Reflex therapy in patients with chronic tension-type headaches: Effectiveness via sensory and affective Mcgill pain questionnaire descriptors

Introduction

Tension-type headaches is the most common type of headache among adults and it rises a challenge in findig an effective and safe treatment method.

Objectives

The study aims to evaluate the corporal acupuncture therapy efficacy in patients with chronic tension-type headaches undergoing a complex treatment plan.

Methods

The study involved 132 patients (74% female and 26% men) aged 18-65 years, who were divided into two groups. Patients reported their pain lasted 0.4-12 years. All the patients received conventional treatment (central muscle relaxants and antidepressants). The study group additionally received classical corporal acupuncture 3 times per week, a course of 12 sessions. Treatment effectiveness was evaluated by measuring pain intensity using a subjective visual analogue scale (VAS) and McGill Pain Questionnaire (MPQ).

Results

Most of the patients (79% and 88% of study and control groups respectively) demonstrated moderate cervical musculoskeletal dysfunctions. At admission pain intensity was 4.2±1.5 and 3.8±1.7 VAS points in the control and study groups respectively, MPQ sensory rank pain index (RPI) was 5.92±1.49 points, affective RPI 3.41±0.84, the total RPI – 7.12±2.56 in the control group, and 6.22±1.74; 2.98±0.62 and 7.14±1.65 points in the study group. 4 weeks after treatment measurements showed following pain intensity changes: 4.21±0.74 vs 3.1±0.95 points in the control and study groups respectively. 3- and 6-month period revealed 3.1±0.57, 2.4±0.74 points and 2.1±0.62, 1.1±0.49 points in the control and study groups respectively.

Conclusions

Classical corporal acupuncture course may benefit chronic tension-type headaches patients providing an effective treatment in a safe way.

Disclosure

No significant relationships.

Prevalence of psychoemotional disorders in patients with pathological kinking of the internal carotid arteries

Introduction

Pathological kinking of the internal carotid arteries (PK ICA) is a controversial issue of angioneurology. Patients with PK ICA often present a variety of complaints, such as headache, dizziness, decreased concentration, memory impairment, and general weakness [1].

Objectives

To study the prevalence of anxiety and depression in patients with PK ICA.

Methods

We studied 132 patients who had PK ICA (main group) and 86 patients without brachiocephalic artery pathology (control group). Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety and depression, considering depression or anxiety if the score was ≥10. Statistical analysis was performed with SPSS software, p-value<0.05 was considered statistically significant.

Results

The mean age of the patients in the main group was 38.4±5.2 years, in patients of the control group 41.2±4.8 years, respectively. Anxiety disorders were detected significantly more frequently in the main group of patients than in the control group (35.7% and 10.2%, p=0.017 respectively). The frequency of depressive disorders was comparable in both groups – 13.6% and 14.3%, p=0.061, respectively. The level of anxiety was also significantly higher in the group of patients with PK compared to the control group (14.2±4.3 and 9.7±3.1 points, p=0.019). patients with PK ICA with anxiety are more likely suffered from depression (10.2% and 5.8%, p<0.001).

Conclusions

Anxiety disorders were present in one-third of patients with PK ICA, while depressive disorders were not typical for this group. In patients with PK ICA, in addition to collecting complaints, anamnesis, and evaluating the neurological status, it is advisable to conduct neuropsychological testing. References:1.Medvedeva LA, Zagorulko OI.Korsakov Journal 2019

Prescribing of adjuvant analgesics among patients in primary care and specialized pain clinic

Introduction

Chronic low back pain (CLBP) is one of the most resistant pain conditions and is often combined with psychoemotional disorders [1].

Objectives

To analyze the frequency of prescribing adjuvant analgesics among patients with CLBP by specialists of the outpatient department and specialized pain clinic.

Methods

The prospective study included 269 patients (group 1) with CLBP treated in an outpatient department and 253 patients (group 2) of specialized pain clinic. We analyzed gender, age, duration, and severity of pain (using the visual analogue scale-VAS), frequency of prescribing anticonvulsants and antidepressants, as well as their combination in both groups. The data were analyzed with IBM SPSS Statistics.

Results

Among the patients of both groups, women predominated (65.3% in group 1 and 57.2% in group 2). The average age was 61.8±14.5 and 58.9±12.7, in the first and second groups, respectively. The disease duration was longer in group 2 (6.8±3.9 years, and 4.5 ± 2.7 in group 1, p<0.05). Pain intensity was comparable in both groups (4.3±2.8 and 5.1±2.5, p<0.067 on VAS). Antidepressants there were prescribed 16.1% and 52.9%, p<0.05, anticonvulsants - 18.8% and 33.2 %, p<0.05, their combination - 2.2% and 13.8%, p<0.05 in the first and second groups, respectively.

Conclusions

Adjuvant analgesics are more often prescribed to patients of specialized pain clinics. It may be associated with more severe descriptions of chronic pain syndrome, as well as insufficient awareness of modern approaches to the management in this category of patients by specialists in primary health care. References: 1.Zagorulko, Medvedeva Russ Pain J. 2019

The fifth cranial nerve in headaches

The fifth cranial nerve is the common denominator for many headaches and facial pain pathologies currently known. Projecting from the trigeminal ganglion, in a bipolar manner, it connects to the brainstem and supplies various parts of the head and face with sensory innervation. In this review, we describe the neuroanatomical structures and pathways implicated in the sensation of the trigeminal system. Furthermore, we present the current understanding of several primary headaches, painful neuropathies and their pharmacological treatments. We hope that this overview can elucidate the complex field of headache pathologies, and their link to the trigeminal nerve, to a broader field of young scientists.