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Liu R, Xu H, Zhang X, Wang X, Yuan Z, Sui Z, Wang D, Bi K, Li Q. Metabolomics Strategy Using High Resolution Mass Spectrometry Reveals Novel Biomarkers and Pain-Relief Effect of Traditional Chinese Medicine Prescription Wu-Zhu-Yu Decoction Acting on Headache Modelling Rats. Molecules 2017; 22:E2110. [PMID: 29258229 PMCID: PMC6149820 DOI: 10.3390/molecules22122110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/26/2017] [Accepted: 11/30/2017] [Indexed: 11/16/2022] Open
Abstract
Headache is a common episodic or chronic neurologic disorder. Treatment options and diagnosis are restricted by an incomplete understanding of disease pathology and the lack of diagnostic markers. Wu-Zhu-Yu decoction (WZYD), a traditional Chinese medicine (TCM) formula containing four TCM herbs, is commonly used in the treatment of headache in China. To deeply understand more about headache and investigate the pain-relief mechanism of WZYD, a comprehensive metabolomics study combined with multivariate data processing strategy was carried out. An LC-high resolution mass spectrometry-based metabolomics approach was applied to characterize metabolic biomarker candidates. Multiple pattern recognition including principal component analysis-discriminant analysis, partial least squares-discriminant analysis and hierarchical cluster analysis were used to determine groups and confirm important variables. A total of 17 potential biomarkers were characterized and related metabolic pathways were identified. The study demonstrated that the established metabolomics strategy is a powerful approach for investigating the mechanism of headache attack and WZYD. In addition, the approach may highlight biomarkers and metabolic pathways and can capture subtle metabolite changes from headache, which may lead to an improved mechanism understanding of central nervous system diseases and TCM treatment.
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Affiliation(s)
- Ran Liu
- National and Local Joint Engineering Laboratory for Key Technology of Chinese Material Medica Quality Control, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Rd., Shenyang 110016, China.
| | - Huarong Xu
- National and Local Joint Engineering Laboratory for Key Technology of Chinese Material Medica Quality Control, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Rd., Shenyang 110016, China.
| | - Xiaowen Zhang
- Guangzhou Bristol Drug Delivery Co., Ltd., 11 Kaiyuan Ave, Guangzhou 510320, China.
| | - Xiaotong Wang
- National and Local Joint Engineering Laboratory for Key Technology of Chinese Material Medica Quality Control, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Rd., Shenyang 110016, China.
| | - Ziyue Yuan
- National and Local Joint Engineering Laboratory for Key Technology of Chinese Material Medica Quality Control, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Rd., Shenyang 110016, China.
| | - Zhenyu Sui
- China Food and Drug Administration Institute of Executive Development, 16 Xi Zhan Nan Rd., Beijing 100073, China.
| | - Dong Wang
- Dalian Institute for Drug Control, 888a Huanghe Rd., Dalian 116000, China.
| | - Kaishun Bi
- National and Local Joint Engineering Laboratory for Key Technology of Chinese Material Medica Quality Control, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Rd., Shenyang 110016, China.
| | - Qing Li
- National and Local Joint Engineering Laboratory for Key Technology of Chinese Material Medica Quality Control, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Rd., Shenyang 110016, China.
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Alhassani G, Treleaven J, Schabrun SS. Combined transcranial and trans-spinal direct current stimulation in chronic headache: A feasibility and safety trial for a novel intervention. Hong Kong Physiother J 2017; 37:1-9. [PMID: 30931040 PMCID: PMC6385152 DOI: 10.1016/j.hkpj.2016.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Chronic primary headache disorders are associated with frequent, severe pain and significant functional impairment, with treatment remaining challenging. Objective: We examined the feasibility and safety of a novel brain [transcranial direct current stimulation (tDCS)] and spinal cord stimulation [trans-spinal cord direct current stimulation (tsDCS)] treatment in chronic headache. Methods: Nine participants (3 males; aged, 40 ± 15 years) suffering from chronic daily headache, chronic tension-type headache, or chronic migraine received the combined brain and spinal cord intervention for 5 consecutive days. Stimulation was applied for a total of 40 minutes (20 minutes of tDCS followed by 20 minutes of tsDCS) at 1 mA. Pain sensitivity and headache symptoms (frequency, severity, duration, and medications recorded via a headache diary, 4 weeks before and after treatment) were assessed. Results: The treatment was safe, feasible, and well tolerated. Headache frequency was reduced following the treatment (p = 0.026) in chronic tension-type headache and chronic migraine, but not in chronic daily headache. Headache severity was reduced immediately post-treatment in 67% of sessions. A trend towards a reduction in medication use was observed (p = 0.075). No changes in headache severity (p = 0.16) or duration (p = 0.34) were present. Conclusion: These data suggest that combined tDCS and tsDCS intervention is safe and feasible, and may improve headache frequency in patients with chronic primary headache disorders.
