Observation Of Neuropsychological And Electrophysiological Features Of Headache Patients With Periorbital Muscle Fascia

Objecave:To study the clinical characteristics of headache patients with pericranial myofascial trigger points(MTrPs),and to explore the possible pathogenesis of MTrPs,We hope to find the possible electrical biomarkers for clinical diagnosis and treatment,and to improve the effect of headache treatment.Methods:To enroll twenty-seven headache patients with MTrPs into the groups in August 2016 to July 2017 in our hospital outpatients and inpatients,including 17 cases of paroxysmal headache and 16 cases of chronic headache.A series of neuropsychological test scale including Pittsburgh Sleep Quality Index(PSQI),Mini-mental State Examination(MMSE),Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HMAD)were evaluated among all patients.The needle pole electromyography(EMG)inspection were practiced on subjects with myofascial trigger points,for recording and analysing those abnormal electrical activitiy.Results: General data showed that there was no significant difference in age,gender,and headache family history between paroxysmal headache group,chronic headache group and the normal control group(P < 0.05).There was no statistically significant difference in the degree of headache(VAS and NRS)between paroxysmal headache group and chronic headache group,and the difference in headache duration and headache frequency was statistically significant(P < 0.05).Neuropsychological test results showed that the incidence of sleep disorders was 64.7%,cognition impairment was 17.6% in paroxysmal headache patients compared to 93.8% and 18.8% in chronic groups,While the incidence of anxiety and depression were 29.4% and 17.6% respectively in paroxysmal in comparison to 62.5% and 37.5% in the chronic subjects.The co-incidence of anxiety and depression were 11.8% and 37.5% respectively in paroxysmaland chronic groups.There were no statistically significant difference in three tests scores between two headache groups.According to the results of needle electrode electromyography(EMG),firstly,the abnormal EMG rate of 17 patients with paroxysmal headache was 94.1%,that of 16 patients with chronic headache was 75.0%,and that of 5 normal subjects was normal.Secondly,on the whole,this research with the aid of EMG tested 170 cranial weeks muscles,including 92 piece(with/without MTrPs,55/37)in paroxysmal headache group,78 pieces(with/without MTrPs,56/22)in chronic headache group,and 20 normal cranial weeks muscles.There was no statistically significant difference in the data of spontaneous electrical activity from results of EMG in the two groups of headache.The EMG abnormal rate of cranial weeks muscles with MTrPs(n=55)in paroxysmal headache group was 70.9%,in chronic headache group(n=56)was 75.0%,along with the clinical features of cranial muscles belt tightening zone,in which we detected the less hard nodules in where electrophysiological examination showed spontaneous electrical activities in different degree.Meanwhile found that both groups of headache has certain false positive rate and false negative rate.Conclusion:Headache patients with MTrPs often have certain extent of sleep disorders and affective disorders comorbidities.The significant proportion of abnormal electrical activities in MTrPs were observerd both in the two headache groups,the electricalcharacteristics were presented with different levels of spontaneous electricalactivity.It can concluded that the emerging of MTrPs abnormal electrical activity hint the new cause and mechanisms in headache.To be timely detected and diagnosised,it can help for the treatment.