Clinical Case Series

Back Clinical Case Series. A Clinical case series Ndiyo inonyanya kukosha yemhando yekudzidza, umo vatsvakurudzi vanotsanangura ruzivo rweboka revanhu. Nyaya dzakatevedzana dzinotsanangura vanhu vanogadzira chimwe chirwere chitsva kana mamiriro. Rudzi urwu rwekudzidza runogona kupa kuverenga kunomanikidza nekuti vanopa nhoroondo yakadzama yeruzivo rwekiriniki rwezvidzidzo zvega zvega. Dr. Alex Jimenez anoita nyaya yake yezvidzidzo zvidzidzo.

Chidzidzo chenyaya inzira yekutsvagisa inowanzoshandiswa musainzi yemagariro. Iri izano rekutsvaga rinoongorora chiitiko mukati memamiriro chaiwo. Dzinobva pakuferefeta kwakadzama kwemunhu mumwechete, boka, kana chiitiko chekuongorora kuti sei matambudziko/zvikonzero. Inosanganisira humbowo hwehuwandu uye inotsamira pane akawanda masosi ehumbowo.

Zvidzidzo zvenyaya irekodhi yakakosha yemakiriniki maitiro ebasa. Havapi hutungamiriri hwehutungamiri hwevarwere vanotevedzana asi irekodhi yekudyidzana kwekiriniki iyo inobatsira kugadzira mibvunzo yezvidzidzo zvekiriniki zvakagadziridzwa. Vanopa zvinhu zvakakosha zvekudzidzisa, izvo zvinoratidza zvese zvechinyakare uye zvisina kujairika ruzivo runogona kutarisana nemudzidzi. Nekudaro, kuwanda kwekudyidzana kwekiriniki kunoitika mumunda uye saka zviri kumurapi kunyora uye kupfuudza ruzivo. Nhungamiro dzakagadzirirwa kubatsira hama yemunyori, nyanzvi, kana mudzidzi kuti afambise chidzidzo ichi kusvika pakuburitswa.

A Case series idhizaini yekudzidza inotsanangura uye ingori nhevedzano yezviitiko zvechero chirwere kana kusawirirana kwechirwere izvo munhu angango cherechedza mukuita kwekiriniki. Mhosva idzi dzinotsanangurwa kuti dzinokurudzira zvakanyanya hypothesis. Zvisinei, hapana boka rekuenzanisa saka hapagoni kuva nemhedziso dzakawanda pamusoro pechirwere kana chirwere chechirwere. Naizvozvo, maererano nekugadzira humbowo hunoenderana neakasiyana maitiro echirwere, ichi chinenge chiri chekutanga. Kuti uwane mhinduro kumibvunzo ipi yaungave unayo ndapota fonera Dr. Jimenez pa915-850-0900

Migraine Headache Mushonga: Atlas Vertebrae Realignment

by Dr Alex Jimenez | Chiropractic, Chiropractic Examination, Clinical Case Reports, Clinical Case Series, Functional Medicine, Kutemwa nemusoro nekurapwa, Migraine

Mhando dzinoverengeka dzemusoro dzinogona kukanganisa wepakati munhu uye imwe neimwe inogona kukonzeresa nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro, zvisinei, migraine misoro inogona kazhinji kuve nechikonzero chakaomarara kumashure kwavo. Vazhinji vezvehutano vezvehutano uye hwakawanda humbowo-hwakavakirwa pakutsvagurudza zvidzidzo vakagumisa kuti kugunun'una mumutsipa, kana kusarongeka kweiyo vertebrae mumuromo wechibereko, ndicho chikonzero chakajairika chemigraine kutemwa nemusoro. Migraine inoratidzirwa nekurwadziwa kwakanyanya kwemusoro kazhinji kunokanganisa rumwe rutivi rwemusoro, kuchiperekedzwa nekusvotwa uye kutadza kuona. Migraine misoro inogona kukanganisa. Mashoko aya ari pasi apa anotsanangura nyaya yekuongorora maererano nemigumisiro yeatlas vertebrae kugadzirisa kune varwere vane migraine.

Migumisiro yeAtlas Vertebrae Kutsigirwa mune Zvidzidzo zveMigraine: An Observational Pilot Study

Name: El Paso Back Clinic | Spine Specialists - El Paso, TX
Price range: $$

ngovepo

Introduction. Mune migraine case study, zviratidzo zvepfungwa zvakaderera zvikuru pamwe nekuwedzera kwekushanda kwekuteerera kwekutsvaga index rinotevera atlas vertebrae rekugadzirisa. Ichi chiitiko chekuongorora chiitiko chekuongorora chiitiko chakatevera chirevo chegumi neurologist chakaongororwa chinonzi migraine zvidzidzo kuti chione kana nyaya dzawanikwa dzichidzokororwa pamusana pekutanga, vhiki ina, uye vhiki yechisere, zvichichitevera National Upper Cervical Chiropractic Association inopindira. Zvidzidzo zvechipiri zvinosanganisira migraine-specific quality yehupenyu zviyero. Nzira. Mushure mokunge vaongororwa neurologist, vazvipiri vakasaina mafomu ekubvumirana uye vakapedza zvinyorwa zvitsva-migraine-zvakabuda. Kuvapo kweatlas kusaruramisa kwakabvumira kudzidza kuiswa, kubvumira kushandiswa kwekutanga kweMRI data. Chiropractic yakaramba ichienderera kwevhiki masere. Postintervention reimaging yakaitika pavhiki yechina nevhiki vhiki gumi nemasere pamwe nemigraine-zvakabuda mamiriro ekuyera. Mhinduro. Zvikamu zvishanu zvegumi nechimwe zvakaratidzwa kuwedzera mumugumisiro wekutanga, kusateerera kwekutenda; zvisinei, zvinoreva kushanduka kwehuwandu kwakaratidzwa pasina nhamba inokosha. Kuguma kwekudzidza kunoreva kushanduka kwemigraine-yakagadziriswa yemigumisiro yekuongorora, yechikamu chechipiri, yakaratidza kliniki zvakakosha kuwedzerwa kwezviratidzo pamwe nekuderera kwemazuva ekuchema. Kukurukurirana. Kushaikwa kwekuwedzera kwakasimba mukuteerera kunogona kunzwisiswa ne logarithmic uye simba rekushanda kwehemodynamic uye hydrodynamic, zvichibvumira chimwe chikamu chinosanganisira kutevedza kwekuchinja asi zvachose chakanga chisina. Zvidzidzo zvidzidzo zvinoratidza kuti maatlas ekugadzirisa kupindira kunogona kuwirirana nekuderedza kuwandisa kwemigraine uye kujekeswa kwekuvandudzwa kwehutano hwehupenyu huri kubvisa kuderedza kuderedza mukuremara kwakabatana nemusoro sezvinowanikwa muboka iri. Kudzidza mune ramangwana nekutonga kunokosha, zvisinei, kusimbisa izvi zvakawanikwa. Clinicaltrials.gov nhamba yekunyora ndeyoNCT01980927.

ziviso

Izvo zvave zvichiratidzwa kuti atlas yakashata atlas vertebra inogadzira musana tambo kukanganisa kunokanganisa neural traffic yeuropi stem nuclei mu medulla oblongata inokomberedza yakajairwa physiology [1 4].

Chinangwa cheNational Upper Cervical Chiropractic Association (NUCCA) yakagadziridza maatlas ekugadzirisa maitiro ndiko kudzoreredza kwakasarudzika musana masisitimu kune iyo yakamira axis kana giravhiti mutsara. Inotsanangurwa seye restoration musimboti, kugadziriswazve kunovavarira kumutsidzira hukama hwese hwevarwere hwebiomechanical hweiyo yepamusoro yekervical spine kune iyo yakatwasuka axis (giravhiti mutsara). Kudzoreredza kunoonekwa sekuumbwa kwakaringana, kuve unokwanisa kusadzorwa kufamba, uye uchibvumira kuderera kukuru kwekushushikana kwesimba [3]. Iko kururamisa zvinodzora kubvisa tambo kusarurama, kwakagadzirwa neatlas kusarongeka kana atlas subluxation tata (ASC), sekunyatsotsanangurwa neNUCCA. Basa reNeurologic rakadzoreredzwa, rakanyatsofungidzirwa kuve muhuropi hunodzora autonomic nuclei, iyo inokanganisa iyo cranial vascular system iyo inosanganisira Cerebrospinal Fluid (CSF) [3, 4].

Izvo zvinoshandiswa pakuteerera zvinongororwa (ICCI) zvinoratidzika kuva kuongororwa kwakajeka kwekuchinja kwakaitwa mu craniospinal biomechanical muvarwere vane zvirwere kupfuura nzvimbo ye hydrodynamic yemiganhu yeCSF inoyerera mafambiro uye tambo kushandiswa kwezviyero [5]. Kubva pane ruzivo irworwo, rwakambocherechedza hukama hwekuwedzera kwekuteerera kusinganzwisisiki kuderedza kuderedza muzviratidzo zvemigraine mushure mekutaura kwemaatlas kwakagadziriswa kushandisa ICCI sechinangwa chekudzidza chinangwa chikuru.

ICCI inokanganisa kukwanisa kweCentral Nervous System (CNS) kuti iwane mafungiro ehupenyu hwehutachiona hunoitika, nokudaro kudzivisa ischemia yezvivako zvehutachiona hwemuviri [5, 6]. Mamiriro ekusimudzirwa kwepamusoro ekubvumira anoita kuti kuwedzera kwekuwedzera kuve kuitika munharaunda yeCNS isina kubvumira pasina kukonzera kusagadzikana kwezvinokonzera kuwedzera kunowanzoitika zvikuru nekugadziriswa kwemazuva panguva ye [system] [5, 6]. Kubuda kunowanikwa munzvimbo yeupine kuburikidza nemukati mutsva mumakumbo kana kana yakarurama, kuburikidza nemvura yakasviba kana yechipiri ine mvura yakasviba. Iyi yakazara pineus eplexus inosvibisa uye masimba, zvichiita kuti ropa riyerere mumatendero ekudzoka, kupinda muCSS kuburikidza nekuchinja kwemashure [7, 8]. Inzvimbo inoshandiswa mvura inoita basa rinokosha pakuronga kushandiswa kwemhepo inonzi fluid system [9]. Kuteerera kunoratidzika kuva kushanda uye kunobva kune rusununguko rwemagazi nenzira idzi dzinowedzera zvinokonzera mhepo inokonzera mvura [10].

Kukuvadzwa kwemusoro uye wemutsipa kunogona kusimbisa kusagadzikana kwebasa repinalusous plexus iyo inogona kukanganisa mvura yepinini inopisa mvura, zvichida nekuda kwekudzivirira kwechiremera kune imwe musana wechipinha ischemia [11]. Izvi zvinoderedza kugadziriswa kwehuwandu hwekuchinja kwehuwandu mukati mekrani yakagadzira nyika yekuderera kwekutenderera kusingabvumirwi.

Damadian naChu vanotsanangura kudzoka kwechirongwa cheScF outflow chichienzaniswa pakati peC-2, vachiratidza kugoverwa kwe28.6% kwechiyero cheScF chemafuro mumurwere apo maatlas akanga agadzirwa zvakanaka [12]. Murwere anorondedzera rusununguko kubva kune zviratidzo (vertigo uye kurutsa apo recumbent) yakaenderana neatlasi inosara mukugadzirisa.

Ongororo yehypertension uchishandisa iyo NUCCA kupindira inoratidza kuti inogona kuita nzira iri pasi pekumanikidza kweropa kunogona kukonzerwa neshanduko mukutenderera kwehuropi maererano neatlas vertebrae chinzvimbo [13]. Kumada et al. akaongorora hutatu-vascular mashandiro muhuropi anodzora BP kumanikidza [14, 15]. Goadsby et al. vakapa humbowo hunogombedzera hwekuti migraine inotangira kuburikidza netrigeminal-vascular system inopindirana kuburikidza neiyo tsinga yehuropi uye yepamusoro yekervical spine [16-19]. Empirical kucherechedza kunoratidza kuderedzwa kwakanyanya kwemigraine varwere 'musoro wekuremara mushure mekushandisa kweatlas kururamisa. Kushandisa migraine-inoratidzwa nyaya yaitaridzika senge yakakosha kuongorora hutachiona hwehutachiona hwakachinjika zvichitevera atlas realignment seyakatanga kudzidziswa mune yehypertension yekudzidza mhedzisiro uye inoita kunge inotsigirwa neinogona kuita huropi hunodzika hutatu-hwevascular kubatana. Izvi zvaizoenderera mberi nekuvandudza kunoshanda pathophysiologic hypothesis yeatlas kusarongeka.

