed that the intergration therapeutics group was more effective than the other two groups in decreasing the migranin symptom-sing scores.
2according to migranin MSQ scores, The MSQ scale included three items: function limitation. Function obstacle and emotion, the three groups before treatmen was no significant difference (P>0.05). After the treatment, each item of the three groups were changed. And the difference was significant (P<0.05). the multiple comparisons showed that, there was significant difference between A and B group, A and C groups (P<0.01P<0.05). But B and C groups had no statistical significance (P>0.05). it showed that the intergration therapeutics group was supper to the other two groups in improving the MSQ scores.
3according to the SF-MPQ scores, the three groups before treatmen was no significant difference (P>0.05). After the treatment, the symptom-sing scores of the three groups were decreased. And the difference was significant (P<0.01). the multiple comparisons showed that, there was significant difference between A and B group, A and C groups (P<0.05P<0.01). But B and C groups had no statistical significance (P>0.05). it showed that the intergration therapeutics group was more effective than the other two groups in decreasing the SF-MPQ scores.
4the clinical efficacy, intergration therapeutics group, the clinical recovery was7, markedly effective3cases, effective7cases, inefficacy3cases, the effective rate was90.0%, while in other two groups, clinical recovery was4, markedly effective10cases, effective11cases, inefficacy
5cases, the effective rate was83.3%, and clinical recovery was2, markedly effective10cases, effective10cases, inefficacy8cases, the effective rate was73.3%, the curative effect of the treatment group was better than others (P<0.05).
Conclusion
In the study, the treatment of strengthening and reducing rotaing needles combined Chinese medicine decoction Da Bu Yuan Jian for kidney deficient type migranine can effectively control attack times, lasting time and accompanied symptoms. And alleviate pain of patients, improve quality of life. Its method is simple, practical, safe and worthy of clinical use.
引文
[1]倪世秋,王继明.偏头痛方剂剂型及用法探析[J].中国中医药信息杂志,2005,12(2)107--108.
[2]杨洪军,王永炎.头痛方剂用药规律研究[J]. 中国中药杂志,2005,30(3)：226—228,232.
[3]路玉良,丁元庆.偏头痛的中医症候、病机与治疗现状分析[J].河南中医,2010,30(1)：101-103
[4]]杨政.平肝熄风化瘀汤治疗偏头痛62例[J].国医论坛,2006,21(5)：31
[5]王智兰,孙建.养血清脑颗粒治疗偏头痛32例疗效观察[J].吉林中医药,2007,27(8)：21
[6]谭嫂娜,林溢涛.吴茱萸汤加味治疗偏头痛40例疗效观察[J].国际医药卫生导报,2007,13(18)：96-97
[7]邹春盛,周锦友.柔肝活血镇痛汤治疗偏头痛临床观察[J].中国中医急症,2004,13(3)：140-141
[8]杨德富,王永生,曹理璞.加味温胆汤治疗胆郁型偏头痛疗效观察[J].四川中医,2008,26(3)：75
[9]李浩,王来瑾.川芎茶调散治疗偏头痛268例临床分析[J].中国实用神经疾病杂志,2008,11(8)：128-129.
[10]崔杰强,丁红梅.芎芷羌葛汤治疗偏头痛临床观察[J].吉林中医药,2009,29(6)：474-475.
[11]全亚萍.天宁饮治疗偏头痛58例临床研究[J].江苏中医药,2004,25(9)：20-21.
[12]]汤湘江,黄培新,雒晓东.血府逐瘀汤加减治疗偏头痛的临床研究[J].甘肃中医,2005,18(7)：11-12
[13]蒋边生.温胆汤治疗疑难病举隅[J].吉林中医药,2008,28(7)：522.
[14]王芳,李伟.谢强“升阳祛霾”法治疗顽固性偏头痛临床经验[J].江西中医药,2009,40(318)：16-17.
