Migraine is a common neurological disorder characterized by recurrent headaches, often accompanied by nausea, vomiting, photophobia, and phonophobia.
Migraine without aura is the most common of all types of migraine in the International Classification of Headache Disorders, Third Edition (ICHD-3). In the Global Burden of Disease (2016), migraine has emerged as the second leading cause of neurological disabling diseases.
Comorbidity is easy to exist in migraine, anxiety, depression, sleep disorders and other diseases, which increases the risk of cognitive dysfunction and cardiovascular and cerebrovascular diseases.
The diagnosis rate of migraine patients is only 52.9%, and there are conditions such as improper use of analgesic drugs and lack of preventive treatment. Migraine headaches can reduce the quality of daily life and productivity of patients.
The economic burden and risk of society and the patient's family are invisibly increased. The incidence of migraine varies among different ethnic groups, with white people having a higher incidence of migraine than other ethnic groups, and this trend is observed in both men and women.
Women have a higher incidence of migraine than men because estrogen activates the inflammatory pathway. In-depth study of the epidemiological characteristics of migraine is of great significance for the prevention and treatment of migraine.
Migraine has a certain familial cluster, and the age of onset is closely related to the patient and the patient's prognosis, and studies have shown that migraine is a polygenic disease controlled by genetic predisposition and environment.
A global genome-wide association analysis identified 41 migraine susceptibility gene loci, primarily involved in glutamatergic neurotransmitters, metalloproteinases, vascular nervous system, and metabolism.
Genetic factors can cause a trigger to lower the sensory threshold. Many common irritants in everyday life, for migraine sufferers, they become harmful stimuli that induce migraines.
Deepening the understanding of migraine through genetic etiology can help better prevent migraine. The vascular theory holds that abnormal intracranial vasoconstriction causes migraine.
As early as the middle of the last century, studies found that the concentration of 5-HT in blood vessels and metabolites in urine correlated with the tension contraction of blood vessel walls, the plasma concentration of 5-HT decreased, and the blood vessel wall dilated and headache occurred.
The vascular theory can be well explained, the important feature of migraine is pulsatile headache, and the clinical 5-HT agonist sumatriptan and the selective calcium antagonist cibilin are effective in the treatment of migraine.
In the past, vascular theory was one of the main mechanisms of migraine, but vascular theory has not been able to explain the unilateral, aura, accompanying symptoms, memory loss during attacks, and pain sensitization of migraine.
Neurological theories suggest that migraine headaches are caused by vascular changes secondary to the dysfunction of nerve cells. With the proposed, it was confirmed that neurogenic inflammation causes vasodilation.
Magnetic resonance angiography or magnetic sensitive-weighted imaging is used to determine whether the intracranial blood vessels change when migraine attacks occur. The study found that the patient had a mildly dilated intracranial artery on the affected side and no significant dilation of the extracranial artery.
It provided an imaging basis for neurological theory, and since then, the study of the pathogenesis of migraine has focused more on peripheral and central pain pathways.
The trigeminal neurovascular theory is the mainstream theory of the pathogenesis of migraine, which combines nerves, blood vessels, and transmitters, and the trigeminal neurovascular system releases vasoactive substances and interacts with blood vessels to cause migraine.
In the 80s of the last century, the journal "TheLancet" integrated the theory of neurology with the theory of blood vessels, and proposed the theory of trigeminal neurovascularity. When the trigeminal nerve vascular reflex system is stimulated by injury, the cerebral blood vessels around the trigeminal nerve endings are activated, releasing CGRP and β-endorphins (β-EP).
As a result, the cerebral blood vessels are over-dilated, plasma proteins are exuded, and aseptic inflammation is produced, which makes the patient sensitive to pain, aggravated pain perception, and accompanied by autonomic symptoms.
CGRP is a 37-amino acid polypeptide, half of the trigeminal neurofibroblasts contain CGRP, CGRP is closely related to trigeminal nerve activity, CGRP levels are significantly increased during migraine attacks, and no changes in other neuropeptides are detected.
In addition to the above mainstream theories, there are also direct or indirect risk factors for migraine. In humans, blood communicates between the left and right atriums during the fetal period, and this channel is called the foramen ovale, which in most people closes when the pulmonary circulation is established.
In the 90s of the last century, the correlation between foramen ovale regurgitation and migraine was verified, and many subsequent studies have reached the same conclusion. With the rapid development of modern science and technology, the social environment and the natural environment have also undergone great changes.