Migumisiro kubva pachikwata chekutanga chekuongorora yakaratidza kuwedzera kwekuwedzera kwe ICCI nekuderera kwechirwere chemukati chemigraine chichitevera NUCCA atlas correction. A 62 ane makore ane makore ane chirwere chinonzi neurologist chinonzi chisingagumi migraine chakazvipira kune imwe nguva-mushure mokunge apedza nyaya yekupindira. Kushandisa Phase Contrast-MRI (PC-MRI), kuchinja mu cerebral hemodynamic uye hydrodynamic kuyerera kwemiganhu kwakayerwa pamusana pekutanga, maawa 72, uyezve masvondo mana mushure mekutaura kweatlas. Iyo imwe nzira yekurovedzwa kweatlas inoshandiswa mukutsvaga kwehutachiona yakateverwa [13]. Maawa 72 mushure mekudzidza akajekesa shanduko inoshamisa mukushanda kwekuteerera kwekambani (ICCI), kubva ku9.4 kusvika ku11.5, kusvika ku17.5 nevhiki yechina, mushure mokunge vapindira. Tichicherechedza kuchinja kwekubuda kwemafuro emvura uye nzvimbo yepamusoro yemvura inowanikwa munzvimbo yeupine yakarongerwa kupfuudzwa kwakawedzerwa kunowedzera kukurudzira kuongorora migraine nyaya munyaya ino nyaya.

Izvo zvinogona kuitika zveatlas kusarudzwa kana ASC pamvura yakasviba hazvizivikanwi. Kucherechedza kuongorora kusagadziriswa kwekugadziriswa kwehutano maererano nemigumisiro yeatrasi kusagadziriswa kupindira kunogona kupa ruzivo rwekuti kururamisa kunogona kuchinja sei migraine musoro.

Kushandisa PC-MRI, chinangwa ichi chezvino chekudzidza, uye chigumisiro chekutanga, chakaenzaniswa ICCI chinoshanduka kubva pakutanga kusvika kwevhiki nere masere mushure meNUCCA kupindira mune rimwe boka rezveuropistori rakasarudza migraine zvidzidzo. Sezvakaratidzwa munyaya yekuongorora, iyo pfungwa inofunga kuti imwe nyaya yeCICC yaizowedzera kuchitevera NUCCA kupinda mukati nekuderera kwakafanana kwezviratidzo zvemigraine. Kana iripo, chero ipi zvayo yakacherechedza kuchinja mumhepo inotyisa uye nzira yekuyerera inofanira kunyorwa kuti iwedzere kufanana. Kuchengetedza migraine zviratidzo zvinopindura, zviitiko zvechipiri zvaisanganisira zvirwere zvinorondedzerwa zvirwere kuti uone kuchinja chero kupi zvako kunoenderana nehutano hunoenderana nehupenyu hwehupenyu (HRQoL), inoshandiswa zvakafanana mukutsvakurudza migraine. Mukati yese yekudzidza, nyaya dzakachengetedza misoro yepamusoro yakaratidza kuderera (kana kuwedzera) muhuwandu hwemazuva emusoro, simba, nemishonga inoshandiswa.

Kufambisa iyi nyaya yekucherechedza, nyaya yekuongorora, yakabvumirwa kuongororwazve kune izvo zvataurwa pamusoro pechiprologic zvinowedzera mukuwedzerwa mberi kwekushanda hypothesis mune pathophysiology yeatlas misalignment. Dhiyabhorosi inotarisirwa kuongororwa kwezvinyorwa zvakakosha panyaya yekuenzanisa masikirwo uye kugadzirisa matanho emitemo ichapa ruzivo rwakakosha rwekuvandudza purogiramu yakanatswa yekuita mapofu, nzvimbo inodzorwa migraine yekuedza achishandisa chirongwa cheNUCCA kururamiswa.

nzira

Uku kutsvagurudza kwakachengeta kutevedzera Helsinki Chiziviso chekutsvaga pamusoro pevanhu zvidzidzo. Yunivhesiti yeCalgary neAlberta Health Services Conjoint Health Research Ethics Board yakabvumidza iyo protocol yekudzidza uye yenyaya fomu yemvumo yekuziva, Ethics ID: E-24116. ClinicalTrials.gov yakapa iyo nhamba NCT01980927 mushure mekunyorwa kwechidzidzo ichi (clinicaltrials.gov/ct2/show/NCT01980927).

Kudzidzira nyaya uye kuongorora kwakaitika paCalgary Headache Assessment uye Purogiramu Yechipatara (CHAMP), nyanzvi-inyanzvi inyanzvi yekuendesa kuchipatara (ona Mufananidzo 1, Table Table 1). CHAMP inotarisa varwere vasingagadziri kudivi yemapromacotherapy uye kurapwa kwemigraine misoro iyo isisati inopa migraine chiratidzo chekuzorodza. Vanachiremba vezvemhuri nevana vekutanga vakataura zvidzidzo zvekudzidza kuCAMP vachigadzira zvigadzirwa zvisingakoshi.

Mufananidzo 1 Kugadziriswa Kwekudzidziswa uye Chidzidzo Chekudzidza

Mufananidzo 1: Nhepfenyuro yehutano uye kudzidza kubuda (n = 11). GSA: Gravity Stress Analyzer. HIT-6: Musoro weChete Impact Test-6. HRQoL: Utano Hwakaenderana Nehupenyu Hweupenyu. MIDAS: Migraine Disability Assessment Scale. MSQL: Migraine-Specific Quality of Life Measure. NUCCA: National High Cervical Chiropractic Association. PC-MRI: Phase Kusiyana Magnetic Resonance Imaging. VAS: Kuona Analog Scale.

Tetera 1 Musoro Wokuiswa Kuiswa uye Kuregererwa Kwekuda

Tafura 1: Chinyorwa chekupinza / chekuregedza maitiro. Zvingangodaro zvidzidzo, na ve kune yepamusoro kervical chiropractic kuchengetedza, yakaratidza pakati pegumi nemakumi maviri nematanhatu emusoro mazuva pamwedzi unozvitaurira wega pamwedzi mina yapfuura. Zvinodikanwa zvaive nemazuva masere ekurwadziwa nemusoro pamwedzi, uko kusimba kwaisvika kanokwana kana, pazero kusvika pagumi Visual Analog Scale (VAS) pain scale.

Kudzidza kuiswa kunoda vanozvipira, pakati pemakore e21 nemakore 65, iyo inogutsa yakatarwa nzira yekuongororwa yemusoro wemusoro. Nyanzvi yezveuropi ine makumi emakumi emakore emigraine ruzivo akaongorora vanyoreri vachishandisa iyo International Classification ye Headache Dambudziko (ICHD-2) yekudzidza kubatanidzwa [20]. Zvingangoitika zvidzidzo, na ve kune yepamusoro kervical chiropractic kuchengetedza, inofanirwa kunge yakaratidza kuburikidza neako-wega-chirevo pakati pegumi nemakumi maviri nematanhatu emusoro mazuva pamwedzi pamwedzi mina yapfuura. Anenge mazuva masere emusoro pamwedzi aifanira kusvika pakukwirisa kanosvika mana pa zero kusvika gumi VAS pain scale, kunze kwekunge wabatwa zvinobudirira nemushonga wakanangana nemagraine. Angangoita mana akapatsanurwa musoro episodes pamwedzi wakaparadzaniswa neinenge maawa makumi maviri nemasere ekurwadziwa-pasina nguva yaidiwa.

Chinokosha musoro kana mutsipa unotambudza unoitika mukati memakore rimwe chete kusati kwadzidzira kusina kubhabhatidzwa. Zvimwe zvirongwa zvekuregererwa zvaisanganisira kushandiswa kwemishonga yakawandisa, nhoroondo ye claustrophobia, yemwoyo kana chirwere chinonzi cerebrovascular, kana chero chero chirwere cheCSS kunze kwemigraine. Tafura 1 inotsanangura zvinokwana zvizere uye zvinoregererwa zvinotorwa. Kushandisa nhengo yebazi ine nyanzvi yekuongorora nyanzvi kuti iongorore zvidzidzo zvingave zvichienderana neICHD-2 uye inotungamirirwa nemitemo yekuisa / kusagadzikana, kuregedzerwa kwezvidzidzo nemamwe magwaro emusoro wepamusoro semisimba inoshandiswa uye mishonga yepamusoro inoputika musoro musoro inowedzera mikana yekubudirira subject recruitment.

Vaya vanosangana nemitemo yekutanga vakasaina chibvumirano chakanaka uye vakagumisa musimboti wekutanga Migraine Disability Assessment Scale (MIDAS). Ma MIDAS anoda mavhiki gumi nemaviri kuti aratidzire kuchinja kwekukosha kwekuchinja [21]. Izvi zvakabvumira nguva yakakwana kudarika kuti ione chero shanduko inogona kuchinja. Pamusoro pezuva rinotevera re28, vakanyora vakanyora tsamba yepamusoro yepamusoro vachipa ruzivo rwekutanga apo vachisimbisa huwandu hwemazuva emusoro uye simba rakadikanwa rekuiswa. Pashure pemavhiki mana, chinyorwa chekuongorora chikonzero chekuongorora chibvumirano chakabvumirwa kushandiswa kwezvakasara zvinotangira HRQoL zviyero:

Migraine-Specific Quality of Life Measure (MSQL) [22],
Musoro weChitact Test-6 (HIT-6) [23],
Nyaya yemazuva ano kuongororwa kwenyika yose kurwadziwa kwepfungwa (VAS).

Kuendeswa kune mushandi weNUCCA, kuti aone kuvepo kwemaatlas kusarongeka, kwakasimbiswa kudiwa kwekupindira kupedzisa chidzidzo chekubatanidzwa? Kubviswa. Kusavapo kwemaatlas zvisarudziro zvinongedzo zvakasarudzika vavhoterwa. Mushure mekuronga kumisikidzwa kweNUCCA kupindira nekutarisira, vadzidzi vanokwanisa vakawana yekutanga PC-MRI matanho. Mufananidzo 1 unopfupisa mamiriro echidzidzo mune zvese zvidzidzo.

Iyo yekutanga NUCCA kupindira yaida katatu akateedzana kushanya: (1) Zuva rekutanga, atlas kusarongeka kwekutarisa, pamberi-kururamisa radiographs; (2) Zuva rechipiri, NUCCA kururamisa pamwe mushure-kururamisa kuongororwa pamwe nema radiographs; uye (3) Zuva rechitatu, mushure mekugadzirisa zvekare. Kuchengeta kwekutevera kwakaitika vhiki nevhiki kwevhiki ina, uyezve kwega kwega mavhiki maviri kune yakasara nguva yekudzidza. Pakushanya kwega kwega kweNUCCA, zvidzidzo zvakapedza ongororo yazvino yekurwadziwa nemusoro (ndapota pima marwadzo ekurwadziwa nemusoro paavhareji pasvondo rapfuura) uchishandisa mupendero wakanangana nepenzura uchimaka 100 mm mm (VAS). Vhiki rimwe mushure mekutanga kupindira, zvidzidzo zvakapedza Possible Reaction to Care remibvunzo. Kuongorora uku kwakapfuura kwakashandiswa pakubudirira kuongorora zviitiko zvakashata zvine chekuita nemhando dzakasiyana dzepamusoro dzekervical correction maitirwo [24].

Phiki yechina, data yePC-MRI yakawanikwa uye zvidzidzo zvakagadzirirwa MSQL uye HIT-6. Kuguma kwokudzidza PC-MRI data yakaunganidzwa pavhiki masere yakateverwa neveurologist exit interview. Pano, zvidzidzo zvakapedzisira kugadziriswa MSQOL, HIT-6, MIDAS, uye VAS migumisiro uye mazita ekunyora maziso akaunganidzwa.

Panguva yevhiki-8 yeurologist inoshanyira, nyaya mbiri dzinofarira dzakapiwa nguva yakareba yekutevera mukana wenguva yakazara yevhiki dze24. Izvi zvaisanganisira kuwedzera kweNUCCA kuongorora zvakare pamwedzi kwemavhiki e16 mushure mekupedzwa kwekutanga kwekudzidza kwevhiki ye8. Chinangwa chekutevera uku kwaiva kubatsira kuziva kana kupfurikidza musoro kwepamusoro kwakaramba kuchienderera mberi pakuchengetedzwa kwemaatlansi paunenge uchicherechedza chero nguva yemazuva ekupedzisira yeNUCCA kutarisira ICCI. Vateereri vanoda kutora chikamu vakasainira chipiri chibvumirano chavo chechikamu chekudzidza nekuenderera mberi kwegore negore NUCCA kutarisira. Pakupera kwemavhiki e24 kubva pakatanga kupindira kweatlas, yechina yeP-MRI imaging study yakaitika. Pahurukuro yevanonzi neurologist exit, vekupedzisira MSQOL, HIT-6, MIDAS, uye VAS migumisiro uye mazita ekunyora maziso akaunganidzwa.