[15]袁云霞.头针治疗偏头痛88例[J].上海针灸杂志,2012,31(2)：122
[16]胡晓,侯雪飞.头针治疗偏头痛25例疗效观察[J].吉林中医药杂志,2011,31(3)：239
[17]赵云燕,刘丕珊,何成华等.头针透穴治疗偏头痛28例临床观察[J].中国中医药科技杂志,2007,14(7)：258
[18]王艳梅,刺络放血疗法治疗偏头痛疗效观察[J].中国民族民间医药,2012,1(2)：76
[19]王非,孙海东.刺络放血疗法治疗偏头痛94例[J].中医外治杂志,2010,13(5)：42-43
[20]王煜明,王浩.此络放血疗法治疗偏头痛疗效观察[J].上海针灸杂志,2010,29(8)：527
[21]王恩忠,卢岩.穴位埋线治疗偏头痛45例[J].中医研究杂志,2012,25(1)：61-63
[22]朱俊岭,孔凡.穴位埋线治疗顽固性偏头痛49例[J].陕西中医,2011,32(11)：1534-1535
[23]田丽琼,尹耀兰.穴位埋线治疗偏头痛42例临床观察[J].中医药导报,2006,3(1)：53.61
[24]卢秀云.风池穴注射曲安奈德复合液治疗偏头痛及枕大神经痛疗效观察[J].社区医学杂志,2011,9(12)：54
[25]赵海丰,周正国,王宝成.穴位注射利多卡因治疗紧张型偏头痛43例[J].实用中医内科杂志,2011,25(10)：85-86
[26]姜进平,张苏婉,程肖芳.32例偏头痛针灸穴位注射治疗分析[J].中国现代药物应用.2011,5(4)：240-241
[27]吴文锋,黄凡.平衡针治疗偏头痛56例[J].中国中医急症杂志,2011,20(7)：1000-1001
[28]董峰,方朝义.平衡针疗法治疗偏头痛50例[J].世界中西医结合杂志.2010,5(1)：62-63
[29]王晖,辛康,吴华清等.火针与体针结合治疗偏头痛[J].中医杂志,2009,50(7)：624-625
[30]林国华,范兆金,李丽霞等.火针与电针治疗偏头痛临床对照研究[J].新中医,2001,2(8)：43-44
[31]宿绍敏,畅艳艳.推拿配合皮肤针治疗偏头痛39例临床观察[J].湖南中医杂志,2011,2(4)：12-13
[32]关健美.皮肤针扣刺治疗偏头痛[J].中国针灸,2001,21(3)：189-190
[33]吕海涛,罗翌,李际强等.薄氏腹针治疗偏头痛40例临床疗效观察[J].辽宁中医杂志.2012,3(5)：764-765
[34]莫绍强.腹针治疗偏头痛38例[J].中国中医急症,201-,19(2)：308
[35]李良平,李明江,王利民等.电针透刺配合腕踝针治疗偏头痛80例的疗效观察[J].按摩与导引,2007,7：31-32
[36]贾晓莉.腕踝针治疗偏头痛50例[J].中国民间疗法,2003,11(5)：11
[37]]李伟洁.蜂针治疗偏头痛30例[J].上海针灸杂志,2009,19(2)：18
[38]朱兰荣.蜂针治疗顽固性偏头痛110例.中国民间疗法,1998,11(5)：8
[39]D'Andrea G, Terrazzino S, Fortin D. et al. Elusive amines and primary headaches: historical background and prospectives. Neurol SCI,2003,24(Suppl2):S65-S67.
[40]王宗信.偏头痛45例临床体会.针灸临床杂志2008.24(1)：22-23
[41]王洪欣,孙远标CGRP与偏头痛关系的研究[J].脑与神经疾病杂志,2003,11(1)：53-55
[42]钟广伟,李炜,邓干初,等.针刺对偏头痛大鼠脑内降钙素基因相关肽基因表达的影响[J].中国临床康复,2002,6(24)：3680-3681
[43]吴月兵,张灿珍,沈丽达·内源性阿片肽与电针镇痛的研究[J].医学综述,2005,(1)：81-89
[44]Kong J, Gollub RL, Rosman IS, et al·Using fMRI to dissociate sensory encoding from cognitive evaluation of heat pain intensity [J].Hum Brain Mapp,2006,27(9):715·
[45]孙丽,施乃久,李红霞·偏头痛患者血液流变学和血液动力学的对照研究[J]·中国厂矿医学,2000,13(2)：89-90
[46]袁军,李梅,王耀民·针刺治疗血液流变学异常偏头痛的临床研究[J]·河北中医,2003,25(3)：207-209
[47]邹文,张季声,童晓欣,等·偏头痛的SPECT脑灌注表现[J]黑龙江医学,2001,25(8)：566-567
[48]周耀群,顾镇京,郑杰,等·针刺对头痛患者脑组织血氧饱和度的影响[J]中国针灸,1998,18(7)：399-400
[49]Appel S, Kuritzky A, Zahavil, et al. Evidence for instability of the autonomic nervous system in patients with migraine headache[J].Headache,1992,32:10-17
[50]Peter D. Cervical sympathetic deficit in unilateral migraine [J]Headache,1991,31:669-669·
[51]杨一中,贾云,熊济明·综合针法治疗血管性头痛125例[J]中国针灸,1996,16(3)：136-137
[52]Lipton RB, Bigal ME, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive therapy [J]. Neurology,2007,68(5):343-349
[53]步怀恩,王建华,王泓午.偏头痛流行病学特点[J].天津中医药大学学报,2006,25(6)：82
[54]李舜伟,李焰生,刘若卓等.中国偏头痛诊断指南[J].中国疼痛医学杂志,2011,17(2)：65-86
[55]邹静,冯智英,李颖,等.偏头痛慢性化的潜在危险因素[J].神经病学与神经康复学杂志,2008.5：133-13
[56]American Headache Society 50th annual scientific meeting:abstractS33. presented 7,28,2008
[57]Nappi G, Costa A, Tassorelli C, et al. Migraine as a complex disease:heterogeneity, comorbidity and genotype-phenotype interactions [J]. Functional Neurology,2000, 15(2):87-93.
