Клинико-епидемиологични проучвания на кластърното главоболие
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2016-06-03
Автори
Грозева, Веселина Тихомирова // Grozeva, Veselina Tihomirova
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ЦЕЛ И ЗАДАЧИ НА ПРОУЧВАНЕТО
Целта на настоящия труд е да се установят съвременни епидемиологични данни и клиничната характеристика на кластърното главоболие в България, както и да се представят нови диагностични и терапевтични подходи при заболяването.
За постигане на целта на дисертационния труд бяха поставени следните задачи:
1. Да се изследва годишната заболяемост от КГ в Русенска област (МБАЛ – Русе) за периода 2004 – 2013 год., като се използват критериите на Международното общество по главоболие – Международна класификация на главоболията/ ICHD -III (beta версия) от 2013 г.
2. Да се установи разпределението на болните с КГ по пол и възраст за всяка от годините в периода 2004 – 2013 г. в Русенска област.
3. Да се установи структурата на заболяването по пол, възраст, форма и клинична характеристика на пациентите от Русенска област (активно открити).
4. Да се установят болните с КГ, преминали през специализиран център по главоболие за период от 6 месеца (пасивно открити) и да се изследва структурата на заболяването по пол, възраст, форма и клинична характеристика.
5. Да се анализира клиничната характеристика на заболяването при установените пациенти с КГ по влияние на следните фактори: - възраст, - пол, - форма на заболяването, - фамилна обремененост, - коморбидност, - клинична изява (активно/пасивно открити; мъже/жени; епизодична/хронична форма), - тригерни фактори, - тютюнопушене, - абортивна терапия, - профилактична терапия,- невромодулираща терапия, - закъснение на диагнозата.
6. На база на получените резултати да се анализира диагностиката, подходът, медикаментозното лечение и новите невромодулиращи подходи при пациентите с кластърно главоболие.
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SUMMARY
Introduction: CH is a strictly unilateral primary headache disorder which is characterized by severe or very severe retro-orbital or temporal pain, lasting 15-180 min, accompanied by one of the following ipsilateral symptoms: conjunctival injection, tearing, nasal conjunction or rhinorrhoea, eyelid oedema, forehead or facial sweating, miosis or prosis, a sense of restlessness or agitation. Although, clinical characteristics of cluster headache have been described by many authors, still little is known about this severe condition in our country. Scarce epidemiological data exist and the condition is unrecognized by specialists. There is a huge diagnostic delay and patients are treated improperly. Cluster headache was considered to be a male-only syndrome for many years. Despite the male predominance, nowadays it is known that women also suffer with this severe disorder. Recent results show that cluster headache presents differently in women than men, its clinical forms have a different course thus patients’ response to treatment differs as well. Treatment of cluster headache is always challenging, but new alternative neuromodulatory methods have shown optimistic results and they are now considered to diminish the huge personal and social burden of the disease.
Objective: To study the incidence of cluster headache in one geographic region in Bulgaria, regarding differences in cluster headache demographics, clinical characteristics, triggers, diagnostic delay and treatment response (pharmacological and neuromodulatory).
Background: There aren’t many studies examining epidemiological data and differences in cluster headache presentation worldwide and little is known about epidemiology and clinical characteristics of cluster headache in Bulgaria.
Methods: The study was performed using the documentary method, personal and telephone interview together. We collected the data for 10 year-period from clinical histories of all cluster headache patients admitted to the Neurology ward in the only hospital with CT and MRI in Ruse district. In order to find the incidence of the disease, we hypothesized the referral of all young patients with excruciating head pain for performing an imaging exam (to exclude a vascular incident). Because of the small number of patients found, we added a larger group of cluster headache patients to study the clinical characteristics of the disease and the therapeutic response. We collected prospectively (for 6 months) all cluster headache patients who have had planned follow-up visits in a specialized headache center at Hospital Clinico Universitario, Valencia. We studied the clinical histories and performed a personal interview with all the newly diagnosed cluster headache patients in the clinic. We focused on various issues related to cluster headache including: demographics, clinical characteristics, comorbid conditions, family history, triggers, smoking history, diagnosis delay, treatment response (pharmacological and neuromodulatory), and some specific female gender issues.
Results: We found out 39 patients with cluster headache from Ruse district and we measured the incidence of cluster headache to be between 1to 5 in 100 000 people. We collected data for 158 patients (116 male and 42 female). We divided the whole studied population into retrospectively and prospectively collected patients (39 retro- and 119 prospectively, episodic and chronic form (100 episodic and 58 chronic), male and female patients (116 male and 42 female) and to patients treated only pharmacologically (136 patients) and those treated with neuromodulatory methods as well (22 patients). All the different groups were compared regardless the mentioned above factors. We found some similar features about cluster headache presentation in the different populations, forms and genders already described in the literature, considering the demographic and clinical characteristics (age of onset, form of cluster headache, pain location, trigger factors); attack characteristics (attacks per day); delay for the correct diagnosis; treatment issues; and female specific cluster headache issues. We found some distinct features that haven’t been described before.
Conclusion: Cluster headache is a rare disorder. Overall the studied groups of patients with episodic and chronic form, women and men have similar clinical characteristics but there are also some distinct differences in clinical presentation and therapy response between forms and genders. New treatment alternatives such as some neuromodulatory methods show promising results in patients with chronic drug-resistant cluster headache. Major limitations to the study are the possibility of incomplete data in patient histories and possible misinterpretation of data.
Описание
Дисертационен труд за придобиване на образователна и научна степен "Доктор" /CD/ / Веселина Тихомирова Грозева . - София, 2014 . - 169 с. + Автореферат /CD/; Научен ръководител: чл. кор. ПРОФ. Д-Р ИВАН МИЛАНОВ, дмн; София, 2014. научно жури в състав:
1. чл. кор. Проф. Д-р Иван Миланов, дмн (становище);
2. Доц. Д-р Десислава Богданова, дм (рецензия);
3. Доц. Д-р Иво Райчев, дм (рецензия);
4. Проф. Д-р Стефка Янчева, дмн (становище);
5. Проф. Д-р Захари Захариев, дмн (становище).
Ключови думи
нервна система - болести; съдово главоболие; клъстърно главоболие - епидемиология; клъстърно главоболие; мозъчно-съдови нарушения // , nervous system diseases; vascular headaches; cluster headache; cerebrovascular disorders