Maitiro akafanana eNUCCA seakambotaurwa akateedzerwa achishandisa yakasimbiswa protocol uye zviyero zvekuchengetedzwa zvakagadzirwa kuburikidza neNUCCA Certification yekuongorora uye atlas kugadzirisazve kana kururamisa kweASC (ona Mifananidzo? Mifananidzo22 5) [2, 13, 25]. Kuongorora kweASC kunosanganisira kuongorora kweanoshanda makumbo-kureba kusaenzana neiyo Supine Leg Tarisa (SLC) uye kuongororwa kweiyo postural symmetry uchishandisa iyo Gravity Stress Analyzer (Upper Cervical Store, Inc., 1641 17 Avenue, Campbell River, BC, Canada V9W 4L5 ) (ona zvimiro? zvimiro22 uye 3 (a) 3 (c)) [26-28]. Kana SLC uye kusaenzana kwemashure zvichionekwa, matatu-maonero radiographic bvunzo inoratidzirwa kuona iyo multidimensional kutarisisa uye degree re craniocervical kusarongeka [29, 30]. Yakanyatso kuongorora radiographic inopa ruzivo rwekuona chidzidzo chakatarwa, chakanakisa atlas yekugadzirisa zano. Chiremba anowana maatomic mabhukumaki kubva kumatatu-ekuona akateedzana, kuyera akaumbwa uye anoshanda angles akatsauka kubva kumisangano yakagadzika orthogonal. Chiyero chekusarongeka uye kutendiswa kwemaatlasi zvinobva zvaziviswa mumatatu (ona Mifananidzo 4 (a) -4 (c)) [2, 29, 30]. Radiographic michina kuenderana, kudzikiswa kwecolimator port saizi, yakakwira-inomhanya firimu-screen musanganiswa, mafirita akasarudzika, grids akasarudzika, uye lead lead kudzivirira kudzikisira maratidziro emwaranzi. Zvekudzidza izvi, avhareji yakazara yakayerwa Kupinda Ganda Rinojekesa kune zvidzidzo kubva pamberi-mushure mekugadzirisa radiographic dzakateedzana yaive 352 millirads (3.52 millisieverts).

Mufananidzo 2 Supine Leg Kuongorora Kuongorora Test SLC

Mufananidzo 2: Supine Gumbo Tarisa Kuongorora Bvunzo (SLC). Kucherekedzwa kweinooneka kapfupi gumbo inoratidza inogona kuitika maatlas kusagadzikana. Izvi zvinoonekwa kunyange.

Mufananidzo 3 Gemikari Stress Analyzer GSA

Mufananidzo 3: Gravity Stress Analyzer (GSA). (a) Chigadzirwa chinogadzira postural asymmetry sechimwe chinongedzo chemaatlas kusarudzwa. Zviwanikwa zvakanaka muSLC neGSA zvinoratidza chidimbu cheNUCCA nhepfenyuro dzemahara. (b) Mumiririri akaenzana asina postural asymmetry. (c) Vashandi venguva dzinoshandiswa kupima mapapiro asymmetry.

Mufananidzo 4: NUCCA radiograph series. Aya mafirimu anoshandiswa kuongorora atlas kusarudzwa uye nekugadzira chirongwa chekururamisa. Mushure mekugadziriswa radiographs kana postfilms vanovimbisa kuti kururamiswa kwakanakisisa kwave kwakagadzirirwa nyaya iyi.

Mufananidzo 5: Kugadzira NUCCA kururamisa. Mutungamiri weNUCCA anopa tanceku kugadzira kuchinja. Muviri wemuongorori nemaoko akafananidza kuendesa kucheneswa kweatambi pamwe chete nepamusoro pesimba rekushandisa kushandisa ruzivo rwakawanikwa kubva kuma radiographs.

Iko NUCCA kupindira kunosanganisira kugadziriswa kwebhuku rehuwandu hwehutachiona hunoshandiswa mumarongero eatomical pakati pehenya, atlas vertebra, uye mhondi yemukomana. Kushandisa biomechanical mazano anobva pane lever system, chiremba anovandudza urongwa hwakakodzera

subject positioning,
practitioner stance,
simbisa vector kururamisa maatlas kusarudzwa.

Zvidzidzo zvakagadzirirwa patafura yechipfuva nechepamusoro-soro yakashongedzerwa uchishandisa mastoid support system. Kushandiswa kwegadziriro yakagadzirirwa yakasarudzwa vector yekururamisa kunonongedza dhehenya kune atlas uye mutsipa kusvika kumatanho ekutenderera kana kuti pakati pekumhanya kwemhepo. Aya maitiro ekugadzirisa anotungamirirwa mukudzika, kutungamirirwa, velocity, uye amplitude, kubudisa kukwana kwakarurama uye kwakakwana kweA ASC.

Uchishandisa pisiform bone reruoko rwekubatana, mushandi weNUCCA anosangana neatlas transverse maitiro. Rumwe ruoko rwakatenderedza ruoko rwekubatana ruoko, kudzora vector uku uchichengetedza kudzika kwesimba rinogadzirwa mukushandisa kwe triceps pull maitiro (ona Mufananidzo 5) [3]. Nokunzwisisa musana biomechanics, muviri wechiremba nemaoko zvakabatana kuti kuburitsa maatlasi kururamisa padhuze neakanakisa vector vector. Simba rinodzorwa, risingavimbike rinoshandiswa munzira yakatemerwa yekudzora. Iyo yakanangana munzira yayo uye nekudzika kuti igadzirise kudzikiswa kweASC kusimbisa kusagadziriswa mune anoshanda masimba emutsipa mhasuru mukupindura shanduko yebiomechanical. Izvo zvinonzwisiswa kuti kuderedzwa kwakaringana kwekusarongeka kunosimudzira kwenguva refu kugadziriswa uye kugadzikana kwekuenderana kwemuzongoza.

Kutevera nguva pfupi yekuzorora, nzira yekutevera-kuongorora, yakafanana neyokutanga kuongorora, inoitwa. A postcorrection radiograph yokuongorora inoshandisa maonero maviri kuti ave nechokwadi chekudzoka kwemusoro uye chiberekero chepervical mumuviri wakaenzana. Vanodzidza vanodzidziswa munzira dzekuchengetedza kururamisa kwavo, nokudaro kudzivirira imwe kusaruramisa.

Kutevedzana kweNUCCA kushanyira kwaive nemusoro wekuongorora misoro yepamusoro uye kuongorora ikozvino kwekunetseka kwepfungwa (VAS). Kureba kwemagetsi kusaenzana uye zvakanyanya kupfurikidza nekushandiswa kwemasimba kwakashandiswa pakusarudza kudiwa kweimwe maatlas kupindira. Chinangwa chekugadzirisa zvakanakisisa ndezvekuti chinangwa chekuchengetedza kujekesa kwenguva yakareba sezvinobvira, neine nhamba shomanana yezvinyorwa zveatlas.

Mune PC-MRI maitiro, kusiyana kwemashizha haisi kushandiswa. PC-MRI nzira dzinounganidza deta mbiri dzedunhu nemhando dzakasiyana dzekuyerera kunowanikwa nekurondedzera zvidimbu zvepakati, izvo zvinogadziriswa sequentially uye zvinoputika munguva yekuenzanisa. Iko data yakasvibiswa kubva kumasere maviri ari kubviswa kuti aone kuyerera kwemazinga.

Kushanyira pa-site kwaMRI Physicist kwakapa mazano eMRI Technologist uye nzira yekufambisa dhesi yakaiswa. Mune miitiro yekudzidzira kuongorora uye kuwedzerwa kwedhesi kwakaitwa kuitira kuti kuchengetedza data kubudirire pasina matambudziko. A 1.5-tesla GE 360 Optima MR scanner (Milwaukee, WI) pakudzidza imaging centre (EFW Radiology, Calgary, Alberta, Canada) yakashandiswa mukufungidzira nekuunganidza deta. A 12-chikamu chinenge chakasungirirwa pamusoro wemakumbo, 3D magnetization-yakagadzirwa nokukurumidza-kuwana maitiro ezvinyorwa (MP-RAGE) sequence yakashandiswa mumashandi ekuongorora. Nhamba yakajeka yenhamba yakawanikwa kuburikidza nekushandisa nzira yakafanana yekuwana (iPAT), kukurumidza kukonzera 2.

Kuyera kuyerera kweropa kuenda uye kubva padenga rehenya, maviri akadzoreredzwa gated, velocity-encoded cine-phase-musiyano scans yakaitwa sekugadzwa neumwe moyo kurova, kuunganidza makumi matatu nemaviri mifananidzo pamusoro peiyo moyo kutenderera. Iyo yakakwira-velocity encoding (70? Cm / s) yakayerwa yakakwira-velocity kuyerera kweropa zvakaringana kune midziyo iri paC-2 vertebra level inosanganisira yemukati carotid arteri (ICA), vertebral arteries (VA), uye zvemukati jugular mutsinga (IJV ). Sekondari venous kuyerera dhata ye vertebral veins (VV), epidural veins (EV), uye yakadzika yemukati mitsipa (DCV) yakawanikwa pakureba kwakaenzana vachishandisa yakaderera-velocity encoding (7 9? Cm / s) kuteedzana.

Dhiyabhorosi dhesi dzakaratidzwa neChidzidzo Chekudzidza ID uye yekufungidzira zuva rokudzidza. Kudzidza neuroradiologist kwakaongorora MR-RAGE kuenzanisa kutonga kunze kwemamiriro ekudzivirira kwehutano. Zviratidzo zvepachiitiko zvakabva zvabviswa uye zvakapiwa ID yekodhi inobvumira kutumirwa kuburikidza nehutano hwakachengetedzwa IP protocol kune physicist yekuongorora. Kushandisa purogiramu yemapurogiramu ega volumetric ropa, Cerebrospinal Fluid (CSF) inoyerera mafashoni emagetsi uye maitiro akawanikwa akaiswa (MRICP version 1.4.35 Alperin Noninvasive Diagnostics, Miami, FL).

Shandisa chirongwa che-pulsatility-based se-lumens, nguva-inotaridzika inotenderera yakawanda inotarirwa nekubatanidza kubuda kwemhepo mukati mechidzitiro chemukati-chikamu nzvimbo pamusoro pemifananidzo yose makumi matatu nemaviri. Zvimwe kuyerera kwemitengo kwakawanikwa kune mishonga yemumuromo, mvura inotanga kushanduka, uye nzira dzechipiri dzinotyisa dzemvura. Zvose zvinokonzerwa neropa rekuyerera zvakawanikwa nekushambadzira kwezvinoreva kutenderera kwemazinga.

Tsananguro yakapusa yekutevedzera ndeye huwandu hwehuwandu uye hwekumanikidza shanduko Intracranial kuteedzera kunoverengerwa kubva pachiyero cheyakanyanya (systolic) isingagadzirisike vhoriyamu shanduko (ICVC) uye kumanikidza kushanduka panguva yemoyo wekutenderera (PTP-PG). Shanduko muI ICVC inowanikwa kubva mukusiyana kwechinguva pakati pehuwandu hweropa uye CSF inopinda nekubuda mucranium [5, 31]. Kumanikidza kushanduka panguva yemoyo kutenderera kunobva mukuchinja kweiyo CSF yekumanikidza gradient, iyo inoverengerwa kubva kune velocity-encoded MR mifananidzo yeiyo CSF kuyerera, uchishandisa Navier-Stokes hukama pakati pezvakatorwa zvevhejendi uye kumanikidza gradient [5, 32 ]. Iyo yekusavimbika kwekutevedzera index (ICCI) inotariswa kubva pachiyero cheICVC uye kumanikidza shanduko [5, 31-33].

Tsananguro yekuongorora yakatora zvinhu zvakawanda. ICCI kuongorora kwedhizimusi kwakabatanidza imwe yomuenzaniso Kolmogorov-Smirnov kuongorora kujekesa kusava nekugoverwa kwemazuva ose muCDCI data, iyo yakashanangurwa kushandiswa kuburikidza neyeri median uye interquartile range (IQR). Kusiyanisa pakati pekutanga uye yekutevera kwaifanira kuongororwa uchishandisa kuwirirana t-kutarisana.

NUCCA yeruzivo rwekuongorora yakatsanangurwa uchishandisa zvinoreva, median, uye interquartile range (IQR). Kusiyanisa pakati pekutanga uye yekutevera kwakaongororwa uchishandiswa kuwirirana t-kuedza.