[58]Montagna P. Molecular genetics of migraine headaches:A review[J]. Cephalalgia, 2000,20(1):3-14.
[59]Svensson DA, Larsson B, Waldenlind E, et al. Genetic and environmental influences on expression of recurrent headache as a function of the reporting age in twins [J]. Twin Res,2002,5 (4):277-286.
[60]程伟进,胡红玲,蓝利民,等.偏头痛病人的情绪状况研究[J].浙江医学,2005,27(4)：283-284.
[61]王立法,冀风云,房树志,等.偏头痛病人个性特征、应对方式及其与头痛发作相关性的研究[J].华北国防医药,2008,20(3)：35-37.
[62]Rothrock J, Lopez I,Zweilfer R, et al.Borderline personality disorder andmigraine[J]. Headache,2007,47(1):22-26.
[63]张红亚,张红云,师天元,等.偏头痛病人颈静脉血血小板活化能力和血管内皮素及镁水平的变化[J].中国全科医学,2007,10(11)：886-887.
[64]刘爱芹.偏头痛病人的相关因素分析[J].中国民康医学,2007，19(9)：89.
[65]宋爱丽.浅析偏头痛的成因及防治措施[J].中国实用医药,2008,3(11)：56.
[66]Nissan GR, Diamond ML. Advances in migraine treatment [J]. JAm Osteopath Assoc,2005, 105(4Suppl 2):9-15.
[67]Anonymous. Headache. The Journal ofHead and Face Pain.2008,49:412-418.
[68]Olesen J. The tschemic hypotheses ofmigraine[J]. Arch Neuro,11987,44(3):321-322.
[69]龚耀先.修订艾森克个性问卷手册[M].长沙：湖南科学技术出版社,1983：1-49.
[70]Teive HA, Kowacs PA, Iaranhao FP, et al. Leao's cortical spreading depression: from experimental artifact to physiological principle[J]. Neruology,2005,65(9): 1455-1459
[71]Gagos A. Migraine with a combination of aura symptoms as a clinical manifestation of cortical spreading depression[J]. Neurol Neurochir Pol,2005,39(2):163-165
[72]Ayata C, Jin H, Kudo C, et al. Suppression of cortical spreading depression in migraine proghylsxis[J]. Ann Neurol,2006,59(4):652-661
[73]Martins IP. Migraine. Acta Med Port[J].2009,,2(5):589-598
[74]Osada T, Tromita M, Suzuki N, et al. Spindle-shaped constriction and propagated dilation of arterioles during cortical spreading depression[J]. Neurophysiol,2006, 17(12):1365-1368
[75]Kruit MC, Launer LJ, Ferrari MD, et al. Brain stem and cerebellar hyperintense lesions in migraine[J]. Stroke,2006,37(40:1109-1112
[76]Montagna P. Hypothalamus, sleep and headaches[J]. Neurol Sci,2006,27(Suppl 2):S138-143
[77]Moskowitz MA, Basic mechanisms in vascular headache[J], Neurol Clin North Am, 1990,8, (4):801-805
[78]Anderou AP, Shields KG, Goadsby PJ. GABA and valproate modulate trigeminovascular nociceptive transmission in the thalamus[J]. Neurobiol Dis 2010,37(2):314-323
[79]Cutrer FM. Pathophysiology of migraine[J]. Semin Neurol,2010,30(2):120-130
[80]L. H. Lassen, V. B. Jacobsen, P. A. Hader-slev, et a.l Involvementof calcitonin gene-re-lated peptide in migraine:regional cerebral blood flow and blood flow velocity in migraine patients [J].Headache Pain,2008,9(3):151-157.
