The Effect Of Acupuncture On The Brain Function Of Patients With Chronic Tension-type Headache

Objective:To observe the clinical efficacy and effect of brain function of acupuncture deqi treatment and acupuncture nondeqi treatment on chronic tension-type headache（CTTH）,and to explore the relationship between the clinical efficacy and brain function.So as to provide the scientific basis for the mechanism of acupuncture deqi treatment and acupuncture nondeqi treatment.Methods:1.Clinical research section67 cases of CTTH were recruited and randomly assigned in the acupuncture deqi group and the acupuncture nondeqi group separately,33 patients in acupuncture deqi group and 34 patients in acupuncture nondeqi group.CTTH patients were treated with acupoints of Baihui and bilateral Taiyang,Fengchi,Hegu and Taichong.The acupuncture deqi group was treated with deep needling,while the acupuncture nondeqi group received shallow needling.The treatment course lasted for 8 weeks.The first 4 weeks were treated 3 times a week,and the last 4 weeks were treated 2times a week,and total 20 times treatement were received.Headache related clinical indicators including number of headache attack days,duration of headache,and headache degree were collected before acupuncture treatment,the fourth week of treatment and the eighth week of treatment.The differences between the above-mentioned clinical parameters in the acupuncture deqi group and the acupuncture nondeqi group were compared to observe whether there were differences in curative effect between the acupuncture deqi and acupuncture nondeqi therapy.2.fMRI research section30 cases of CTTH were recruited and randomly assigned in the acupuncture deqi group and the acupuncture nondeqi group separately,16 patients in acupuncture deqi group and 14 patients in acupuncture nondeqi group.Acupoints for the treatment,acupuncture methods,treatment courses,and clinical observation indexes of CTTH patients are the same as clinical research section.Before acupuncture treatment and after 8 weeks of treatment,two groups of patients were performed fMRI scan.17healthy subjects were recruited simultaneously to match the age and sex of the CTTH patients,and fMRI scan was performed for just 1 time.Brain function indicators for statistical analysis include:（1）regional homogeneity（ReHo）:to observe changes in ReHo before and after treatment in both groups of patients.（2）Correlation analysis of brain function-condition:Correlate analysis of the index of the disease characteristics of patients with CTTH and ReHo values was performed to explore whether there was a correlation between the severity of illness and changes in brain function and the degree of correlation.（3）Functional connectivity analysis:Brain regions with significant differences in ReHo between the CTTH patients and healthy subjects were used as the seed points for functional connectivity analysis.（4）Correlation analysis of improvement of headache symptom changes in brain function:Correlation analysis of changes in clinical indicators of headache and changes in brain function activity were performed to observe whether there was a correlation and degree of relevance between headache indicators and brain function changes,in order to explore the key regulating brain area of acupuncture deqi treatment and nondeqi therapy.Results:1.Clinical research section（1）Excluding shedding cases,a total of 61 CTTH patients were included in the statistical analysis,including 31 patients in the acupuncture deqi group and 30patients in the acupuncture nondeqi group.Baseline data analysis showed that there was no significant difference in gender,age,height,weight,duration of illness,anxiety and depression scores,number of days of headache attack,degree of headache,and duration of headache between the two groups（P>0.05）,so the baseline was comparable.（2）A comparison of deqi sensation of CTTH patients in acupuncture deqi group and acupuncture nondeqi group（MASS score）showed that the deqi sensation of the acupuncture deqi group was significantly higher than that of the acupuncture nondeqi group,and the comparison between the two groups showed a significant difference（P<0.01）.（3）Comparison of the two groups of curative effects showed that compared to acupuncture nondeqi group,the number of days of headache attack in acupuncture deqi group were significantly lower（P<0.01）after 4 weeks and 8 weeks treatment,and the duration of headache were significantly reduced（P<0.01）after 8 weeks treatment.However,there was no statistical difference between the two groups in reducing duration of headache after 4 weeks of treatment（P>0.05）.And there was also no statistical difference between the two groups in reducing the degree of headache after 4 weeks and 8 weeks of treatment（P>0.05）.2.fMRI research section（1）Excluding the data of excessive head movement and data that affected fMRI data analysis,a total of 27 CTTH patients were included in the statistical analysis of fMRI data,including 14 patients in the acupuncture deqi treatment group and 13patients in the acupuncture nondeqi treatment group.（2）Baseline data analysis showed that there was no significant difference in gender,age,height,weight,duration of disease,anxiety and depression scores,number of days of headache attack,degree of headache,and headache duration between the acupuncture deqi group and the acupuncture nondeqi group（P>0.05）.Baseline data of patients with CTTH and healthy subjects showed that there was no significant difference in gender,age,height,weight,anxiety and depression scores between patients and healthy subjects（P>0.05）,so the baseline was comparable.（3）A comparison of the acupuncture deqi sensation（MASS score）between the two groups showed that the deqi sensation of the acupuncture deqi group was significantly higher than that of the nondeqi group,and the comparison between the two groups showed a significant difference（P<0.01）.