Zvichienderana nemugumisiro wekugadzirisa, nheyo yekutanga, vhiki yechina, vhiki yechisere, uye vhiki gumi nemaviri (MIDAS chete) mazano ekutevera akaenzaniswa achishandisa zvinorehwa uye kuperevedza kwakakwana. Dhiyabhorosi data yakabatanidzwa pakutsvaga kwepurojekiti yekutanga yeurogi yaiva nechikwata chimwe chekutevera pakupera kwevhiki gumi nembiri.

Kusiyanisa kubva kune imwe nheyo kusvika kune imwe nhanho yekutevera yakaedzwa kuburikidza nekutarisana kwemaviri t. Izvi zvakaguma nehuwandu hwep p kubva kune mbiri yekutevera-kutarisa kune imwe sarudzo kunze kwe MIDAS. Sezvo chinangwa chimwe chemufambisi wechikwata ichi kupa huongorori hwekutsvakurudza mune ramangwana, zvakakosha kurondedzera apo kusiyana kwakaitika, panzvimbo yekushandisa nzira imwechete ANOVA kusvika kune imwechete p pamuenzaniso mumwe nomumwe. Kuvhiringidzika kwekuenzanisa kwakadaro kwakawanda ndiko kuwedzera kweTepe I kukanganisa kwenhamba.

Kuti uongorore dhidhi yeVAS, nhamba yega yega yepamusoro yakaongororwa mumwe nomumwe uye ipapo neine mutsara wekugadzirisa mutsara unonyatsokodzera data. Kushandiswa kwetsika dzakasiyana-siyana dzakasiyana-siyana pamwe nemitemo miviri yakasiyana-siyana uye nharaunda isina kumira yakapa mumwe munhu mutsetse wepamusoro wakagadzirirwa murwere mumwe nomumwe. Izvi zvakaongororwa zvichirwisana nemuenzaniso unongoratidzika-wega, unofanirwa nekodzero yekugadzirisa mitsara pamwe netsika yakafanana yezvose zvidzidzo, asi kubvumirana mazwi kunobvumirwa kusiyana. Iko muenzaniso wekuenzanisa wekuenzanisa wakagamuchirwa, sezvo pakanga pasina humwe uchapupu hwokuti nzvimbo dzisina maturo dzakagadziridzwa zvakanyatsokodzera kukodzera kune data (uchishandisa chiitiko chinowanzo chiverengero). Kuenzanisira kusiyanisa kwemashoko asi kwete mumatope, ruzivo rwomunhu mumwe nomumwe rwakanga rwuri kurongwa kune murwere mumwe nomumwe ane mutengo wepamusoro wekutenderera mutsara kumusoro.

Results

Kubva kutanga kuongororwa kweurourologist, vazvipiri gumi nevasere vaikodzera kuiswa. Mushure mekupedza edzidziso yekutanga misoro, avo vashanu vakasarudzwa havana kusangana nematanho ekubatanidza. Vatatu vakashaiwa anodiwa mazuva emusoro pamadhigiramu ekutanga kuti aiswe, imwe yaive nezviratidzo zvisina kujairika zveitsinga nekuramba kusingaite unodzivirira, uye imwe yaitora calcium chiteshi blocker. Mushandi weNUCCA akawana vaviri vakwikwidzi vasingakodzeri: mumwe achishaiwa kusarongeka kwemaatlasi uye wechipiri aine Wolff-Parkinson-White mamiriro uye kukanganisa kwakanyanya kwemashure (39 ) nekupinda munguva pfupi yapfuura mune yakanyanya kukonzeresa tsaona yemotokari ne whiplash (ona Mufananidzo 1) .

Zvidzidzo gumi nerimwe, vakadzi vasere nevarume vatatu, avhareji yemakore makumi mana nerimwechete (makore 21-61 makore), vanokodzera kuiswa. Zvidzidzo zvitanhatu zvakaratidza chisingaperi migraine, ichitaura gumi nemashanu kana kupfuura mazuva emusoro pamwedzi, iine gumi nerimwe-revo inoreva mazuva e14.5 emusoro pamwedzi. Migraine chiratidzo chenguva chakatarwa kubva pamaviri kusvika makumi matatu nemashanu makore (zvinoreva makore makumi maviri nematatu). Yese mishonga yakachengetedzwa isina kuchinjika kwenguva yekudzidza kuti isanganise yavo migraine prophylaxis regimens sekurairwa.

Zviratidzo zvekuregera, hapana nyaya dzakabatanidzwa dzakagadziriswa kuonekwa kwepfungwa dzinokonzerwa nekukuvadzwa kunorwadza kumusoro nemutsipa, kugunun'una, kana kupfurikidza misoro inonzi inonzi whiplash. Zvikamu zvipfumbamwe zvakataurwa zvakanyanya kure kare kare, zvakapfuura makore mashanu kana kupfuura (kurereji kwemakore mapfumbamwe) pamberi pehutano hwezveshu. Izvi zvaibatanidza kukuvara kwemusoro kwakabatana nemitambo, kukwikwidza, uye / kana whiplash. Zvidzidzo zviviri zvinoratidzirwa kusina musoro wekutanga kana kukuvara kwemutsipa (ona Table 2).

Tafura 2 Mutsva Intracranial Compliance Index ICCI Data

Tafura 2: Nhepfenyuro inobata maitiro ekutevedzera index (ICCI) data (n = 11). PC-MRI6 yakagamuchira ICCI1 data yakataurwa panguva yekutanga, vhiki ina, uye vhiki masere inotevera NUCCA5 kupinda. Mitsara yakasimbiswa inoratidza chikonzero nechechipiri yemvura inotyisa. MVA kana mTBI yakaitika makore anopfuura 5 vasati vadzidza kubatanidzwa, mushure mekunge makore 10.

Pamwechete, zvidzidzo zvishanu zvakaratidza kuwedzera kweICCI, nhatu nhatu dzemitemo dzakaramba dzakangofanana, uye zvitatu zvakaratidza kuderera kubva pakutanga kusvika kumagumo ezviyero zvekudzidza. Shanduko dzese mukuteerera kwekusavimbika kunoonekwa mu Tafura 2 uye Mufananidzo 8. Iwo epakati (IQR) maitiro eICCI aive 5.6 (4.8, 5.9) pakutanga, 5.6 (4.9, 8.2) pavhiki rechina, uye 5.6 (4.6, 10.0) pa vhiki sere. Misiyano yanga isiri manhamba akasiyana. Musiyano wepakati pakati pekutanga uye svondo rechina waive? 0.14 (95% CI? 1.56, 1.28), p = 0.834, uye pakati pekutanga uye vhiki sere yaive 0.93 (95% CI? 0.99, 2.84), p = 0.307. Iyi misoro miviri ye24-vhiki ICCI yekudzidza mhedzisiro inoonekwa muTebhu 6. Chidzidzo 01 chakaratidza kuwedzera kuri kuitika muICCI kubva ku5.02 pakutanga uye 6.69 pavhiki 24, nepo pavhiki 8, mhedzisiro yakadudzirwa seyakaenzana kana kuramba yakafanana. Chidzidzo 02 chakaratidza kuderera kwemaitiro muICCI kubva pakutanga kwe15.17 kusvika 9.47 pavhiki 24.

Mufananidzo 8 Chidzidzo ICCI Data Dzakaenzaniswa Nezvakaitika Dhepfenyuro Dzakanyorwa muMabhuku

Mufananidzo 8: Kudzidza ICCI dhepfu kana ichienzaniswa nedzivo yakambotaurwa mumabhuku acho. I-MRI nguva nguva maitiro anogadziriswa panotangira, vhiki ye4, uye vhiki ye8 mushure mekupindira. Aya mazano ehutano ezvidzidzo anowa akafanana nemashoko akataurwa naPomschar pane zvidzidzo zvinouya neTTI chete.

Tafura 6 24 Week Intracranial Compliance Index ICCI Data

Tafura 6: 24-vhiki ICCI zvitsva zvinoratidza kuwedzera kwechiitiko munyaya 01 asi pamagumo ekudzidza (vhiki ye8), zvigumisiro zvakashandurwa zvakafanana kana kuti zvichiri zvakafanana. Nyaya 02 yakaramba ichiratidza kutadza kuitika mu ICCI.

Tafura 3 inoshuma shanduko mukuongororwa kweNUCCA. Musiyano unoreva kubva pakutanga kusvika mushure mekupindira uri unotevera: (1) SLC: 0.73 inches, 95% CI (0.61, 0.84) (p <0.001); (2) GSA: 28.36 zviyero zviyero, 95% CI (26.01, 30.72) (p <0.001); (3) Atlas Gare gare: 2.36 madhigirii, 95% CI (1.68, 3.05) (p <0.001); uye (4) Atlas Rotation: 2.00 madigiri, 95% CI (1.12, 2.88) (p <0.001). Izvi zvaizoratidza kuti shanduko ingangoitika zvichitevera kupindira kwemaatlasi sekubva pakuongorora kwenyaya.

Tafura 3 Inotsanangura Nhamba dzeNUCCA Kuongorora

Tafura 3: Zvinyorwa zvinotsanangurwa [zvinoreva, kuparadzana kwakakwana, miviri, uye interquartile range (IQR2)] yeNUCCA1 kuongorora zvisati zvaitika-mushure mekunge apindira (n = 11).

Musoro weDaily diary results inowanikwa mukati Tafura 4 uye Mufananidzo 6. Pakutanga zvidzidzo zvaive zvine chirevo 14.5 (SD = 5.7) mazuva emusoro pamwedzi wezuva 28. Pakati pemwedzi wekutanga uchitevera kugadziriswa kweNUCCA, zvinoreva mazuva ekurwadziwa nemusoro pamwedzi akaderera nemazuva 3.1 kubva pakutanga, 95% CI (0.19, 6.0), p = 0.039, kusvika 11.4. Pakati pemwedzi wechipiri mazuva ekurwadziwa nemusoro akaderera nemazuva 5.7 kubva pakutanga, 95% CI (2.0, 9.4), p = 0.006, kusvika pamazuva 8.7. Pakati pevhiki sere, zvitanhatu zvevanegumi nemumwe zvidzidzo zvakaderedzwa> 30% mumazuva emusoro pamwedzi. Kwemavhiki makumi maviri nemana, nyaya 24 yakataura kuti hapana shanduko mumazuva ekurwadziwa nemusoro apo 01 yakange iine kudzikiswa kwezuva rimwe chete remusoro pamwedzi kubva pachidzidzo chekutanga chemanomwe kusvika kumagumo emishumo yekudzidza kwemazuva matanhatu.

Mufananidzo 6 Musoro weMazuva uye Musoro weHumusoro Pain Intensity kubva kuDaary

Mufananidzo 6: Musoro wemazuva uye misoro inorwadza simba kubva kudhiari (n = 11). (a) Nhamba yezuva remusoro pamwedzi. (b) Avhareji yemusoro musoro wepamusoro (pamusoro wemazuva). Denderedzwa inoratidza zvinorehwa uye bhar rinoratidza 95% CI. Denderedzwa pane mumwe munhu pachikoro. Kuwedzerwa kukuru kwemazuva ekuchema pamwedzi kwakaonekwa pamasvondo mana, kaviri kechipiri pavhiki masere. Zvidzidzo zvina (#4, 5, 7, uye 8) zvakaratidza hukuru kupfuura 20% kuderera mumusoro wepamusoro. Kushandiswa kwemishonga pamwe chete kunogona kutsanangura kuderera kuduku kwepfungwa zvakasimba.

Pamusoro penheyo, inoreva kuti kuora musoro kwemazuva mumazuva ane misoro, pamwero we zero kusvika gumi, waiva 2.8 (SD = 0.96). Zvichireva misoro yakasimba inoratidzika pasina nhamba inoshanduka kuchinja pane zvina (p = 0.604) uye masere (p = 0.158) masvondo. Zvidzidzo zvina (#4, 5, 7, uye 8) zvakaratidza hukuru kupfuura 20% kuderera mumusoro wepamusoro.

Unhu hwehupenyu uye hutachiona hutachiona hutachiona hunoonekwa muTebhenekeri 4. Iko kunoreva chikwata cheHIT-6 pachikamu chekutanga chaiva 64.2 (SD = 3.8). Pavhiki mana mushure meNUCCA kururamisa, kureva kuderera kwezvikoro kwaiva 8.9, 95% CI (4.7, 13.1), p = 0.001. Vhiki-masereji mazana, zvichienzaniswa nekutanga kwekutanga, zvakaratidzwa zvinoreva kuderera ne 10.4, 95% CI (6.8, 13.9), p = 0.001. Muchikwata che24-vhiki, pasi peCXUMUMX yakaratidza kuderera kwemashoko e01 kubva ku10 pavhiki 58 kusvika ku8 pavhiki 48 apo nyaya inonzi 24 yakaderera 02 points kubva 7 pavhiki 55 kusvika 8 pavhiki 48 (ona Mufananidzo 24).