[81]JZeller, KTPoulsen, JE Sutton, eta.l CGRP function-blocking antibodies inhibitneurogenic vasodilatationwithoutaffectingheartrate orarte-rialblood pressure in the rat[J]. BrPharmaco,1 2008,155(7):1093-1103
[82]Buzzi MG, Moskowitz MA. The pathophysiology of migraine:year 2005[J]. Headache Pain,2005,6(3):105-111
[83]Neeb L, Meents J, Reuter U.5-HT(1F) Receptor agonists:A new treatment option for migraine attacks[J]. Neurotherapeutics,2010,7(2):176-182
[84]Juhasz G, Zsombok T, Gonda X, et al. Nitroglycerin-induced headaches. Orv Hetil, 2004,145 (46):2323-2328.
[85]Akerman S, W illiamson DJ, Kaube H, et al. Nitric oxide syn-thase inhibitors can antagonize neurogenic and calcitonin gene- related peptide induced dilation of duralmeningeal vessels. Br JPharmacol,2002,137 (1):62-68.
[86]Juhasz G, Zsombok T, Modos T, et al. NO-induced migraine attack:strong increase in plasma calcitonin gene-related peptide (CGRP) concentration and negative correlation with platelet serotonin release. Pain,2003,106 (3):461-470.
[87]Genazzani AR, Nappi G, Facchinetti F, et al. Progressive impairment of CSF beta-EP levels in migraine sufferers. Pain,1984,18 (2):127-133.
[88]Anselmi B, Tarquini R, Panconesi A, et al. Serum beta-en-dorphin increase after intravenous histamine treatment of chronic daily headache. Recenti ProgMed,1997, 88 (7-8):321-324.
[89]Leone M, Sacerdote P, D' Amico D, et al. Beta-endorphin concentrations in the peripheral blood mononuclear cells of migraine and tension-type headache patients. Cephalalgia,1992,12 (3):154-157.
[90]Koseoglu E, Akboyraz A, Soyuer A, et al. Aerobic exercise and plasma beta endorphin levels in patients with migrainous headache without aura. Cephalalgia,2003,23 (10): 972-976.
[91]刘晓燕.临床脑电图学[M].北京：人民卫生出版社,2006：325.
[92]杨谦.偏头痛患者发作期间听觉诱发电位和经颅多谱勒的变化[J].第四军医大学学报,2005,26(18)：1710-1712.
[93]羊毅,李萍,叶海翠.偏头痛病人脑干诱发电位及个性测定[J].湖南医科大学学报,2000,25(1)：63-64.
[94]黄定九.内科理论与实践[M].上海：上海科技出版社,2009：2049—2051
[95]李彤,车咏梅,韩求静.偏头痛的诊断治疗及护理进展[J].护理研究,2008,22(1A)：23-25
[96]Pascual-Gomez J. The role of the neuromodulators in the preventive treatment of migraine [J]. Rev Neurol,2009,49 (1):25-32.
[97]朱凯云,黄焰,胡运新等.托吡酯和丙戊酸钠预防偏头痛发作的对比研究[J].临床神经病学杂志,2007,20(4)：271—273.
[98]于生元,董钊,李焰生,等.盐酸氟桂利嗪预防性治疗偏头痛的疗效和安全性[J].中国疼痛医学杂志,2007,13(4)：199—201.
[99]Koch HJ, Jurgens TP. Antidepressants in long-term migraine prevention [J]. Drugs, 2009,69 (1):1-19.
[100]Keskinbora K, Aydinli I. A double-blind randomized controlled trial of topiramate and amitriptyline either alone or in combination for the prevention of migraine [J]. Clin NeurolNeurosurg,2008,110(10):979-984.
[101]Louter MA, Veen G, Ferrari MD, et al. Migraine and depression should be treated concurrently [J]. Ned Tijdschr Geneeskd,2010,154(29):1044.
[102]Terwindt GM, FerrariMD, TijhuisM, et al. The impact of migraine on quality of life in the general population:the GEM study. Neurology,2000,55 (5):624-629.
