| PurposeThe pathogenesis of migraine is related to many factors,seriously influencing the treatment in patients with acute migraine attack.Therefore,it is essential to choose the medications for acute migraine attack.“Pain sensitization theory of migraine” has become a hotspot in the study of migraine pathogenesis and treatment,and pain sensitization signal transduction pathway of molecular target drug is the future developing direction of the therapy for acute migraine attack,which has important significance for the clinical treatment of migraine.The gabapentin is used as a preventative treatment drug for migraine by international guideline,but there are less studies of the treatment of acute migraine attack using the gabapentin.Thus,the mechanism of the gabapentin for treating acute migraine attack is unclear.Our previous animal experiments and clinical studies show that the gabapentin can effectively treat acute migraine attack,but it is needed to further study the analgesic mechanism of the gabapentin from the clinical level.In the transduction of central sensitization signal caused by the migraine,the neuropetide calcitonin gene-related peptide(CGRP),and the protein kinase C(PKC)are important signal transduction pathways.In this paper,the changes of CGRP and PKC levels in patents with acute migraine attack are observed after treating them using the gabapentin.And the mechanism of the gabapentin for treating acute migraine attack is futher discussed to lay the theory foundation for treating acute migraine attack using the gabapentin.MethodsA total of 68 patients with migraine are selected from patients in department of neurology in our hospital during September 2014 and February 2016.They are in the 18-52 age range,and 18 of them are male and 50 are female,and 17 are with migraine aura and 51 are with migraine without aura.They are randomly divided into flunarizine control group of 33 cases and gabapentin treatment group of 35 cases according to random number table method.The patients in two groups have no significant difference in the general data such as age and gender ratios,etc.Method of administration:(1)gabapentin group: A dose is between 900mg/d ~ 2400mg/d and taken orally in 3 portions,and the medication treatment last for 3 days.(2)Flunarizine group: A dose is 10 mg and taken every 10 pm,and the medication treatment last for 3 days.The Visual analog pain score(VAS)is adopted to assess the subjective pain degree of the patients with migraine in two groups.The pain scales are accessed respectively before the gabapentin treatment,12 h after the treatment,24 h after the treament,48 h after the treament and 72 h after the treament.The pain relief is divided into 3 levels.Marked: VAS?3 After treatment;Valid: VAS between 4 and 6;Invalid: VAS>6.The total effective rate in each group is the sum of marked effective rate and valid effective rate in each group.In two groups,the CGRP and PKC levels in the patients' peripheral venous blood on an empty stomach are detected respectively before the treatment,12 h after the treatment,24 h after the treament,48 h after the treament and 72 h after the treament.Result1.Baseline data of patients: In this study,68 patients with migraine patients are selected.The control group has 33 patients,and 29 are included in the analysis.While the treatment group has 35 patients,and 29 of them are analysed.The baseline data includes gender,age,incentive,education,duration(seizure frequency is among 2-14 times/month)and clinical manifestation,however,the differences of the baseline data of the patients in two groups are not statistically significant(P>0.05).2.Migraine VAS comparison: The VAS of patients decrease after treatment in both the flunarizine control group and the gabapentin treatment group.Compared with the VAS of patients before the treatment respectively,the VAS significantly reduce 12 h,24h,48 h and 72 h after the treatment in both groups(P<0.05 or P<0.01).The VAS in the gabapentin group are significantly lower than that in the flunarizine group(P<0.05)in the same period.3.Treatment efficacy to migraine: The total effective rates of 12 h,24h,48 h and 72 h after the treament are 41.9%,54.8%,67.7% and 83.9%,respectively,in the gabapentin treatment group.The total effective rates of 12 h,24h,48 h and 72 h after the treament are 13.8%,24.1%,34.5% and 55.2%,respectively,in the flunarizine control group.The total efficiency of the gabapentin group is significantly better than that of the flunarizine group in the same period(P<0.05).4.Comparison of plasma CGRP levels: The CGRP levels of patients 12 h,24h,48 h and 72 h after treatment increase significantly in both the flunarizine group and the gabapentin group,respectively,compared with that before the treatment(P<0.05 or P<0.01).12 h,24h,48 h after treatment,the CGRP levels in the gabapentin group are significantly lower than that in the flunarizine group in the same period(P<0.05).5.Comparison of plasma PKC levels: The PKC levels of patients 12 h,24h,48 h and 72 h after the treatment increase significantly in both the flunarizine group and the gabapentin group,respectively,compared with that before the treatment(P<0.05 or P<0.01).12 h,24h,48 h and 72 h after the treatment,the PKC levels in the gabapentin group are significantly lower than that in the flunarizine group in the same period(P<0.05 or P<0.05).Conclusion1.Gabapentin can significantly reduce the VAS of the patient with acute migraine attack,and is an effective treatment of acute migraine attack.2.The plasma CGRP and PKC levels increase during acute migraine attack,and the plasma CGRP and PKC may participate in the pathogenesis of the acute migraine attack.3.Gabapentin can significantly reduce the plasma CGRP and PKC levels during acute migraine attack,which may be the mechanism of gabapentin for treating acute migraine attack. |
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