Objective:To observe any therapeutic effect of repeated high-frequency transcranial magnetic stimulation (rTMS) on patients with medication overuse headache (MOH).Methods:Fifty-seven persons with MOH were divided at random into a control group of 29 cases and an rTMS group of 28 cases. Both groups of patients stopped taking analgesics and were treated with topiramate and trazodone. The rTMS group received an additional 20 minutes of rTMS treatment daily, 5 days a week for 8 consecutive weeks. The control group received sham stimulation. Before and after the treatment, both groups′ headache symptoms, disability, depression, anxiety, cognition and sleep quality were evaluated using a visual analog scale (VAS) for pain, a migraine disability assessment scale (MIDAS), the Montreal cognitive assessment (MoCA), the Hamilton depression scale (HAMD), the Hamilton anxiety scale (HAMA) and the Pittsburgh sleep quality index (PSQI). Auditory event-related potential P300 was also measured for both groups.Results:After the treatment, the average VAS, MIDAS, HAMD, HAMA and PSQI scores of both groups had decreased significantly. The HAMD, HAMA and PSQI average scores of the rTMS group were then significantly better than the control group′s averages. The average MoCA score of the rTMS group had also improved significantly. The average latency of the auditory event-related potential P300 in the rTMS group was then (368.25±9.25)ms and its amplitude was (6.62±1.40)μV, showing significant improvement compared to before the treatment and compared with the control group.Conclusions:On the basis of oral administration of topiramate and trazodone, additional high-frequency rTMS treatment can significantly alleviate anxiety and depression in MOH patients, and improve their sleep quality and the latency and amplitude of event-related potential P300.

Objective:To observe any therapeutic effect of repeated high-frequency transcranial magnetic stimulation (rTMS) on patients with medication overuse headache (MOH).Methods:Fifty-seven persons with MOH were divided at random into a control group of 29 cases and an rTMS group of 28 cases. Both groups of patients stopped taking analgesics and were treated with topiramate and trazodone. The rTMS group received an additional 20 minutes of rTMS treatment daily, 5 days a week for 8 consecutive weeks. The control group received sham stimulation. Before and after the treatment, both groups′ headache symptoms, disability, depression, anxiety, cognition and sleep quality were evaluated using a visual analog scale (VAS) for pain, a migraine disability assessment scale (MIDAS), the Montreal cognitive assessment (MoCA), the Hamilton depression scale (HAMD), the Hamilton anxiety scale (HAMA) and the Pittsburgh sleep quality index (PSQI). Auditory event-related potential P300 was also measured for both groups.Results:After the treatment, the average VAS, MIDAS, HAMD, HAMA and PSQI scores of both groups had decreased significantly. The HAMD, HAMA and PSQI average scores of the rTMS group were then significantly better than the control group′s averages. The average MoCA score of the rTMS group had also improved significantly. The average latency of the auditory event-related potential P300 in the rTMS group was then (368.25±9.25)ms and its amplitude was (6.62±1.40)μV, showing significant improvement compared to before the treatment and compared with the control group.Conclusions:On the basis of oral administration of topiramate and trazodone, additional high-frequency rTMS treatment can significantly alleviate anxiety and depression in MOH patients, and improve their sleep quality and the latency and amplitude of event-related potential P300.

Objective:To investigate the correlation between migraine and overall burden of cerebral small vessel disease (CSVD).Methods:Migraine patients who visited the headache clinic of Jiangyin People's Hospital from January 2021 to October 2021 were selected as the case group, and healthy people who had no previous primary headache of any type and matched age and sex in the same period were selected as the control group. Various CSVD phenotypes, including vasogenic lacuna, white matter hyperintensities (WMHs), cerebral microbleeds (CMBs) and enlarged perivascular space (EPVS) were detected by the multimodal MRI, and the overall burden score of CSVD was calculated. The detection rates of CSVD and its phenotypes and the overall burden of CSVD were compared between the case group and the control group. The subjects with CSVD were divided into mild group, moderate group and severe group according to the overall burden score of CSVD. The independent influencing factors of the overall burden of CSVD were identified by the ordinal multi-classification logistic regression model. Results:A total of 109 migraine patients and 100 healthy controls were enrolled. The detection rate of CSVD (65.13% vs. 46.00%; P=0.005) and the proportion of patients with severe CSVD overall burden (24.77% vs. 10.00%; P=0.005) in the case group were significantly higher than those in the control group. In terms of specific CSVD phenotypes, the detection rates of WMHs (48.62% vs. 33.00%; P=0.022) and CMBs (35.80% vs. 19.00%; P=0.007) in the case group were significantly higher than those in the control group, while there were no significant differences in vasogenic lacuna and moderate to severe EPVS. Univariate analysis showed that the overall burden of CSVD was significantly associated with age, migraine, hypertension, baseline diastolic blood pressure, low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (all P<0.05). Multivariate logistic analysis showed that age (odds ratio [ OR] 3.731, 95% confidence interval [ CI] 1.051-1.217; P=0.001), migraine ( OR 2.812, 95% CI 1.045-5.124; P=0.012), hypertension ( OR 2.112, 95% CI 1.525-4.021; P=0.032), and LDL-C ( OR 2.512, 95% CI 1.541-4.312; P=0.023) were independently associated with the overall burden of CSVD. Conclusions:The detection rate of CSVD in migraine patients is higher than that in the general population, especially WMHs and CMBs. Migraine is independently associated with the overall burden of CSVD.

Objective　To explore the relationship between the total burden of cerebral small vessel disease (CSVD) and the progression of large artery atherosclerosis (LAA) cerebral infarction in acute stage.Methods　One hundred and forty-three patients with acute LAA cerebral infarction were collected.The CSVD total load score (0~4 points) was calculated according to MRI and CSVD total load scale.According to the progress of the disease in the acute phase,the patients were divided into two groups:non progressive cerebral infarction group (NPCI) and progressive cerebral infarction group (PCI).The baseline data,CSVD sub items and total load scores were compared between two groups.Logistic regression analysis was used to analyze the relationship between CSVD total load score and the progression of LAA type cerebral infarction.Results　There was significant difference in CSVD total load score between PCI group and NPCI group (P<0.05).In group PCI,smoking history,diabetes history,baseline diastolic blood pressure,fasting blood glucose,vascular lacuna,moderate and severe WMH,CMBs and CSVD total load score were all higher than those in NPCI group (P<0.05),and LDL-C level was lower than that in NPCI group (P<0.05).Logistic regression analysis showed that fasting blood glucose,moderate and severe WMH and CSVD total load score were independent risk factors for the progression of LAA cerebral infarction in acute stage (P<0.05).Conclusion　The severity of CSVD in patients with LAA type cerebral infarction is closely related to the progress of the disease in acute phase.