[103]叶明柱.捻转针法起源考.中国针灸,2005,25(4)：297.
[104]陆寿康.刺法灸法学.北京：中国中医药出版社,2003：75-76.
[105]张俊英,陈湘生.金针王乐亭经验集.北京：人民卫生出版社,2004：86.
[106]南京中医学院.针灸学.上海：上海科学技术出版社,1979：148.
[107]谢锡亮,关玲.针灸基本功.北京：人民卫生出版社,2007：87.
[108]袁青.靳瑞针灸传真.北京：人民卫生出版社,2006：135.
[109]周立群.王岱针灸临床七讲.北京：人民卫生出版社,2000：28-29.
[110]伦新.实用针灸手法学.北京：人民卫生出版社,2004：75.
[111]伦新.实用针灸手法学.北京：人民卫生出版社,2004：80
[112]石学敏.石学敏针灸全集.第2版.北京：科学出版社,2006：334.
[2]杨洪军,王永炎.头痛方剂用药规律研究[J]. 中国中药杂志,2005,30(3)：226—228,232.
[3]路玉良,丁元庆.偏头痛的中医症候、病机与治疗现状分析[J].河南中医,2010,30(1)：101-103
[4]]杨政.平肝熄风化瘀汤治疗偏头痛62例[J].国医论坛,2006,21(5)：31
[5]王智兰,孙建.养血清脑颗粒治疗偏头痛32例疗效观察[J].吉林中医药,2007,27(8)：21
[6]谭嫂娜,林溢涛.吴茱萸汤加味治疗偏头痛40例疗效观察[J].国际医药卫生导报,2007,13(18)：96-97
[7]邹春盛,周锦友.柔肝活血镇痛汤治疗偏头痛临床观察[J].中国中医急症,2004,13(3)：140-141
[8]杨德富,王永生,曹理璞.加味温胆汤治疗胆郁型偏头痛疗效观察[J].四川中医,2008,26(3)：75
[9]李浩,王来瑾.川芎茶调散治疗偏头痛268例临床分析[J].中国实用神经疾病杂志,2008,11(8)：128-129.
[10]崔杰强,丁红梅.芎芷羌葛汤治疗偏头痛临床观察[J].吉林中医药,2009,29(6)：474-475.
[11]全亚萍.天宁饮治疗偏头痛58例临床研究[J].江苏中医药,2004,25(9)：20-21.
[12]]汤湘江,黄培新,雒晓东.血府逐瘀汤加减治疗偏头痛的临床研究[J].甘肃中医,2005,18(7)：11-12
[13]蒋边生.温胆汤治疗疑难病举隅[J].吉林中医药,2008,28(7)：522.
[14]王芳,李伟.谢强“升阳祛霾”法治疗顽固性偏头痛临床经验[J].江西中医药,2009,40(318)：16-17.
[15]袁云霞.头针治疗偏头痛88例[J].上海针灸杂志,2012,31(2)：122
[16]胡晓,侯雪飞.头针治疗偏头痛25例疗效观察[J].吉林中医药杂志,2011,31(3)：239
[17]赵云燕,刘丕珊,何成华等.头针透穴治疗偏头痛28例临床观察[J].中国中医药科技杂志,2007,14(7)：258
[18]王艳梅,刺络放血疗法治疗偏头痛疗效观察[J].中国民族民间医药,2012,1(2)：76
[19]王非,孙海东.刺络放血疗法治疗偏头痛94例[J].中医外治杂志,2010,13(5)：42-43
[20]王煜明,王浩.此络放血疗法治疗偏头痛疗效观察[J].上海针灸杂志,2010,29(8)：527
[21]王恩忠,卢岩.穴位埋线治疗偏头痛45例[J].中医研究杂志,2012,25(1)：61-63
[22]朱俊岭,孔凡.穴位埋线治疗顽固性偏头痛49例[J].陕西中医,2011,32(11)：1534-1535
[23]田丽琼,尹耀兰.穴位埋线治疗偏头痛42例临床观察[J].中医药导报,2006,3(1)：53.61
[24]卢秀云.风池穴注射曲安奈德复合液治疗偏头痛及枕大神经痛疗效观察[J].社区医学杂志,2011,9(12)：54
[25]赵海丰,周正国,王宝成.穴位注射利多卡因治疗紧张型偏头痛43例[J].实用中医内科杂志,2011,25(10)：85-86
[26]姜进平,张苏婉,程肖芳.32例偏头痛针灸穴位注射治疗分析[J].中国现代药物应用.2011,5(4)：240-241
[27]吴文锋,黄凡.平衡针治疗偏头痛56例[J].中国中医急症杂志,2011,20(7)：1000-1001
[28]董峰,方朝义.平衡针疗法治疗偏头痛50例[J].世界中西医结合杂志.2010,5(1)：62-63
[29]王晖,辛康,吴华清等.火针与体针结合治疗偏头痛[J].中医杂志,2009,50(7)：624-625
[30]林国华,范兆金,李丽霞等.火针与电针治疗偏头痛临床对照研究[J].新中医,2001,2(8)：43-44
[31]宿绍敏,畅艳艳.推拿配合皮肤针治疗偏头痛39例临床观察[J].湖南中医杂志,2011,2(4)：12-13