Mufananidzo 9 24 Week HIT 6 Zvikoro Murefu Murefu Tevera Zvidzidzo

Mufananidzo 9: 24-vhiki HIT-6 zvidzidzo munguva dzenguva refu yekutevera. Mwedzi unoverengeka yakaramba ichiderera mushure mevhiki 8, kuguma kwokutanga kudzidza. Kubva pana Smelt et al. mitemo, inogona kududzirwa kuti mukati memunhu-kuchinja kwakakosha kunowanikwa pakati pevhiki 8 nevhiki 24. HIT-6: Musoro weChete Impact Test-6.

MSQL inoreva chikamu chekutanga chaive 38.4 (SD = 17.4). Pavhiki ina mushure mekugadziriswa, zvinoreva zvikoro zvezvinhu zvese gumi nerimwe zvakawedzera (zvakagadziriswa) ne30.7, 95% CI (22.1, 39.2), p <0.001. Nevhiki sere, kupera kwekudzidza, zvinoreva kuti maMSQL akawedzera kubva kubva pakutanga ne 35.1, 95% CI (23.1, 50.0), p <0.001, kusvika 73.5. Izvo zvinotevera-zvidzidzo zvakaramba zvichiratidza kumwe kuwedzera pamwe nekuwedzera zvibodzwa; zvisinei, zvakawanda zvikwiriso zvakapetwa zvakasara zvakafanana kubvira svondo 8 (ona Mifananidzo 10 (a) -10 (c)).

Mufananidzo 10 24 Week MSQL Chikoro muKutevedzana Kwenguva p Pfungwa

Mufananidzo 10: ((a) (c)) makumi maviri nemana masvondo eMSQL makosi mune enguva refu yekutevera zvidzidzo. (a) Chidzidzo 24 chave chakapetwa mushure mesvondo 01 kusvika kumagumo echidzidzo chechipiri. Chidzidzo 8 chinoratidza zvikoro zvichiwedzera nekufamba kwenguva zvichiratidza kusiyana kwakakosha kwakanangana naCole et al. zviyero nevhiki 02. (b) Nyaya dzezvidzidzo dzinoita sedzakakwira nesvondo 24 nezvidzidzo zvese zviri kuratidza zvikoro zvakafanana zvakataurwa pavhiki 8. (c) Chidzidzo 24 zvikoro zvinoramba zvichingoenderana mukudzidza pese apa nyaya 2 inoratidza kuvandudzika kwakatsiga kubva pakutanga kusvika kumagumo vhiki 01. MSQL: Migraine-Yakasarudzika Hupenyu hweKuyera Hupenyu.

Zvinoreva MIDAS mamaki pane yekutanga yaive 46.7 (SD = 27.7). Mumwedzi miviri mushure meNUCCA kururamisa (mwedzi mitatu inotevera yekutanga), zvinoreva kuderera muzvikamu zveMODAS zviyero zvaive 32.1, 95% CI (13.2, 51.0), p = 0.004. Dzidzo dzinotevera dzakaramba dzichiratidza kuvandudzwa nezvikamu zvakadzikira zvine simba zvichiratidza kuvandudzika kushoma (ona zvimiro 11 (a) -11 (c)).

Mufananidzo 11 24 Week Week MIDAS Zvikoro muKutora kwenguva refu Tevera Zvidzidzo

Mufananidzo 11: 24-vhiki MIDAS dzakawanda munguva dzenguva refu yekutevera. (a) Nhamba dzeMASAS dzakawanda dzakaramba dzichiderera pamusoro peC24-vhiki yekudzidza. (b) Kuwedzera kwezvikoro zvakaramba zvichivandudzwa. (c) Kunyange zvazvo 24-vhiki yakawanda yaive yakakwirira kudarika vhiki ye8, kubudirira kunowanikwa kana kuchienzaniswa neshoko rekutanga. MIDAS: Migraine Disability Assessment Scale.

Kuongororwa kwemazuva ano kurwadziwa kwepfungwa kubva kuVAS data yakawanda kunoonekwa muChifananidzo 7. Iyo multilevel linear regression modhi yakaratidza humbowo hwemhedzisiro mhedzisiro yekubvisa (p <0.001) asi kwete yekutsvedza (p = 0.916). Nekudaro, iyo inogamuchirwa yakasarudzika inogamuchira modhi inofungidzira akasiyana nzira yekubatira kune mumwe nemumwe murwere asi yakajairika kutsvedza. Nzvimbo inofungidzirwa yemutsetse uyu yaive? 0.044, 95% CI (? 0.055,? 0.0326), p <0.001, zvichiratidza kuti pakanga paine kuderera kukuru muchikamu cheVAS che0.44 pamazuva gumi mushure mekutanga (p <10). Icho chirevo chekutanga chekutanga chaive 0.001, 5.34% CI (95, 4.47). Iyo mhedzisiro mhedzisiro yekuongorora yakaratidza musiyano wakakura muchikamu chekutanga (SD = 6.22). Sezvo magadzirirwo akasarudzika achiwanzogoverwa, izvi zvinoratidza kuti 1.09% yenzira dzakadai dziri pakati pe95 na3.16 dzichipa humbowo hwekusiyana kwakakura mumatanho ekutanga pane vese varwere. VAS zvikoro zvakaramba zvichiratidza kuvandudzika mu7.52-vhiki mbiri-hurukuro yekutevera-boka (ona Mufananidzo 24).

Mufananidzo 7 Musoro Kuongorora Global Global Headache VAS

Mufananidzo 7: Nyaya yenyika yose kuongororwa kwemusoro (VAS) (n = 11). Ikoko kwaive nekusiyana kwakasiyana-siyana muzvinyorwa zvekutanga kune varwere. Mitsara inoratidza kukodzera kwemhando yega yega yevane gumi nevaviri. Iyo yakareba yakajeka mutsara wakaita mutsara inomiririra kukodzera kukodzera kwakakwana kune vose vane gumi nevane varwere. VAS: Kuona Analog Scale.

Mufananidzo 12 24 Week Yotevera Gwaro Kuongorora Kwepasi rose kweHemisache VAS

Mufananidzo 12: 24-vhiki yekutevera-boka rekuongorora kwepasirese kwemusoro (VAS). Kana zvidzidzo zvabvunzwa, - ndokumbirawo utarise marwadzo epfungwa paavhareji pasvondo rapfuura- VAS zvikoro zvakaramba zvichiratidza kuvandudzika mune makumi maviri nemaviri-vhiki mbiri-yekutevera boka.

Izvo zvakajeka kuitika kuNUCCA kupinda uye kuchengetwa kunoratidzwa nenyaya gumi kwaiva nemutsipa wakanyarara kusinganzwisisiki, yakarongerwa kuenzana kwevatatu kubva kune gumi pakutambudzika kwekutambudzika. Mune nharo nhanhatu, kurwadziwa kwakatanga kwemaawa makumi maviri nemana mushure meatori yekururamisa, inogara kwemaawa makumi maviri nemana. Hapana nhau yakataurwa chero ipi zvayo yakakosha pamabasa avo ezuva nezuva. Vose venyaya vakataura kugutsikana neNUCCA kuchengetedza mushure mevhiki imwe chete, mapeji mapfupi, gumi, pane zero kusvika gumi.

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight

“Ndave ndichirwadziwa nemusoro wemusoro kwemakore anoverengeka ikozvino. Pane chikonzero chekurwadziwa nemusoro wangu here? Chii chandingaite kudzikisa kana kubvisa zviratidzo zvangu? ” Migraine misoro yemusoro inofungidzirwa kuva inyanzvi yekutambudzika kwemusoro, zvisinei, chikonzero chavo chakangofanana nemamwe marudzi ose emusoro. Kukuvadza kunorwadza kumucheto womukati, zvakadai sokuputika kwechiitiko chemotokari kana kukuvadzwa kwemitambo, kunogona kukonzera kusarudzwa mumutsipa nekumusoro kwekumusoro, izvo zvinogona kutungamirira kumigraine. Kuita zvisina kunaka kunogona kukonzera nharo dzemutsipa dzinogona kutungamirira kumarwadzo emusoro nemutsipa. Nyanzvi yehutano inonyanya kugadzirisa nyaya dzehutano hwepelinha inogona kuziva kuti chii chinobva pamusoro wemusoro wako. Uyezve, muongorori anoziva uye ane ruzivo anogona kuita kugadzirisa kwemapapiro pamwe nekugadzirisa manyorerwo ekubatsira kugadzirisa chero kusarudzwa kwemupfungwa kunogona kukonzera zviratidzo. Nyaya inotevera inopfupikisa nyaya yekuongorora inobva pakuvandudza kwezviratidzo shure kweatlanti vertebrae kujekesa kune avo vanobatana ne migraine.

hurukuro

Muchikamu chechidiki chemashumi gumi nemaviri emigraine, pakanga pasina kuwandisa kwekukosha kuI ICCI (primary results) mushure meNUCCA kupinda. Zvisinei, kuchinja kukuru muhutano hweHRQoL hwechipiri kwakaitika sezvakanyorwa muchidimbu cheTables 5. Kubatana kwehutano uye hutungamiri hwekuvandudza kune idzi hutano hweHRQoL hunoratidza kuvimba mukusimudzira hutano hwepfungwa pamusoro pemwedzi miviri yekudzidza pashure pezuva 28-zuva rekutanga.

Tafura 5: Chidimbu Kuenzaniswa kweZviitiko Zvakaenzaniswa

Kubva pane zviitiko zvekuongorora nyaya, iyi tsvakurudzo yakagadzirisa kuwedzera kukuru kwe ICCI mushure me atlas intervention iyo yakanga isina kuonekwa. Kushandisa PC-MRI kunobvumira kuverenga kwehukama hwakasimba pakati pekubuda kwechirwere, kuputika kwevhuni, uye CSF inoyerera pakati pekrani uye mugero wepelinha [33]. Intracranial compliance index (ICCI) inotarisa kukwanisa kweuropi kupindura ropa rinouya risina nguva panguva ye systole. Tsanangudzo yekuyerera kwakasimba kunomiririrwa neukama hwemonoexponential huripo pakati peScF volume uye CSF. Nekuwedzerwa kana kuwedzerwa kwekuteerera kusingabatsiri, zvakare kunotsanangurwa sekuchengetedzwa kwakanaka kwekubhadhara, ropa rinouya rinopinda rinogona kugadziriswa nezviri mukati mazviri zvine zvishanduko zviduku mukudzvinyirira kusingaiti. Kunyange zvazvo kuchinja kwekushaya simba kana kuwedzera kunogona kuitika, zvichienderana nehuwandu hwehutano hwehukama-hukama, kuchinja kwekutevera-kupindira ICCI kunogona kusakwanisa kuitika. Kunyanya kuongororwa kweMRI data nedzimwezve zvidzidzo zvinotarisirwa kuvhara zviratidzo zvingashandiswa zvinoshandiswa kushandiswa sechinangwa chinogadziriswa chinonyatsoratidza kunyorwa kwechifoologic mushure maatlas kururamisa.

Koerte et al. Mishumo yevasingagumi vachirini varwere inoratidza huwandu hwemvura yakasvibirira inokonzerwa nemhepo inokonzera mhepo (chirwere chepaspinal plexus) muchikamu chepamusoro kana ichienzaniswa nehutano-uye hutano hunofananidzwa nehutano [34]. Zvimwe zvidzidzo zvekudzidza zvakaratidzwa mvura yechipiri yemvura ine nhatu neyezvikamu zvitatu zvezvikamu izvi zvichiratidza kuwedzera kunoshamisa kwekuteerera mushure mokunge vapindira. Izvo zvinorehwa hazvizivikanwi pasina kudzidza zvakare. Saizvozvowo, Pomschar et al. yakashuma kuti kutongwa nekukuvara kunokonzera uropi (mTBI) kunoratidza kuwedzera kwemvura kuburikidza nedzimwe nhengo dzechipiri dzinokonzerwa nemhepo dzinokonzera mhuka [35]. Izvo zvinoreva kushandiswa kwekodzero yekutevedzera inoratidzika zvakaderera mumatare eMTBI kana ichienzaniswa nekutonga.

