| BackgroundThe chronic daily headache(CDH)is a headache headache with a chronic headache occurring more than 3 months per month.The incidence rate of chronic daily headache is about 3.9%.At present,traditional drugs such as sibelium are widely used in the treatment of CDH in China,but the therapeutic effect is not good.Because CDH is often associated with anxiety and depression,the combination of carbaryl and antidepressant drugs such as Deanxit is more and more common.Repetitive transcranial magnetic stimulation(rTMS)is a new non-invasive diagnostic and therapeutic technique.It has been widely used in mental,neurological and rehabilitation fields.It has been reported that rTMS can improve the clinical manifestations of migraine patients,but there is little evidence of rTMS in the treatment of CDH.ObjectiveTo observe the clinical efficacy of traditional medicine sibelium,sibelium and deanxit,as well as sibelium combined with rTMS in the treatment of CDH,and compare the differences of different treatment methods,so as to provide theoretical guidance for the clinical diagnosis and treatment of CDH.Methods111 patients with chronic daily headache admitted to our hospital from August 2017 to August 2018 were selected as the study objects.They were randomly divided into traditional medicine group(41 cases),combined medicine group(37 cases)and medicine combined rTMS group(33 cases).The patients in the traditional medicine group were only treated with sibelium,the patients in the combined medicine group were treated with sibelium and deanxit,the patients in the medicine combined with rTMS group were treated with sibelium combined with high frequency rTMS,The severity and frequency of headache were recorded before treatment,at the end of treatment,1 week,4 weeks and 8 weeks after treatment.The frequency of analgesic use was recorded before treatment,at the end of treatment,4 and 8 weeks after treatment.The degree of anxiety and depression was measured before treatment,at the end of treatment and 8 weeks after treatment.The incidence of adverse reactions during treatment was observed.SPSS 23.0 statistical software was used to analyze the above data,in order to evaluate the effect of different treatment schemes in patients with chronic daily headache.Results1.There was no significant difference in headache frequency among the three groups before treatment(P=0.537).There was no significant difference in VAS score at each time point in the traditional medicine group(P>0.05),but the VAS score in the combined drug group and combined rTMS group decreased after treatment.At the end of treatment,the VAS score of the combined drug group decreased significantly compared with other groups,and returned to the baseline level at 4 weeks.There was significant difference in VAS score between different treatment groups(F=120.329,P<0.001),and there was significant difference between different treatment time(F=32.117,P<0.001).There was interaction between time and treatment group(F=27.334,P<0.001).The VAS scores at the end of combined drug treatment(F=32.530,P<0.001)and 1 week after treatment(F=30.112,P<0.001)were significantly lower than those before treatment.The VAS score of rTMS group decreased continuously at the end of treatment(F=20.579,P<0.001),1 week(F=23.758,P<0.001),4 weeks(F=31.367,P<0.001)and 8 weeks(F=27.352,P<0.001)in rTMS group,which were statistically significant compared with those before treatment.At the end of treatment and 1 week after treatment,VAS scores of combined drug group(F=35.073,P<0.05;F=29.314,P<0.05)and rTMS group(F=25.032,P<0.05;F=29.503,P<0.05)were lower than those of traditional medicine group(f=52.350,P<0.001)and combined drug group(F=41.521,P<0.05)at the end of treatment and 1 week after treatment.2.There was no significant difference in VAS scores among the three groups before treatment(P=0.537).There was no significant difference in VAS score at each time point in the traditional medicine group(P>0.05),but the VAS score in the combined drug group and combined rTMS group decreased after treatment.At the end of treatment,the VAS score of the combined drug group decreased significantly compared with other groups,and returned to the baseline level at 4 weeks.There was significant difference in VAS score between different treatment groups(F=120.329,P<0.001),and there was significant difference between different treatment time(F=32.117,P<0.001).There was interaction between time and treatment group(F=27.334,P<0.001).The