[32]关健美.皮肤针扣刺治疗偏头痛[J].中国针灸,2001,21(3)：189-190
[33]吕海涛,罗翌,李际强等.薄氏腹针治疗偏头痛40例临床疗效观察[J].辽宁中医杂志.2012,3(5)：764-765
[34]莫绍强.腹针治疗偏头痛38例[J].中国中医急症,201-,19(2)：308
[35]李良平,李明江,王利民等.电针透刺配合腕踝针治疗偏头痛80例的疗效观察[J].按摩与导引,2007,7：31-32
[36]贾晓莉.腕踝针治疗偏头痛50例[J].中国民间疗法,2003,11(5)：11
[37]]李伟洁.蜂针治疗偏头痛30例[J].上海针灸杂志,2009,19(2)：18
[38]朱兰荣.蜂针治疗顽固性偏头痛110例.中国民间疗法,1998,11(5)：8
[39]D'Andrea G, Terrazzino S, Fortin D. et al. Elusive amines and primary headaches: historical background and prospectives. Neurol SCI,2003,24(Suppl2):S65-S67.
[40]王宗信.偏头痛45例临床体会.针灸临床杂志2008.24(1)：22-23
[41]王洪欣,孙远标CGRP与偏头痛关系的研究[J].脑与神经疾病杂志,2003,11(1)：53-55
[42]钟广伟,李炜,邓干初,等.针刺对偏头痛大鼠脑内降钙素基因相关肽基因表达的影响[J].中国临床康复,2002,6(24)：3680-3681
[43]吴月兵,张灿珍,沈丽达·内源性阿片肽与电针镇痛的研究[J].医学综述,2005,(1)：81-89
[44]Kong J, Gollub RL, Rosman IS, et al·Using fMRI to dissociate sensory encoding from cognitive evaluation of heat pain intensity [J].Hum Brain Mapp,2006,27(9):715·
[45]孙丽,施乃久,李红霞·偏头痛患者血液流变学和血液动力学的对照研究[J]·中国厂矿医学,2000,13(2)：89-90
[46]袁军,李梅,王耀民·针刺治疗血液流变学异常偏头痛的临床研究[J]·河北中医,2003,25(3)：207-209
[47]邹文,张季声,童晓欣,等·偏头痛的SPECT脑灌注表现[J]黑龙江医学,2001,25(8)：566-567
[48]周耀群,顾镇京,郑杰,等·针刺对头痛患者脑组织血氧饱和度的影响[J]中国针灸,1998,18(7)：399-400
[49]Appel S, Kuritzky A, Zahavil, et al. Evidence for instability of the autonomic nervous system in patients with migraine headache[J].Headache,1992,32:10-17
[50]Peter D. Cervical sympathetic deficit in unilateral migraine [J]Headache,1991,31:669-669·
[51]杨一中,贾云,熊济明·综合针法治疗血管性头痛125例[J]中国针灸,1996,16(3)：136-137
[52]Lipton RB, Bigal ME, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive therapy [J]. Neurology,2007,68(5):343-349
[53]步怀恩,王建华,王泓午.偏头痛流行病学特点[J].天津中医药大学学报,2006,25(6)：82
[54]李舜伟,李焰生,刘若卓等.中国偏头痛诊断指南[J].中国疼痛医学杂志,2011,17(2)：65-86
[55]邹静,冯智英,李颖,等.偏头痛慢性化的潜在危险因素[J].神经病学与神经康复学杂志,2008.5：133-13
[56]American Headache Society 50th annual scientific meeting:abstractS33. presented 7,28,2008
[57]Nappi G, Costa A, Tassorelli C, et al. Migraine as a complex disease:heterogeneity, comorbidity and genotype-phenotype interactions [J]. Functional Neurology,2000, 15(2):87-93.