Mamwe maonero angangowanikwa mukuenzanisa nedhaka iyi yeCICC yekudzidza kune zvataimbova zvidzidzo zvekare uye avo vane mTBI inoratidzwa mumufananidzo 8 [5, 35]. Zvishoma nezvishoma nhamba shomanana dzezvidzidzo zvakadzidzwa, kukosha kwezvakawanikwa zvitsva zvinogona kunge zvine chokuita nePomschar et al. hazvisati zvichinyatsozivikanwa, zvichipa kungofungidzira kwezvimwe zviitiko zvekutsvaga mune ramangwana. Izvi zvinowedzera zvakaoma nekusawirirana kweCICC kuchinjwa mune zvidzidzo zviviri zvakateverwa kwevhiki dze24. Nhepfenyuro mbiri neyechipiri yemvura yakaratidzwa yakaratidza kuderera kwe ICCI mushure mekupindira. Chiyero chikuru chetabhobhobiti chakarongedzwa nematongerwo anokosha pachidzidzo chekukura kwemashoko kunogona kuratidzira tsanangudzo yakanyatsojekeswa physiologic shanduko mushure mekushandiswa kweNUCCA kururamisa nzira.

Maitiro eHQoL anoshandiswa pakiriniki kuti aongorore kubudirira kwehutano hwekurapa kuti kuderedza marwadzo nekuremara zvine chokuita nekudzivirira musoro musoro. Zvinotarisirwa kuti kurapa kunobudirira kunovandudza murwere anoona kurwadziwa nekuremara kwakaenzaniswa nezviridzwa izvi. Zvose maitiro eHRoL mukuongorora uku zvakaratidza kukosha uye kuwedzera kwekuvandudzwa kwevhiki rechina rinotevera kushandiswa kweNUCCA. Kubvira vhiki yechina kusvika kwevhiki hupfumi humwe chete hunovandudzwa hwakaonekwa. Zvakare, zvishoma chete kuvandudzwa kwakaonekwa munyaya mbiri dzakateverwa kwevhiki dze24. Kunyange zvazvo chidzidzo ichi chakanga chisiri kuratidzira kuratidzira kubva kuNUCCA kupindira, mhinduro dzeHRQoL dzinoita chido chakasimba chekuwedzera kudzidza.

Kubva pamusoro wekunyorwa kwepfungwa, kupera kukuru kwemazuva emusoro pamwedzi kwakaonekwa pamasvondo mana, kaviri kuwirirana pavhiki masere. Zvisinei, kusiyana kukuru kwepamusoro-soro kuwedzera kwemazuva kwakange kusinganzwisisiki kubva kune iyi dhiari data (ona Mufananidzo 5). Kunyange zvazvo nhamba yemusoro yakaderera, zvidzidzo zvekare zvakashandisa mishonga yekuchengetedza misoro yakasimba mumatambudziko anoregererwa; saka, inofungidzirwa kuti misiyano inonyanya kukosha mumusoro wepamusoro yakasimba haikwanise kutaridzirwa. Kubatana mumusoro wezuva zuva nhamba dzinowanikwa muvhiki 8 mune zvidzidzo zvinotevera zvinogona kutungamira kunyanya kuongororwa kwekutsvaga mukugadzirisa nguva yekuvandudza kunowanikwa kubatsira mukugadza chirongwa cheNUCCA chekuchengetedza migraine.

Kuchinja kwakakodzera mune zveHIT-6 kwakakosha kuti unzwisise zvakazara zvabuda. Shanduko yechipatara inonzwisisika kune mumwe murwere yakatsanangurwa neiyo HIT-6 gwaro revashandisi sa? 5 [36]. Coeytaux et al., Uchishandisa ina dzakasiyana nzira dzekuongorora, zvinoratidza kuti musiyano-weboka musiyano muHIT-6 zviyero zvezvikamu zve2.3 nekufamba kwenguva zvinogona kutariswa kuchipatara zvakakosha [37]. Smelt et al. akadzidza main care migraine varwere vanhu mukuvandudza mazano akakurudzirwa vachishandisa HIT-6 mamaki ekushandurwa kwekutarisirwa kwekiriniki uye kutsvagisa [38]. Zvichienderana nemhedzisiro inokonzeresa kubva kunhema kunyepa kana zvisizvo, mukati-memunhu shanduko yakakosha zvishoma (MIC) uchishandisa mean shanduko nzira yaifungidzirwa kuve 2.5 mapoinzi. Paunenge uchishandisa iyo cereceiver inoshanda hunhu (ROC) curve kuongorora- shanduko ye6-poindi inodiwa. Yakakurudzirwa pakati-peboka mutsauko wakakosha zvishoma (MID) iri 1.5 [38]

Uchishandisa iyo anmean shanduko nzira, zvese zvidzidzo asi imwe yakaratidza shanduko (kuderera) yakakura kupfuura? 2.5. Iyo OCROC analyses yakaratidzawo kuvandudzwa nezvidzidzo zvese asi imwe. Uyu umwe wenyaya aive munhu akasiyana mukuongorora kwega kwega kwekuenzanisa. Kubva paSmelt et al. Maitiro, iwo anoteedzera-zvidzidzo zvakaramba zvichiratidza mukati-memunhu kukosha kwakanyanya kukosha sekuonekwa paMufananidzo 10.

Zvese zvidzidzo asi zviviri zvakaratidza kugadziridzwa pane iyo MIDAS mamaki pakati pekutanga uye matatu-mwedzi mhedzisiro. Ukuru hweshanduko hwaive hwakaenzana neyekutanga MIDAS mamakisi, nezvose zvidzidzo asi zvitatu zvichishuma makumi mashanu muzana muzana kana shanduko huru. Izvo zvinotevera-zvidzidzo zvakaramba zvichiratidza kuvandudzwa sezvinoonekwa mukuenderera mberi kuderera muzvikamu nevhiki 24; ona Zvimiro 11 (a) 11 (c).

Kushandisa kweHIT-6 uye MIDAS pamwe chete semagumisiro ekugadzirira kunogona kupa kuongororwa kwakazara kwehutano hwehutano hwakabatana [39]. Kusiyana pakati pezviyero zviviri kunogona kufanotaura kuporesa kubva pamusoro wepfungwa kurwadziwa kwepamusoro uye kuora musoro kwepamusoro, nekupa mamwe mashoko pamusoro pezvinhu zvine chokuita nehuwandu hunoitika kunze kwehugumisiro hunoshandiswa uri woga. Kunyange zvazvo MIDAS ichiita sechishandura zvakawanda nemusoro wepamusoro, kushaya musoro musoro kunoita kuti kuve nehuwandu hweHIT-6 kupfuura MIDAS [39].

Nzira iyo migraine misoro inobata uye inogadzirisa murwere anoonekwa zuva rega rega inoshushwa neMSQL v. 2.1, mumatatu matatu e3: basa rekudzivirira (MSQL-R), basa rekudzivirira (MSQL-P), uye kushanda mupfungwa (MSQL-E). Kuwedzerwa kwezvikamu kunoratidza kuvandudzwa mune izvi nzvimbo nemitemo kubva ku 0 (varombo) kusvika ku100 (yakanakisisa).

Chiyero cheMSQL chakavimbika kuongororwa naBagley et al. taura mhedzisiro kuve zvine mwero kune zvakabatana zvikuru neHIT-6 (r =? 0.60 kusvika? 0.71) [40]. Kudzidza naCole et al. inoshuma misiyano yakakosha (MID) kiriniki shanduko yedunhu rega rega: MSQL-R = 3.2, MSQL-P = 4.6, uye MSQL-E = 7.5 [41]. Mhedzisiro kubva kumusoropiramate yekuongorora inoshuma munhu zvishoma zvakakosha kiriniki (MIC) shanduko: MSQL-R = 10.9, MSQL-P = 8.3, uye MSQL-E = 12.2 [42].

Vose vadzidzisi kunze kweivo vane ruzivo rwehutano hunokosha hwechipatara huchichinja hweMSQL-R yepamusoro kupfuura 10.9 nevateveri vhiki nesere musangano reMSQL-R. Zvose asi zvidzidzo zviviri zvakashuma kuchinja kwemashoko anopfuura 12.2 mu MSQL-E. Kuvandudza muSMSQL-P zvikwata zvakakonzerwa nemashoko gumi kana kupfuura mune zvese zvidzidzo.

Kudzokorora kuongororwa kweVAS kuwedzerwa kwekufamba kwenguva kwakaratidza kuchinja kwakakosha kwepamwedzi pamusoro pemwedzi we3. Ikoko kwaive nekusiyana kwakasiyana-siyana muzvinyorwa zvekutanga kune varwere. Kushandura zvishoma kuduku kwakaratidzwa muzinga rekuvandudza. Izvi zvinoratidzika kunge zvakafanana mune zvidzidzo zvemasvondo e24 sezvinoonekwa mumufananidzo 12.

Dr Jimenez anoshanda pamutsipa wrestler

Vadzidzi vakawanda vachishandisa kupindira kwemishonga vakaratidza nzvimbo yakawanda inoshanda kune varwere vanobva kune dzimwe nyika [43]. Kusarudza kunogona kugadzirisa migraine kudarika mwedzi mitanhatu, kushandisa kumwe kupindira uye kusina kupindira, zvinokosha kune chero kuenzaniswa kwemigumisiro. Tsvakurudzo yemigumisiro ye placebo inobvuma kuti kupindira kwepa placebo kunopa hurumende yakasununguka asi haishanduki pathophysiologic nzira dziri pasi pemamiriro ezvinhu [44]. Chinangwa MRI miganho inogona kubatsira mukuzarura nzvimbo iyo yakagadzirisa kuburikidza nekuratidzira kuchinja kwepimologicic miviri yekuyerera kwemaitiro anowanikwa mushure mokunge inonzi interventionbo inopindira.

Kushandiswa kwetatu-tesla magnet nokuda kwekuunganidza dhi data kunowedzera kuvimbika kwezviyero nekuwedzera huwandu hwemashoko hunoshandiswa kuita kuti kubuda uye ICCI kuverenga. Ichi ndicho chimwe chekutsvakurudza kokutanga kushandura kuI ICC sechiitiko pakuongorora kupindira. Izvi zvinokonzera matambudziko mukududzira kweMRI yakawana dhesi kuti iite mahedheni kana kuti humwe hutungamiri hwekusimudzira pfungwa. Kusiyana kwehukama pakati pehupenyu hunopfuurira kusvika uye kubva kuuropi, CSF inoyerera, uye kuwedzera kwemwoyo kwezvirevo izvi-zvakasiyana-siyana zvataurwa [45]. Kusiyana kwakaonekwa mune zvishoma zvitatu-zvinongororwa zvinyorwa zvinodzidza zvakatungamirira kugumisiro kuti ruzivo rwakakonzerwa kubva mumatambudziko ega ega rinogona kududzirwa nekuchenjerera [46].

Iwo mabhuku anoenderera mberi achitaura mune hombe zvidzidzo zvakakosha kuvimbika mukuunganidza aya MRI akawana volumetric kuyerera dhata. Wentland et al. yakashuma kuti zviyero zveCSF velocities muvanhu vanozvipira uye nesinusoidally ichichinja mafantom velocities haina kusiyana zvakanyanya pakati pemaitiro maviri eMRI anoshandiswa [47]. Koerte et al. akadzidza maviri macohort ezvidzidzo akafananidzirwa muzvivakwa zviviri zvakasiyana nemidziyo yakasiyana. Vakataura kuti intraclass correlation coefficients (ICC) yakaratidza kuvimbika kwepakati nepakati kwePC-MRI volumetric flow rate zviyero zvakasara zvakazvimiririra zvemidziyo inoshandiswa uye hunyanzvi-chikamu cheanoshanda [48]. Nepo kusiana kweatomic kuripo pakati pezvidzidzo, haina kutadzisa zvidzidzo zvevarwere vakawanda mukutsanangura zvinogona kuitika zvisina kujairika kubuda kwematanho [49, 50].

Kuve nekugadzirirwa chete pamwoyo nepfungwa dzekuzviisa pasi, pane kukwana pakushandisa zvirwere zvinorondedzerwa zvinonzi [51]. Chero chipi nechipi chinoita kuti pfungwa dzive nechinangwa mumamiriro avo ehupenyu zvinogona kukanganisa mugumisiro wekuongorora chero kupi zvako kunoshandiswa. Kusava nemugumisiro wechiratidzo chekuzivisa zviratidzo, manzwiro, nekuremara zvinogumirawo kududzirwa kwezvibereko [51].

Kufananidza uye kuongorora kweMRI kudhura kunodhura kushandiswa kweboka rinodzora, kuderedza chero huwandu hwemigumisiro yemigumisiro iyi. Chimwe chikwata chikuru chekuenzanisa chinogona kubvumira kugadzirisa kubva pane nhamba dzemauto uye kuderedza rudzi rweTe I. Tsanangudzo yezvimwe zvinorehwa mumigumisiro iyi, pavanenge vachiratidza maitiro azvinogona, inoramba ichifungidzirwa zvakanaka. Iyo huru isina kuzivikanwa inoenderera mberi mukana wekuti kuchinja uku kunobatanidza nekupindira kana kune chimwe chiitiko chisingazivikanwi nevatsvakurudzi. Izvi zvinowedzera ku muviri weruzivo rwekare zvisingatauri kuti inogona kuitika hemodynamic uye hydrodynamic shanduko mushure meNUCCA kupindira, uyewo kuchinja kune migraine HRQoL vane zvirwere zvinorondedzerwa sezvakaratidzwa muboka iri.

