Study On The Relationship Between Post-Stroke Depression And Tension Type Headache

Background:Cerebrovascular disease is one of the main diseases that endanger the health and life of the elderly.Stroke is the main clinical type of cerebrovascular disease,with high morbidity,mortality and disability rate,and its rehabilitation effect is not good.The sequelae of limb paralysis,depression and headache in many patients with stroke seriously affect the quality of life of patients.Post-stroke depression(PSD)is a common complication of emotional disorder after stroke,which affects the prognosis and life of patients with stroke.Stroke associated headache(SH)is a common paroxysmal symptom in patients with stroke,which can occur before,after and at the time of stroke.Among them,post-stroke headache is mainly tension-type headache(TTH).TTH is the most common type of primary headache in neurology clinic,and depression is currently believed to be related to TTH.Objective:To observe the combination of TTH in PSD patients,and to explore the correlation between PSD and TTH,so as to provide reference for the treatment and rehabilitation of stroke patients.Methods:A total of 301 stroke patients hospitalized in the department of neurology of shaanxi provincial people's hospital from December 2017 to December 2018 were collected,including 191 males and 110 females,aged between 26 and 89.Patients were divided into two groups according to whether they had depression after stroke: the PSD group(95patients,47 males and 48 females)and the non-psd group(206 patients,144 males and 62females).PSD patients were subdivided into TTH subtypes: The PSD without TTH(group A);PSD combined with infrequent episodic TTH(IETTH,group B);PSD combined with frequent episodic TTH(FETTH,group C);PSD merger Chronic TTH(CTTH,group D).Basic data,previous medical history,liver and kidney function,blood lipid,HCY,etc.were collected.The severity of neurological defects was assessed by the neurological deficit scoring scale(NHISS)in all stroke patients.Depression was scored with 24 items of self-rating depression scale(SDS)and Hamilton depression scale(HAMD)to evaluate the severity of depression(mild,moderate and severe).According to the international headache classification of diseases(ICHD)the latest version(ICHD-?)in the diagnosis of TTH.Chi-square test was used to compare the difference of TTH incidence between PSD group and non-psd group,and the difference of different depression degree and TTH classification in PSD group.Non-parametric rank sum test was used to compare the difference of HAMD scores between the four groups of PSD combined with different types of TTH,and the HAMD scores between the four groups were further compared by extended t test,whose corrected test level was alpha'=0.05/6?0.008.Spearman correlation test was adopted to explore the correlation between TTH typing and HAMD score.Results:1.Incidence of PSD in stroke patients: 301 cases of stroke patients,191 cases of male patients and 110 cases of female patients were diagnosed with PSD.The incidence of PSD was 31.6%,including 43 cases of mild psdaccounting for 45.3%,34 cases of moderate psdaccounting for 35.8%,and 17 cases of severe psdaccounting for 17.9%.2.Comparison of general data between the PSD group and the non-psd group: differences in age(P=0.161),education level(P=0.13),marital status(P= 0.418),smoking history(P= 0.082),drinking history(P=0.433),stroke type(P=0.429),hypertension(P=0.499),diabetes(P=0.895),coronary heart disease(P=0.17)were not statistically significant(P>0.05).The differences in gender(P=0.001)and NHISS(P=0.006)between the two groups were statistically significant(P< 0.05).3.Comparison of biochemical data between PSD group and non-psd group: TC(P=0.666),HDL-C(P=0.936),LDL-C(P=0.197),TG(P=0.994),TBiL(P=0.522),DBiL(P=0.541),UREA(P=0.185),CRE(P=0.24),and UA(P=0.331)showed no significant diff erence between the two groups(P<0.05).4.Comparison of biochemical data between the PSD group and non-PSD group sh owed no statistically significant differences in TC(P=0.666),HDL-C(P=0.936),LDLC(P=0.197),TG(P=0.994),TBiL(P=0.522),DBiL(P=0.185),CRE(P=0.24),UA(P=0.331).The difference in HCY(P=0.049)between the two groups was statisticall y significant(P<0.05).5.Comparison of different depression degree and TTH classification in PSD patients: the difference between the two was statistically significant(P<0.001),and the depression degree was correlated with TTH classification.The incidence of CTTH in patients with severe PSD is higher than that in patients with mild and moderate PSD.6.Comparison of depression scores of PSD combined with TTH: the non-parametric ranksum test of PSD combined without TTH group(group A),PSD combined with IETTH group(group B),PSD combined with FETTH group(group C)and PSD combined with CTTH group(group D)showed that the HAMD scores of the four groups were significantly different(P<0.001).The HAMD scores of the four groups were further compared by extended t test,and it was found that there were statistically significant differences in HAMD scores between group A,group B,group C and group D(P<0.008).There were statistically significant differences in HAMD scores between group B,group C and group D(P<0.008).There was no statistically significant difference in HAMD scores between group C and group D(P> 0.008).7.Spearman correlation analysis between depression severity(HAMD score)and TTH typing in PSD group showed that r=0.726,P<0.001,and the difference was statistically significant.Conclusion:1.The incidence of PSD is relatively high,and light and moderate PSD are the most common.2.The occurrence of PSD may be related to gender,NHISS score and HCY level.3.The incidence of TTH in PSD patients is 40%;Compared with non-psd patients,PSD patients are more likely to be combined with TTH,and there is a certain correlation between PSD and TTH.4.The depression degree of PSD is correlated with the classification of TTH.The more severe the depression,the more likely TTH is chronic.