[58]Montagna P. Molecular genetics of migraine headaches:A review[J]. Cephalalgia, 2000,20(1):3-14.
[59]Svensson DA, Larsson B, Waldenlind E, et al. Genetic and environmental influences on expression of recurrent headache as a function of the reporting age in twins [J]. Twin Res,2002,5 (4):277-286.
[60]程伟进,胡红玲,蓝利民,等.偏头痛病人的情绪状况研究[J].浙江医学,2005,27(4)：283-284.
[61]王立法,冀风云,房树志,等.偏头痛病人个性特征、应对方式及其与头痛发作相关性的研究[J].华北国防医药,2008,20(3)：35-37.
[62]Rothrock J, Lopez I,Zweilfer R, et al.Borderline personality disorder andmigraine[J]. Headache,2007,47(1):22-26.
[63]张红亚,张红云,师天元,等.偏头痛病人颈静脉血血小板活化能力和血管内皮素及镁水平的变化[J].中国全科医学,2007,10(11)：886-887.
[64]刘爱芹.偏头痛病人的相关因素分析[J].中国民康医学,2007，19(9)：89.
[65]宋爱丽.浅析偏头痛的成因及防治措施[J].中国实用医药,2008,3(11)：56.
[66]Nissan GR, Diamond ML. Advances in migraine treatment [J]. JAm Osteopath Assoc,2005, 105(4Suppl 2):9-15.
[67]Anonymous. Headache. The Journal ofHead and Face Pain.2008,49:412-418.
[68]Olesen J. The tschemic hypotheses ofmigraine[J]. Arch Neuro,11987,44(3):321-322.
[69]龚耀先.修订艾森克个性问卷手册[M].长沙：湖南科学技术出版社,1983：1-49.
[70]Teive HA, Kowacs PA, Iaranhao FP, et al. Leao's cortical spreading depression: from experimental artifact to physiological principle[J]. Neruology,2005,65(9): 1455-1459
[71]Gagos A. Migraine with a combination of aura symptoms as a clinical manifestation of cortical spreading depression[J]. Neurol Neurochir Pol,2005,39(2):163-165
[72]Ayata C, Jin H, Kudo C, et al. Suppression of cortical spreading depression in migraine proghylsxis[J]. Ann Neurol,2006,59(4):652-661
[73]Martins IP. Migraine. Acta Med Port[J].2009,,2(5):589-598
[74]Osada T, Tromita M, Suzuki N, et al. Spindle-shaped constriction and propagated dilation of arterioles during cortical spreading depression[J]. Neurophysiol,2006, 17(12):1365-1368
[75]Kruit MC, Launer LJ, Ferrari MD, et al. Brain stem and cerebellar hyperintense lesions in migraine[J]. Stroke,2006,37(40:1109-1112
[76]Montagna P. Hypothalamus, sleep and headaches[J]. Neurol Sci,2006,27(Suppl 2):S138-143
[77]Moskowitz MA, Basic mechanisms in vascular headache[J], Neurol Clin North Am, 1990,8, (4):801-805
[78]Anderou AP, Shields KG, Goadsby PJ. GABA and valproate modulate trigeminovascular nociceptive transmission in the thalamus[J]. Neurobiol Dis 2010,37(2):314-323
[79]Cutrer FM. Pathophysiology of migraine[J]. Semin Neurol,2010,30(2):120-130
[80]L. H. Lassen, V. B. Jacobsen, P. A. Hader-slev, et a.l Involvementof calcitonin gene-re-lated peptide in migraine:regional cerebral blood flow and blood flow velocity in migraine patients [J].Headache Pain,2008,9(3):151-157.
[81]JZeller, KTPoulsen, JE Sutton, eta.l CGRP function-blocking antibodies inhibitneurogenic vasodilatationwithoutaffectingheartrate orarte-rialblood pressure in the rat[J]. BrPharmaco,1 2008,155(7):1093-1103
[82]Buzzi MG, Moskowitz MA. The pathophysiology of migraine:year 2005[J]. Headache Pain,2005,6(3):105-111
[83]Neeb L, Meents J, Reuter U.5-HT(1F) Receptor agonists:A new treatment option for migraine attacks[J]. Neurotherapeutics,2010,7(2):176-182
[84]Juhasz G, Zsombok T, Gonda X, et al. Nitroglycerin-induced headaches. Orv Hetil, 2004,145 (46):2323-2328.