Maitiro ekuunganidza data uye kuongororwa ari kupa ruzivo runodikanwa kuti kuenzaniswa kwezvinyorwa zvakakosha zvidzidzo zvinyorwa zvinyorwa mukuwedzera kudzidza. Resolved procedural challenges kubva mutungamiri wechikwata vanobvumira kuti purogiramu yakanyatsogadziridzwa yekubudirira kuita basa iri.

Muchidzidzo ichi, kushayikwa kwekuwedzera kwakasimba mukuteerera kunogona kunzwisiswa nelogarithmic uye simba rekushanda kwehemodynamic uye hydrodynamic kutumbuka, zvichibvumira zvimwe zvikamu zvinosanganisira kutevedza kwekuchinja asi zvachose haina. Kupindira kunobudirira kunofanira kuvandudza chidzidzo chinonzwisisika kurwadziwa nekuremara kwakabatana nemusoro wemusoro sezvinoyerwa neiyo HRQoL midziyo inoshandiswa. Izvi zvinogadziriswa zvinoratidza kuti malastiki ekugadzirisa kupindira kunogona kuve nekubatanidza kuderedza migraine nguva zhinji, kujekeswa kunoitwa muhupenyu hwehupenyu hunoita kukonzera kuderedza mukuremara kwakagadzikana nemusoro sezvakaratidzwa muboka iri. Kuvandudzika kwaHRQoL zviitiko kunobatsira kufambisa chido chekuwedzera kudzidza, kusimbisa izvi zvitsva, zvikurukuru nedzimwe huru dzimba uye boka re placebo.

Kutenda

Vanyori vanobvuma Dr. Noam Alperin, Alperin Diagnostics, Inc., Miami, FL; Kathy Waters, Study Coordinator, uye Dr. Jordan Ausmus, Radiography Coordinator, Britannia Clinic, Calgary, AB; Sue Curtis, MRI Technologist, Elliot Fong Wallace Radiology, Calgary, AB; uye Brenda Kelly-Besler, RN, Muongorori Wekutsvakurudza, Calgary Headache Kuongorora uye Gwaro Rokuchengetedza (CHAMP), Calgary, AB. Sangano rezvemari rinopiwa ne (1) Hecht Foundation, Vancouver, BC; (2) Tao Foundation, Calgary, AB; (3) Ralph R. Gregory Memorial Foundation (Canada), Calgary, AB; uye (4) Mukuru weCervical Research Foundation (UCRF), Minneapolis, MN.

Abbreviations

ASC: Atlas subluxation yakaoma
CHAMP: Calgary Headache Kuongorora uye Purogiramu Yekuchengetedza
CSF: Cerebrospinal Fluid
GSA: Gravity Stress Analyzer
HIT-6: Musoro weChete Impact Test-6
HRQoL: Utano Hwakaenderana Nehupenyu Hweupenyu
ICCI: Intracranial compliance index
ICVC: Intracranial volume inoshanduka
IQR: Interquartile range
MIDAS: Migraine Disability Assessment Scale
MSQL: Migraine-Specific Quality of Life Measure
MSQL-E: Migraine-Specific Quality of Life Zvimwe-Emotional
MSQL-P: Migraine-Specific Quality of Life Nhamba-Nyama
MSQL-R: Migraine-Specific Quality of Life Kuenzanisa-Kunogadzirisa
NUCCA: National High Cervical Chiropractic Association
PC-MRI: Phase Kusiyana Magnetic Resonance Imaging
SLC: Supine Leg Check
VAS: Kuona Analog Scale.

Kukonana kwezvaunofarira

Vanyori vanoparidza kuti hapana mari kana zvimwe zvingakwikwidzana pamusoro pekubudiswa kwepa pepa.

Mupiro wevanyori

H. Charles Woodfield III akagamuchira chidzidzo chacho, akabatsira mukugadzirwa kwayo, akabatsirwa mukubatana, uye akabatsira kunyora pepa racho: sumo, nzira dzokudzidza, migumisiro, kukurukurirana, uye kugumisa. D. Gordon Hasick akaongorora zvidzidzo zvekudzidza kusanganisira / kusagadzikana, kupa mazano ekuNUCCA, nekucherechedza zvidzidzo zvose mukutevera. Akabatanidzwa mukudzidza nekugadzirisa nekugadzirisa, achibatsira kutora zvinyorwa, NUCCA Methods, uye Kukurukurirana kwepa pepa. Werner J. Becker akaongorororwa nyaya dzekudzidza kusanganisa / kubviswa, akabatanidzwa mukugadzidza nekugadzirisa, uye akabatsira kunyora pepa: maitiro ekudzidza, migumisiro nekukurukurirana, nekugumisa. Marianne S. Rose akaita nhamba yekuongororwa panyaya yekudzidza uye akabatsira kunyora pepa: nhamba nzira, zvigumisiro, nekukurukurirana. James N. Scott akabatanidzwa mukugadzirwa kwekudzidza, akashanda semuongorori wekufungidzira kuongororwa zvikwereti zvehutano, uye akabatsira kunyora pepa: PC-MRI nzira, mhinduro, nekukurukurirana. Vose vanyori vakaverenga uye vakabvuma pepa rokupedzisira.

Mukupedzisa, iyo nyaya yekuongorora pamusoro pekuvandudzwa kwemigraine misoro yepacheche inoenderana neatlas vertebrae kugadziriswa kwakaratidza kuwedzera mune zvakaguma zvaitika, zvisinei, chiyero chekutsvakurudza kwekutsvakurudza kwakaratidzawo kusina nhamba inokosha. Pose, nyaya yacho yakagumisa kuti varwere vakagamuchira atlas vertebrae kugadziriswa kurapwa kwakave nekuvandudzika kukuru kwezviratidzo nekuderera musoro kwemazuva. Mashoko anotsanangurwa kubva kuNational Center for Biotechnology Information (NCBI). Kuwanda kweruzivo rwedu kunogumira kune chiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota ivai vakasununguka kubvunza Dr. Jimenez kana kuti tibvunzei kwatiri 915-850-0900 .

Yakarongedzwa naDkt Alex Jimenez

Mimwe Misoro: Neck Pain

Kutambudzika kwemutsipa ndiko kunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Maererano nehuwandu, hukuvadza kwemotokari uye kukuvara kweputika ndeimwe yezvikonzero zvinowanzokonzera kurwadziwa kwemutsipa pakati pevanhu vakawanda. Pakaitika pangozi yemotokari, kusvibiswa kwechiitiko ichi kunogona kuita kuti musoro nemutsipa zvive zvishoma nezvishoma zvekare zvichienda mberi, zvichikuvadza zvivako zvakakomba zvakakomberedza mutsara. Kutambudza kumatokoni nemirasi, pamwe chete neyimwe michina mumutsipa, kunogona kukonzera marwadzo emutsipa uye kupenya kwezviratidzo mumuviri womunhu.

blog chinyorwa chekartoon paperboy makuru makuru

CHINOKOSHA CHINOKOSHA: KUDZIDZA KUNYANYA: Anokufadza Iwe!

ZVIMWE ZVINOKOSHA ZVINOKOSHA: KUTAURA: Kukuvara Kwemitambo? | Vincent Garcia | Mwoyo murefu | El Paso, TX Chiropractor

Hazvina kuchena

References

1. Magoun HW Caudal uye cephalic maitiro europi anosvika pakugadzirwa. Physiological Reviews. 1950;30(4): 459 474. [PubMed]

2. Gregory R. Bhuku reKuberekwa kweCervical Analysis. Monroe, Mich, USA: National Upper Cervical Chiropractic Association; 1971.

3. Thomas M., editor. NUCCA Mitemo neMafungiro. 1st. Monroe, Mich, USA: National Upper Cervical Chiropractic Association; 2002.

4. Grostic JD Dentate ligament-cord kusiyanisa hypothesis. Chiropractic Research Journal. 1988;1(1): 47 55.

5. Alperin N., Sivaramakrishnan A., Lichtor T. Magnetic resonance imaging-based zviyero zve cerebrospinal fluid uye neropa rekuyerera sezviratidzo zvekuita kusingabvumirwi nevarwere vane Chiari malformation. Nhamba yeNeurosurgery. 2005;103(1):46�52. doi: 10.3171/jns.2005.103.1.0046. [PubMed] [Cross Ref]

6. Czosnyka M., Pickard JD Kuongorora uye kududzirwa kwekusagadzikana kwechisimba. Nyaya yeNeurology, Neurosurgery uye Psychiatry. 2004;75(6):813�821. doi: 10.1136/jnnp.2003.033126. [PMC free article] [PubMed] [Cross Ref]

7. Tobinick E., Vega CP Nzira yeutachiona yakasvibiswa: utomy, physiology, uye kliniki zvinoshandiswa. MedGenMed: Medscape General Medicine. 2006;8(1, chinyorwa 153) [PubMed]

8. Eckenhoff JE Kukosha kwe physiologic yevirtebral venous plexus. Kuvhiya Gynecology uye Obstetrics. 1970;131(1): 72 78. [PubMed]

9. Nguruve CB Venous hemodynamics muhutano hwehutano: kuongorora kuongorora ne hydrodynamic analysis. BMC Medicine. 2013;11, chinyorwa 142 doi: 10.1186/1741-7015-11-142. [PMC free article] [PubMed] [Cross Ref]

10. Nyuchi dzinonzi CB Cerebral dzinoputika uye dzinonzi cerebrospinal fluid dynamics. Masvini neLymphatics. 2014;3(3):81�88. doi: 10.4081/vl.2014.1867. [Cross Ref]

11. Cassar-Pullicino VN, Colhoun E., McLelland M., McCall IW, El Masry W. Hemodynamic kuchinja muparvertebral venous plexus mushure mekukuvara kwepamuviri. Radiology. 1995;197(3):659�663. doi: 10.1148/radiology.197.3.7480735. [PubMed] [Cross Ref]

12. Damadian RV, Chu D. Nzvimbo inogona kuitika yekristani-cervical trauma uye yakawanda CSF hydrodynamics mujesis of multiple sclerosis. Physiological Chemistry uye Physics uye Medical NMR. 2011;41(1): 1 17. [PubMed]

13. Bakris G., Dickholtz M., Meyer PM, et al. Atlas vertebra realignment uye kubudirira kwepfungwa zvinokonzera chinangwa mune varwere vane hutachiona hwepamusoro: chidzidzo chekufambisa. Zvinyorwa zveHinha Hypertension. 2007;21(5):347�352. doi: 10.1038/sj.jhh.1002133. [PubMed] [Cross Ref]

14. Kumada M., Dampney RAL, Reis DJ Inonzi trigeminal depressor response: a reflex heart reflex from the trigeminal system. Bongo Research. 1975;92(3):485�489. doi: 10.1016/0006-8993(75)90335-2. [PubMed] [Cross Ref]

15. Kumada M., Dampney RAL, Whitnall MH, Reis DJ Hemodynamic kufanana pakati pezvitatu uye aortic vasodepressor mhinduro. Iyo American Nhoroondo yePhysology Moyo uye Inotenderera Physiology. 1978;234(1): H67 H73. [PubMed]

16. Goadsby PJ, Edvinsson L. Inonzi trigeminovascular system uye migraine: zvidzidzo zvinoratidzira hutachiona uye neuropeptide shanduko dzinoonekwa kuvanhu uye mukati. Annals of Neurology. 1993;33(1):48�56. doi: 10.1002/ana.410330109. [PubMed] [Cross Ref]

17. Goadsby PJ, Fields HL Pamusoro pekushanda kwemaitiro emagraine. Annals of Neurology. 1998;43(2, chinyorwa 272) nei: 10.1002 / ana.410430221. [PubMed] [Cross Ref]

18. May A., Goadsby PJ The trigeminovascular system in human: pathophysiologic zvinokonzerwa nemusoro wepfungwa dzinonzi syndromes dzeveural nehuipi pamusana pekupararira kwepfungwa. Nyaya yeCerebral Blood Flow uye Metabolism. 1999;19(2): 115 127. [PubMed]

19. Goadsby PJ, Hargreaves R. Refractory migraine uye isingaperi migraine: pathophysiological mechanisms. kurwadziwa nemusoro. 2008;48(6):799�804. doi: 10.1111/j.1526-4610.2008.01157.x. [PubMed] [Cross Ref]