Anxiety and depression caused by life stress will be more likely to induce migraine, which will aggravate anxiety and depression, and will form a vicious circle, so it is necessary to popularize the knowledge of related diseases for migraine patients.
The ancient books of traditional Chinese medicine have been recorded in the "Yellow Emperor's Neijing: Su Wen" on the "first wind" and "brain wind", and later called "head wind", "partial head wind", "partial head wind", and later generations of doctors gradually summarized and improved their etiology and pathogenesis.
Wind evil, fire evil, phlegm, stasis, dampness, qi stagnation, blood deficiency, qi deficiency, etc. can all cause migraine. During the Jin and Yuan dynasties, the "Ten Books of Dongyuan" proposed external headaches and internal injury headaches.
Wang Kentang of the Ming Dynasty "Six Disciplines of Evidence and Treatment Criteria" contains: "There are many medical books, headaches and headaches, and wind are two doors...... After healing, it also relapses. "Divide headaches into new-onset headaches and long-term headaches.
"Medical Invention" contains "the general rule is not pain, and the pain is not passed", so the treatment is mainly to promote qi and blood, and relieve pain through the channels. Acupuncture mainly selects A is acupoint and foot less yang gallbladder meridian acupuncture points, "Jade Dragon Song" contains: "Partial head wind pain is difficult to treat, silk bamboo gold needle can also be applied, along the skin backward permeability valley, one needle and two acupoints are rare in the world." ”
The accumulation of migraine is the place where the foot and yang meridians follow, and the joint application of all acupoints can play a role in clearing and clearing the qi and relieving pain.
"Lingshu: Nine Needles and Twelve Originals" proposed: "The movement of the machine does not leave its emptiness." In "The Recipe for a Thousand Gold": "There is a law of Ah yes, if a person is sick, he will be ordered to pinch it, if it is right, do not ask about the holes." That is, to get the stool or the sore place, that is, Yun A is, moxibustion and thorns are tested, so it is said that A is the acupoint. ”
The body enters a pathological state locally, forming pain trigger points such as Ah Shi acupoint and pain sensitive acupoint, and selecting Ah Shi acupoint can enhance the role of evacuation and communication meridians, regulating qi and blood, and achieve the effect of "qi to effective and effective".
From the development of the pre-Qin period to the present, the understanding of migraine in traditional Chinese medicine has continued to improve, opening up new ideas for later generations of scholars, and the treatment methods have also advanced with the progress of theories.
Migraine first appeared as a disease name in Huangfu Mi's "Acupuncture and Moxibustion A and B Sutra", and the "Orchid Secret Collection" recorded migraine as "a person with pain in the half of the head". However, there are certain differences between the concept of migraine in ancient times and the concept of migraine as defined by modern medicine, and most of the dialectic and treatment of migraine in ancient times are attributed to headache.
From a macro perspective, the causes of migraine can be divided into two categories: external and internal. Li Dongyuan of the Jin Dynasty wrote "The Theory of Internal and External Injuries and Confusion" has a cloud: "Internal symptoms of headaches, sometimes done, sometimes stopped, external evidence headaches, often have to be passed into the real prescription."
This is also the difference between internal and external symptoms, and "aims to distinguish the onset of external evil and internal injury through the characteristics of pain, and believes that headache caused by external sensation can be transformed into internal injury headache after a long illness."
Zhu Danxi of the Yuan Dynasty recorded in "Pulse Cause Treatment" that "cold, headache or migraine pain on half of the side are blown by the cold wind, and when the wind is cold, it will ...... The pulse string is thin out of the inch mouth is also. "Aiming to distinguish and classify through the pulse, "above the peak, but the wind can reach" the wind is yang evil, easy to invade the head, and the upper offender is empty, and can "all the five qi", with cold, heat, deficiency and stasis to cause disease together.
"The Yellow Emperor's Neijing: Lingshu" records that "where the evil is, it is insufficient." "Deficiency of viscera is the internal cause of migraine, and when the viscera is deficient, it is not only susceptible to the invasion of external evils, but also prone to phlegm coagulation and blood stasis, so that the meridian stasis obstructs the qi machine is not smooth.
Wind evil is the key inducing factor of migraine, and visceral deficiency is the main internal factor of migraine. Zhang Zhongjing summarized the etiology and pathogenesis of headaches caused by external evil in "Treatise on Typhoid Fever", pioneered the treatment of headaches according to the syndrome differentiation of scriptures, and used the sweat method, the lower method, and the temperature method, each with its main formula.