[85]Akerman S, W illiamson DJ, Kaube H, et al. Nitric oxide syn-thase inhibitors can antagonize neurogenic and calcitonin gene- related peptide induced dilation of duralmeningeal vessels. Br JPharmacol,2002,137 (1):62-68.
[86]Juhasz G, Zsombok T, Modos T, et al. NO-induced migraine attack:strong increase in plasma calcitonin gene-related peptide (CGRP) concentration and negative correlation with platelet serotonin release. Pain,2003,106 (3):461-470.
[87]Genazzani AR, Nappi G, Facchinetti F, et al. Progressive impairment of CSF beta-EP levels in migraine sufferers. Pain,1984,18 (2):127-133.
[88]Anselmi B, Tarquini R, Panconesi A, et al. Serum beta-en-dorphin increase after intravenous histamine treatment of chronic daily headache. Recenti ProgMed,1997, 88 (7-8):321-324.
[89]Leone M, Sacerdote P, D' Amico D, et al. Beta-endorphin concentrations in the peripheral blood mononuclear cells of migraine and tension-type headache patients. Cephalalgia,1992,12 (3):154-157.
[90]Koseoglu E, Akboyraz A, Soyuer A, et al. Aerobic exercise and plasma beta endorphin levels in patients with migrainous headache without aura. Cephalalgia,2003,23 (10): 972-976.
[91]刘晓燕.临床脑电图学[M].北京：人民卫生出版社,2006：325.
[92]杨谦.偏头痛患者发作期间听觉诱发电位和经颅多谱勒的变化[J].第四军医大学学报,2005,26(18)：1710-1712.
[93]羊毅,李萍,叶海翠.偏头痛病人脑干诱发电位及个性测定[J].湖南医科大学学报,2000,25(1)：63-64.
[94]黄定九.内科理论与实践[M].上海：上海科技出版社,2009：2049—2051
[95]李彤,车咏梅,韩求静.偏头痛的诊断治疗及护理进展[J].护理研究,2008,22(1A)：23-25
[96]Pascual-Gomez J. The role of the neuromodulators in the preventive treatment of migraine [J]. Rev Neurol,2009,49 (1):25-32.
[97]朱凯云,黄焰,胡运新等.托吡酯和丙戊酸钠预防偏头痛发作的对比研究[J].临床神经病学杂志,2007,20(4)：271—273.
[98]于生元,董钊,李焰生,等.盐酸氟桂利嗪预防性治疗偏头痛的疗效和安全性[J].中国疼痛医学杂志,2007,13(4)：199—201.
[99]Koch HJ, Jurgens TP. Antidepressants in long-term migraine prevention [J]. Drugs, 2009,69 (1):1-19.
[100]Keskinbora K, Aydinli I. A double-blind randomized controlled trial of topiramate and amitriptyline either alone or in combination for the prevention of migraine [J]. Clin NeurolNeurosurg,2008,110(10):979-984.
[101]Louter MA, Veen G, Ferrari MD, et al. Migraine and depression should be treated concurrently [J]. Ned Tijdschr Geneeskd,2010,154(29):1044.
[102]Terwindt GM, FerrariMD, TijhuisM, et al. The impact of migraine on quality of life in the general population:the GEM study. Neurology,2000,55 (5):624-629.
[103]叶明柱.捻转针法起源考.中国针灸,2005,25(4)：297.
[104]陆寿康.刺法灸法学.北京：中国中医药出版社,2003：75-76.
[105]张俊英,陈湘生.金针王乐亭经验集.北京：人民卫生出版社,2004：86.
[106]南京中医学院.针灸学.上海：上海科学技术出版社,1979：148.
[107]谢锡亮,关玲.针灸基本功.北京：人民卫生出版社,2007：87.
[108]袁青.靳瑞针灸传真.北京：人民卫生出版社,2006：135.
[109]周立群.王岱针灸临床七讲.北京：人民卫生出版社,2000：28-29.
[110]伦新.实用针灸手法学.北京：人民卫生出版社,2004：75.
[111]伦新.实用针灸手法学.北京：人民卫生出版社,2004：80
[112]石学敏.石学敏针灸全集.第2版.北京：科学出版社,2006：334.