VAS scores at the end of combined drug treatment(F=32.530,P<0.001)and 1 week after treatment(F=30.112,P<0.001)were significantly lower than those before treatment.The VAS score of rTMS group decreased continuously at the end of treatment(F=20.579,P<0.001),1 week(F=23.758,P<0.001),4 weeks(F=31.367,P<0.001)and 8 weeks(F=27.352,P<0.001)in rTMS group,which were statistically significant compared with those before treatment.At the end of treatment and 1 week after treatment,VAS scores of combined drug group(F=35.073,P<0.05;F=29.314,P<0.05)and rTMS group(F=25.032,P<0.05;F=29.503,P<0.05)were lower than those of traditional medicine group(f=52.350,P<0.001)and combined drug group(F=41.521,P<0.05)at the end of treatment and 1 week after treatment.3.There were significant differences in the use of analgesic drugs in different treatment groups(F=28.098,P<0.001),and there were significant differences in the use of analgesic drugs in different treatment time(F=16.996,P<0.001).There was interaction between time and treatment group,and the difference was statistically significant(F=18.387,P<0.001).There was no significant difference in the use of analgesic drugs at each time point in the traditional medicine group(F=0.176,P>0.05);the frequency of analgesic drugs decreased most significantly in the combined drug group at the end of treatment(F=35.178,P<0.001),and there was no significant difference at 4 weeks and 8 weeks(P>0.05);after treatment(F=475.327,P<0.001)and follow-up for 4 weeks(F=25.618,P<0.001)and 8 weeks(F=23.089,P<0.05)in the combined drug group 001)were lower than before treatment.At the end of treatment,compared with the traditional medicine group,the frequency of analgesic drug use in the combined drug group decreased most significantly(F=48.370,P<0.001);at 4 weeks(F=23.883,P<0.001)and 8 weeks(F=38.392,P<0.001),the frequency of analgesic drugs in the combined rTMS group decreased significantly compared with the traditional medicine group,and the difference was statistically significant.4.The HAMA scores were analyzed before treatment,at the end of treatment and at 8 weeks follow-up.There was no significant difference in HAMA score between the two groups(P>0.05);the HAMA scores of the combined medication group decreased significantly at the end of the treatment(F=30.523,P<0.05);the HAMA scores of the patients in the combined rTMS group at the end of the treatment and 8-week follow-up were significantly lower than those before treatment(F=43.516,P<0.05).At the end of the treatment,there was no significant difference between the combined drug group and the combined rTMS group(F=31.330,P>0.05);at the 8-week follow-up,the combined rTMS group was significantly different from the combined drug group and the traditional medicine group(F=40.176,P<0.05).5.The HAMD scores were analyzed before treatment,at the end of treatment and at 8 weeks follow-up.There was no significant difference in HAMD score between the two groups(P>0.05);the HAMD scores in the combination group decreased significantly after treatment(F=41.734,P<0.05);the HAMD scores in the combined rTMS group at the end of treatment(F=38.147,P<0.05)and 8-week follow-up were significantly lower than those before treatment(F=42.651,P<0.05).At the end of treatment,there was no significant difference in HAMD score between the combined drug group and the combined rTMS group(P>0.05);at the 8-week follow-up,there was a significant difference between the combined rTMS group and the combined drug group and the traditional medicine group(F=45.123,P<0.05).6.The dry mouth,constipation,sleep disorders and fatigue were the most common adverse events in this study,which were mild to moderate.There was no significant difference in the total incidence of adverse reactions among the three groups(P=0.249).Conclusion:The effect of traditional medicine sibelium in the treatment of CDH is not good.The combination of sibelium and deanxit and high frequency rTMS can treat and prevent the attack of CDH,and each has its own advantages.The effect of sibelium combined with Deanxit is rapid,but the curative effect disappears in a short time after stopping the drug,which is easy to cause repeated symptoms;the curative effect of sibelium combined with rTMS is longer,but the onset of effect is slower than that of combined Deanxit,which suggests that the combination of sibelium and deanxit and rTMS may be the best strategy for CDH treatment. |
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