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Affiliation(s)
- Ghufran Alhassani
- Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Sydney, New South Wales, Australia
| | - Julia Treleaven
- School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Siobhan S.M. Schabrun
- Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Sydney, New South Wales, Australia
- Corresponding author. Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, New South Wales 2751, Australia. E-mail address: (S.S.M. Schabrun)
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Williams DR, Stark RJ. Intravenous Lignocaine (Lidocaine) Infusion for the Treatment of Chronic Daily Headache with Substantial Medication Overuse. Cephalalgia 2016; 23:963-71. [PMID: 14984229 DOI: 10.1046/j.1468-2982.2003.00623.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients with chronic daily headache with medication overuse are difficult to treat, especially when the doses of analgesia are substantial. We have previously shown that intravenous lignocaine (lidocaine) infusion is useful in maintaining pain control while the offending analgesic agent is withdrawn in these patients. The published data on long-term efficacy of this treatment is limited. We undertook a retrospective survey of 71 consecutive patients admitted for lignocaine infusion (mean 8.7 days) for treatment of chronic daily headache, with substantial analgesic abuse. Ninety percent of patients had a history of migraine headaches. In 80% of patients codeine was the predominant agent implicated in the analgesic rebound headaches (mean 1053 mg/week) and 24% used ergotamine-containing medications (mean 16 mg/week). Thirty-one percent frequently used injected narcotics. At completion 90% reported that their daily headache was absent or improved, and the analgesic agent was withdrawn successfully in 97%. At six month follow-up, 70% of patients reported that their daily headache was absent or improved and 72% of patients remained free of the offending analgesic agent. Intravenous lignocaine is a useful treatment in the management of chronic daily headache with substantial medication overuse. The benefits of the program last for at least six months.
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Lovati C, D’Amico D, Bertora P. Allodynia in migraine: frequent random association or unavoidable consequence? Expert Rev Neurother 2014; 9:395-408. [DOI: 10.1586/14737175.9.3.395] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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5
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Sokolov AY, Lyubashina OA, Panteleev SS. The role of serotonin receptors in migraine headaches. NEUROCHEM J+ 2011. [DOI: 10.1134/s1819712411020085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Han DG, Lee CJ. Headache associated with visceral disorders is “parasympathetic referred pain”. Med Hypotheses 2009; 73:561-3. [DOI: 10.1016/j.mehy.2009.05.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 05/07/2009] [Accepted: 05/12/2009] [Indexed: 10/20/2022]
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Rossi C, Pini LA, Cupini ML, Calabresi P, Sarchielli P. Endocannabinoids in platelets of chronic migraine patients and medication-overuse headache patients: relation with serotonin levels. Eur J Clin Pharmacol 2007; 64:1-8. [DOI: 10.1007/s00228-007-0391-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2007] [Accepted: 09/24/2007] [Indexed: 12/22/2022]
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Tenhunen K, Elander J. A qualitative analysis of psychological processes mediating quality of life impairments in chronic daily headache. J Health Psychol 2005; 10:397-407. [PMID: 15857870 DOI: 10.1177/1359105305051425] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Quality of life impairments are greater in chronic daily headache (CDH) than in episodic headache conditions like migraine. This qualitative interview study aimed to identify psychological processes associated with quality of life impairments among individuals meeting diagnostic criteria for CDH. Grounded theory analysis showed that perceived loss of control was the central experience mediating the impact of CDH on quality of life. The results provide explanations for previous quantitative findings about quality of life impairments in CDH, and could inform interventions to reduce the impact of CDH. Further research could also examine the roles played by perceived control in the onset and development of CDH, including possible links with pre-emptive analgesic use.