"Headaches must be treated with Chuanxiong, if it does not heal, add menstrual medicine. and "Headache should be judged as the third cause" both emphasize the important role of menstrual inducing drugs in the treatment of headaches.
The "Theory of Three Causes and One Disease" further points out that the occurrence of headache may be related to internal causes, external causes and non-internal and external causes. Internal injury headache focuses on the treatment of phlegm stasis, qi deficiency, qi stagnation, and blood deficiency, and external headache focuses on Chuanxiong, nepeta and other anti-wind and anti-surface medicines.
A new pathogenesis of food accumulation headache is proposed, and the spleen and stomach should be taken care of in the treatment of food accumulation headache. In the Qing Dynasty, Wang Qingren included in the "Medical Forest Correction of Errors" representative prescription Xuefu Zhuyu Tang, which was used to treat headaches caused by blood stasis.
Through the study of 236 related literatures, the modern research summarized the 36 flavors of high-frequency Chinese medicines required for the treatment of migraine, and analyzed them, mainly focusing on the traditional Chinese medicines of partial temperature, pungent taste and return to the liver and spleen.
The above 36 commonly used traditional Chinese medicines mainly play the role of invigorating blood and removing blood stasis, calming the liver and calming wind, and nourishing qi and blood. There are many excellent Chinese patent medicines for the treatment of migraine in clinical practice, such as Yangsan Brain Granules, Zhengtian Pills, etc.
Some of these drugs also have a preventive effect on migraine, and 219 patients have been clinically observed to have a similar preventive effect of Tongtian oral liquid and sibilin on migraine, and there are no obvious side effects.
Acupuncture has fewer adverse reactions and limitations in the treatment of migraine, and has a long history, which has irreplaceable advantages in the choice of non-drug treatment of migraine.
On the basis of traditional physicians taking acupoints according to the scriptures, local acupoints, and distinguishing the meridians and acupoints, modern doctors have put forward the balance acupuncture method, the method of adjusting the mind and reasoning, the method of stabbing the head acupoints, and the acupuncture method of dragon and tiger fighting.
The efficacy of balance acupuncture on migraine patients was observed, and the treatment effect was better than that of the sham acupoint group (P<0.05). The intestinal flora of mice was measured before and after acupuncture, and it was found that acupuncture could regulate the intestinal flora of mice, and acupuncture could not only relieve pain, but also inhibit the trigeminal neurovascular pathway by maintaining internal environmental homeostasis.
On the basis of conventional acupuncture, the electroacupuncture instrument is connected after the acupuncture is exhausted. This therapy can not only save manpower in the treatment process, but also control the amount of stimulation more objectively, which is a commonly used treatment method in modern clinical acupuncture treatment.
In the clinical trial of electroacupuncture Siguan acupoint and oral flunarizine hydrochloride capsule in the treatment of hepatophanshang-type migraine, it was found that electroacupuncture Siguan acupoint could effectively reduce the number of headache attack days, headache intensity, and improve migraine symptoms.
Electroacupuncture of migraine rats showed that electroacupuncture could reduce the expression of some vasoactive substances, including endothelin, nitric oxide, calcitonin gene-related peptide (CGRP), etc.
Reduces neurogenic inflammatory response and inhibits trigeminal neurovascular pathway. In addition to traditional treatment methods such as massage, moxibustion, scraping, stabbing and bloodletting, acupuncture, auricular pressure beans, etc., combined with a variety of other techniques, more significant curative effects can be obtained.
"Su Wen: Three Books and Nine Candidates" said: "You must first remove its blood and then adjust it, without asking about its illness, and take it for a peaceful period." "Thumb micro-phlebotomy combined with Long's manipulation for migraine.
For migraine patients, the evil qi is gathered on one side, and the moxibustion method uses burning mugwort leaves to penetrate the heat into the skin, so as to achieve the effect of warming and circulating qi and blood, mobilizing yang qi, and strengthening the righteousness and dispelling evil spirits, and the effect on migraine caused by cold and dampness and menstrual cramps before and after is quite significant.
The combination of moxibustion and auricular pressure beans was used to treat migraine with weak qi and blood, which effectively improved the clinical symptoms of patients. Physicians conducted a clinical study on 80 patients using the meridian scraping method, and found that the meridian scraping method could improve the quality of life of patients with hepato-yang hyperactive migraine and alleviate the clinical symptoms of patients with hepa-yang hyperactive migraine.