（4）Results based on ReHo analysis（1）Compared with healthy subjects,the brain areas with significantly higher ReHo values were left cerebellum,right frontal gyrus,dorsomedial nucleus of the left thalamus,and calcarine fissure of left occipital lobe,and ReHo values were significantly reduced in left upper temporal gyrus in CTTH patients before treatment.（2）Compared to the beginning of treatment,the brain areas with significantly higher ReHo values were the right middle temporal gyrus and inferior temporal gyrus,left middle temporal gyrus and inferior temporal gyrus,and the brain regions with significantly decreased ReHo values were left occipital middle gyrus,right posterior cerebellar in CTTH patients after treatment of the acupuncture deqi group.（3）Compared to the beginning of treatment,the brain areas with significantly increased ReHo values were left parahippocampus gyrus,medial dorsomedial nucleus of the left thalamus and left corpus striatum,and the brain area of ReHo significantly decreased was left anterior cingulate gyrus after treatment in CTTH patients of acupuncture nondeqi group.（4）Correlation analysis of disease and brain function activity based on ReHo:There was a positive correlation between the duration of the CTTH and the ReHo value of the calcarine fissure of left occipital lobe（r=0.417,p=0.038）.That is,the longer the course of the CTTH patient,the higher the ReHo value of the calcarine fissure of left occipital lobe.There was no correlation between other headache indicators（days of headache attack,duration of headache,degree of headache）and ReHo values in other brain regions.（5）Results based on FC analysis（1）The calcarine fissure of left occipital lobe was used as the seed point.Compared with healthy subjects,the brain areas with increased FC were right pons,right anterior cunees and left superior anterior gyrus,and no FC-reduced brain regions were found.Compared to the beginning of treatment,the area of increased FC was rostral ventromedial medulla（RVM）,and the area of decreased FC was right medial frontal gyrus in CTTH patients of the acupuncture deqi group after treatment.And the brain area of increased FC after treatment in the acupuncture nondeqi group was right fusiform gyrus and left middle frontal gyrus,also no FC-reduced brain area was seen.（2）Using the dorsomedial nucleus of the left thalamus as the seed point,compared with healthy subjects in CTTH patients,the brain regions with increased FC were left supramarginal gyrus and midbrain,but no FC-reduced brain regions were observed.Compared to the beginning of treatment,the brain area with increased FC after treatment of patients in acupuncture deqi group was the left posterior lobe of cerebellum,and there was no brain area with FC reduction.And the brain area with increased FC after acupuncture in patients with nondeqi therapy was left angular gyrus and no FC-reduction brain area were found.（6）Headache index improvement and brain function change analysisThere was a negative correlation between the days of headache reduction at the8^th week of the acupuncture deqi group and the change of ReHo in the middle occipital region.The Pearson’s correlation coefficient was-0.561,p=0.037.However,no correlation was found with headache reduction time and degree of headache reduction,p>0.05.The degree of headache reduction at 8 weeks in the acupuncture nondeqi group was positively correlated with the change of ReHo in the left hippocampus gyrus,Pearson’s correlation coefficient was 0.709,p=0.022.However,no correlation was found with days of headache reduction and headache reduction time,p>0.05.There was no correlation between the improvement scores of headache indicators obtained in the acupuncture deqi group and the nondeqi group at the 8th week of treatment and the FC value changes based on using the calcarine fissure of left occipital lobe and the dorsomedial nucleus of the left thalamus as seed points,p>0.05.Conclusion:1.The needle sensation（MASS score）produced by deep acupuncture treatment was significantly stronger than that produced by shallow acupuncture treatment.The MASS scale can significantly evaluate and distinguish the acupuncture sensations produced by these two different stimulation techniques.2.Compared to acupuncture nondeqi group,there were significant differences in the number of headache attack days in acupuncture deqi group after 4 as well as 8weeks of treatment.But a significant difference was not found in the headache duration（h）until 8 weeks of treatment.There was also no significant difference after4 and 8 weeks of treatment in the degree of headache.Therefore,the advantage of acupuncture deqi treatment is the reduction of headache days,followed by the reduction of headache duration,but there was no advantage in improving headache degree.3.The calcarine fissure of left occipital lobe and the dorsomedial nucleus of the left thalamus were brain regions with significant differences in ReHo values between CTTH patients and healthy subjects.And the former is positively related to the course of CTTH,and the latter is key brain area affected by acupuncture deqi therapy.The calcarine fissure of left occipital lobe-right pontine,the calcarine fissure of left occipital lobe-somatosensory cortex（right quadrate gyri,left upper parietal gyrus）,dorsomedial nucleus of the left thalamus-somatosensory cortex（left supramarginal gyrus）and dorsomedial nucleus of the left thalamus-midbrain were the brain area with increased functional connectivity in CTTH patients compared with healthy subjects.The calcarine fissure of left occipital lobe-rostral ventromedial medulla（RVM）was the key brain regions of functional connectivity affected by acupuncture deqi therapy.4.The effect of acupuncture deqi therapy to reduce the number of days of headache attack was related to the reduction of neuronal activity synchronization in the left occipital middle gyrus.The effect of acupuncture nondeqi treatment to reduce the degree of headache is related to the increase of synchronization of neuronal activity in the left parahippocampal gyrus.