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Affiliation(s)
- Katri Tenhunen
- Child Psychiatric Evaluation Unit, City of Helsinki Health Centre, Finland
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Gallai V, Alberti A, Gallai B, Coppola F, Floridi A, Sarchielli P. Glutamate and nitric oxide pathway in chronic daily headache: evidence from cerebrospinal fluid. Cephalalgia 2003; 23:166-74. [PMID: 12662182 DOI: 10.1046/j.1468-2982.2003.00552.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A central sensitization has been advocated to explain chronic daily headache (CDH) due to sustained peripheral sensitization of allogenic structures responsible for sustained trigeminovascular system activation. Several mechanisms have been suggested to underlie central sensitization, but have been poorly investigated in CDH. They involve N-methyl-D-aspartate (NMDA) receptor activation and nitric oxide (NO) production and supersensitivity and increased and maintained production of sensory neuropeptides. The present study supports the above pathogenic mechanisms demonstrating a significant increase in glutamate and nitrite levels in the CSF of CDH patients, without a significant difference between patients without and those with analgesic overuse headache (P < 0.0001 and P < 0.002). The increase in CSF nitrites was accompanied by a significant rise in the CSF values of cyclic guanosine monophosphate (cGMP) in patients in comparison with controls (P < 0.0001). A statistically significant correlation emerged between visual analogic scale (VAS) values and glutamate, nitrites and cGMP. Although substance P (SP) and calcitonin gene-related peptide (CGRP), and to a lesser extent neurokinin A, were significantly increased in CSF compared with control subjects, their values did not correlate with glutamate, nitrites and cGMP levels in CSF in the patient group. The present study confirms the involvement of glutamate-NO-cGMP-mediated events underlying chronic head pain that could be the target of a new therapeutic approach which should be investigated.
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Affiliation(s)
- V Gallai
- Interuniversity Centre for the Study of Headache and Neurotransmitter Disorders, Perugia, Italy
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Biondi DM. Opioid resistance in chronic daily headache: a synthesis of ideas from the bench and bedside. Curr Pain Headache Rep 2003; 7:67-75. [PMID: 12525274 DOI: 10.1007/s11916-003-0013-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Chronic daily headache is a complex pain disorder that encompasses many diagnostic and therapeutic challenges. Our understanding of the pathophysiologic processes of intermittent migraine has improved over the past decade, but the biologic basis of chronic daily headache remains obscure. Some of the more common issues confounding management of patients who experience chronic daily headache are medication overuse, psychiatric comorbidity, refractoriness to pharmacologic treatments, and disability. Long-acting opioid analgesics would appear to provide a viable treatment option for those patients who remain refractory to other treatment interventions; however, clinical experience often does not support this belief. Current concepts of the pathophysiologic basis of chronic pain and associated neural plasticity may elucidate a biologic basis for the general inefficacy of opioids in the management of chronic daily headache. This article explores the models of pathophysiology for migraine and chronic daily headache, the concept of chronic daily headache as a neuropathic pain syndrome, neural plasticity in the context of neuropathic pain states, the physiologic basis for opioid tolerance and opioid-induced hyperalgesia, and how each of these conditions interact to provoke the general lack of opioid efficacy often observed in the management of chronic daily headache.
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Affiliation(s)
- David M Biondi
- Spaulding Rehabilitation Hospital, 125 Nashua Street, Boston, MA 02114, USA.
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Abstract
There are many people who experience headaches that are independent of illness, injury, or hangover. Approximately 4% of the population suffer from headaches on a daily or near-daily basis. It is apparent that patients with chronic daily headache in community samples differ in important ways from patients with chronic daily headache in subspecialty clinics. In this manuscript, we review clinic-based data on risk factors for chronic daily headache and summarize the current data on the epidemiology of chronic daily headache.
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Affiliation(s)
- Ann I Scher
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, 7201 Wisconsin Avenue, MSC 9205, Bethesda, MD 20892-9205, USA.
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Guidetti V, Galli F. Psychiatric comorbidity in chronic daily headache: pathophysiology, etiology, and diagnosis. Curr Pain Headache Rep 2002; 6:492-7. [PMID: 12413409 DOI: 10.1007/s11916-002-0069-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Chronic daily headache is a challenge for clinical practitioners and researchers. Etiology, pathophysiology, diagnosis, treatment, and prognosis of chronic daily headache present many questions that need answers. A chance occurrence of psychiatric disorders (mostly anxiety and mood disorders) in patients with chronic daily headache should not be excluded. This results in the need to understand the involved mechanisms, which requires us to draw new insights into the etiology, diagnosis, treatment, and prognosis of chronic daily headache. Psychiatric comorbidity seems to be cross-related to each of these dimensions, although the meanings need to be drawn. Each domain is discussed, considering the status of knowledge and stressing the future lines of research.
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Affiliation(s)
- Vincenzo Guidetti
- Department of Child and Adolescent Neurology and Psychiatry, Interuniversity Center for the Study of Headache and Neurotransmitter Disorders Section of Rome, University of Rome La Sapienza, Via dei Sabelli 108, Italy.
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