20. Olesen J., Bousser M.-G., Diener H.-C., uye al. Iko kusarudzika kwepasirese kwekushungurudzika kwepfungwa, 2nd edition (ICHD-II) -kutarisa kweanotarisirwa 8.2 mishonga-yakanyanyisa musoro musoro. Cephalalgia. 2005;25(6):460�465. doi: 10.1111/j.1468-2982.2005.00878.x. [PubMed] [Cross Ref]

21. Stewart WF, Lipton RB, Whyte J., et al. Chidzidzo chepasi rose chekuongorora kuvimbika kweMigraine Disability Assessment (MIDAS). Neurology. 1999;53(5):988�994. doi: 10.1212/wnl.53.5.988. [PubMed] [Cross Ref]

22. Wagner TH, Patrick DL, Galer BS, Berzon RA Chigadzirwa chitsva chekuongorora hurefu hwehupenyu hwehupenyu hwemigraine: kukura nekuongorora kwepfungwa ye MSQOL. kurwadziwa nemusoro. 1996;36(8):484�492. doi: 10.1046/j.1526-4610.1996.3608484.x. [PubMed] [Cross Ref]

23. Kosinski M., Bayliss MS, Bjorner JB, et al. Tsvakurudzo yechinyorwa-shomanana yechitanhatu yekuyera kuora musoro kwepamusoro: HIT-6. Quality of Life Research. 2003;12(8):963�974. doi: 10.1023/a:1026119331193. [PubMed] [Cross Ref]

24. Eriksen K., Rochester RP, Hurwitz EL Maitiro echirwere, kuguma kwechipatara uye kugutsikana kwechigarire kunobatanidza nepamusoro yekervical chiropractic kuchengetedza: anotarisira, multicenter, kudzidza kweboka. BMC Musculoskeletal Matambudziko. 2011;12, chinyorwa 219 doi: 10.1186/1471-2474-12-219. [PMC free article] [PubMed] [Cross Ref]

25. National Upper Cervical Chiropractic Association. NOKUDA Maitiro Ezviito uye Kuchengeta Mwoyo Murefu. 1st. Monroe, Mich, USA: National Upper Cervical Chiropractic Association; 1994.

26. Gregory R. Muenzaniso wechiri chepamusoro chekuongorora. Upper Cervical Monograph. 1979;2(6): 1 5.

27. Woodfield HC, Gerstman BB, Olaisen RH, Johnson DF Kutenderera kwekutendeseka kwekutenderera mhete dzekutsika kwekusarura kusagadzikana kwemajoko-urefu. Nyaya yeManpulative uye Physiological Therapeutics. 2011;34(4):239�246. doi: 10.1016/j.jmpt.2011.04.009. [PubMed] [Cross Ref]

28. Andersen RT, Winkler M.. Nyaya yeCanada Chiropractic Association. 1983;2(27): 55 58.

29. Eriksen K. Kukurukurirana X-ray analysis. Muna: Eriksen K., mhariri. Kumusoro Cervical Subluxation Complex Ongororo yeiyo Chiropractic uye Kurapa Zvinyorwa. 1. Philadelphia, Pa, USA: Lippincott Williams & Wilkins; 2004. mapeji 163-203.

30. Zabelin M. X-ray analysis. Muna: Thomas M., mhariri. NUCCA: Mitemo uye Maonero. 1st. Monroe: National Upper Cervical Chiropractic Association; 2002. pp 10-1-48.

31. Miyati T., Mase M., Kasai H., et al. Noninvasive MRI chirongwa chekuteerera kusinganzwisisiki mune idiopathic kazhinji inonzi hydrocephalus. Nyaya yeMagnetic Resonance Imaging. 2007;26(2):274�278. doi: 10.1002/jmri.20999. [PubMed] [Cross Ref]

32. Alperin N., Lee SH, Loth F., Raksin PB, Lichtor T. MR-intracranial pressure (ICP). Imwe nzira yekuyera kupisa kwemajoka uye kusamanikidzwa zvisina kufanana nenzira yeM imaging MR: bhunon uye kudzidza kwevanhu. Radiology. 2000;217(3):877�885. doi: 10.1148/radiology.217.3.r00dc42877. [PubMed] [Cross Ref]

33. Raksin PB, Alperin N., Sivaramakrishnan A., Surapaneni S., Lichtor T. Kubata nekuteerera kusinganzwisisiki uye kukonzerwa nekushandiswa kwemasimba magnetic resonance ekuyerera kweropa uye cerebrospinal fluid flow: kudzokorora mitemo, kushandiswa, uye dzimwe nzira dzisingasviki. Neurosurgical Focus. 2003;14(4, chinyorwa E4) [PubMed]

34. Koerte IK, Schankin CJ, Immler S., et al. Yakashandurwa mvura inoshandiswa muchengeti mune varwere vane migraine sezvinoongororwa nechikamu-kusiyana magnetic resonance imaging. Investigative Radiology. 2011;46(7):434�440. doi: 10.1097/rli.0b013e318210ecf5. [PubMed] [Cross Ref]

35. Pomschar A., Koerte I., Lee S., uye al. MRI uchapupu hwekushandurwa kwemvura yakashata uye kusagadzikana kwekutadza mukutambudzika kwakakomba kweuropi. PLoS ONE. 2013;8(2) ini: 10.1371 / magazini.pone.0055447.e55447 [PMC free article] [PubMed] [Cross Ref]

36. Bayliss MS, Batenhorst AS Iyo HIT-6 YeMushandisi gwara. Lincoln, RI, USA: QualityMetric Incorporated; 2002.

37. Coeytaux RR, Kaufman JS, Chao R., Mann JD, DeVellis RF Nzira ina dzekufungidzira zvishoma zvakakosha zvikamu zvakasiyana zvakaenzaniswa nekugadzirisa kuchinja kukuru kweHemisache Impact Test. Zvinyorwa zveKliniki Epidemiology. 2006;59(4):374�380. doi: 10.1016/j.jclinepi.2005.05.010. [PubMed] [Cross Ref]

38. Smelt AFH, Assendelft WJJ, Terwee CB, Ferrari MD, Blom JW Chii chinonzi kuchinja kwechipatara kune mhinduro yeHIT-6? Inofungidzirwa munharaunda yepamusoro-yevanhu vanoita migraine varwere. Cephalalgia. 2014;34(1):29�36. doi: 10.1177/0333102413497599. [PubMed] [Cross Ref]

39. Saul KM, Rose Rose, Becker WJ, et al. HIT-6 uye MIDAS sezviyero zvepfungwa dzakagadzikana muhutano hwekutumira vanhu. kurwadziwa nemusoro. 2010;50(3):383�395. doi: 10.1111/j.1526-4610.2009.01544.x. [PubMed] [Cross Ref]

40. Bagley CL, Rendas-Baum R., Maglinte GA, et al. Kutsigira migraine-chaiyo yehupenyu hwemibvunzo yemibvunzo v2.1 mu episodic uye isingaperi migraine. kurwadziwa nemusoro. 2012;52(3):409�421. doi: 10.1111/j.1526-4610.2011.01997.x. [PubMed] [Cross Ref]

41. Cole JC, Lin P., Rupnow MFT Zvimwe zvakasiyana-siyana zvakasiyana muMigraine-Specific Quality of Life Questionnaire (MSQ) version 2.1. Cephalalgia. 2009;29(11):1180�1187. doi: 10.1111/j.1468-2982.2009.01852.x. [PubMed] [Cross Ref]

42. Dodick DW, Silberstein S., Saper J., et al. Iko kunokonzerwa ne-topiramate pamusoro pehutano hunoenderana nehutano hwehupenyu hwezviratidzo muhupenyu husingaperi. kurwadziwa nemusoro. 2007;47(10):1398�1408. doi: 10.1111/j.1526-4610.2007.00950.x. [PubMed] [Cross Ref]

43. Hr bjartsson A., G tzsche PC Placebo kupindira kwemamiriro ese emakiriniki. Cochrane Database yekuongorora kwakarongeka. 2010; (1) CD003974 [PubMed]

44. Meissner K. Inonzi effectbo nehutachiona hwehurumende: huchapupu hwehukama hwepedyo. Philosophical Transactions dze Royal Society B: Biological Sciences. 2011;366(1572):1808�1817. doi: 10.1098/rstb.2010.0403. [PMC free article] [PubMed] [Cross Ref]

45. Marshall I., MacCormick I., Sellar R., Whittle I. Kuongororwa kwezvinhu zvinokonzera kuongorora kweMRI kushanduka kwevashandi uye kuwedzera kwekuyeresa. British Journal yeNeurosurgery. 2008;22(3):389�397. doi: 10.1080/02688690801911598. [PubMed] [Cross Ref]

46. Raboel PH, Bartek J., Andresen M., Bellander BM, Romner B. Kuwedzera kushandiswa kutsvaga: zvinopesana nenzira dzisingasviki-Kuongorora. Tsvakurudzo Inoshandiswa Pakutsvakurudza uye Kuita. 2012;2012: 14. doi: 10.1155 / 2012 / 950393.950393 [PMC free article] [PubMed] [Cross Ref]

47. Wentland AL, Wieben O., Korosec FR, Haughton VM Kururamisira uye kubereka kwechikamu-kusiyana-siyana MR imaging zviyero zve CSF inoyerera. American Journal of Neuroradiology. 2010;31(7):1331�1336. doi: 10.3174/ajnr.A2039. [PMC free article] [PubMed] [Cross Ref]

48. Koerte I., Haberl C., Schmidt M., et al. Kuratidzira uye kuvimbika kwehutano neropa uye cerebrospinal fluid flow quantification nechikamu-kusiyana kweMRI. Nyaya yeMagnetic Resonance Imaging. 2013;38(3):655�662. doi: 10.1002/jmri.24013. [PMC free article] [PubMed] [Cross Ref]

49. Stoquart-Elsankari S., Lehmann P., Villette A., et al. Chikamu-kusiyana kweMRI kudzidza ye physiologic cerebral flowous venous. Nyaya yeCerebral Blood Flow uye Metabolism. 2009;29(6):1208�1215. doi: 10.1038/jcbfm.2009.29. [PubMed] [Cross Ref]

50. Atsumi H., Matsumae M., Hirayama A., Kuroda K. Matanho ekuda kushanda nesimba uye kutevedza kuratidza kushandisa 1.5-T muchipatara chemishonga yeMRI. Tokai Journal of Experimental and Clinical Medicine. 2014;39(1): 34 43. [PubMed]

51. Becker WJ Kuongorora hutano hwehutano hwehupenyu hwevarwere vane migraine. Canadian Journal of Neurological Sciences. 2002;29(kuwedzera 2): S16 S22. doi: 10.1017 / s031716710000189x. [PubMed] [Cross Ref]

Close Accordion

Chiropractic Spinal Manipulative Therapy for Migraine

by Dr Alex Jimenez | Chiropractic, Clinical Case Reports, Clinical Case Series, Mamiriro Ekutongwa, Functional Medicine, Migraine, Migraines, Physical Rehabilitation

Musoro wemusoro unogona kunge uri kunyanya kukonzera nyaya, kunyanya kana izvi zvichatanga kuitika kakawanda. Kunyanya zvakadaro, misoro inogona kuva dambudziko guru kana chirwere chinowanikwa chepfungwa chinenge chichiita migraine. Kurwadziwa kwemukoko kazhinji chiratidzo chinokonzerwa nekukuvara kwepasi uye / kana mamiriro pamwe nechepamusoro pemutsipa wekervical, kana kumusoro nehuro. Nenzira yakanaka, nzira dzakasiyana-siyana dzokurapa dzinowanikwa kubatsira kubatsira kubata misoro. Chiropractic kuchengetedza inonyanya kuzivikanwa nzira yokurapa inoshandiswa iyo inowanzokurudzirwa kurwadziwa kwemutsipa, misoro uye migraines. Chinangwa chekutsvakurudza kwekutsvakurudza ndekutsvaga kubudirira kwechiropractic spinal manipulative therapy for migraine.

Chiropractic Spinal Manipulative Therapy for Migraine: Chidzidzo Chekudzidza Chimwe Chete-Chiremera Chechipiri-Chichirongwa Chichirongwa Chirwere Chirwere

ngovepo

ziviso

Migraine inokanganisa 15% yehuwandu hwevanhu, uye ine hutano hwakawanda uye hupfumi hwemagariro evanhu. Pharmacological management inotanga kurapa. Zvisinei, mishonga yakaoma uye / kana prophylactic inogona kuregererwa nekuda kwemigumisiro yechirwere kana kupesana. Nokudaro, isu tinotarisira kuongorora kushanda kwechiropractic spinal manipulative therapy (CSMT) yeigraineurs mune imwechete-yakafukidzirwa placebo-inochengetedzwa kushandiswa kwechipatara chirongwa (RCT).

Method uye Analysis

Sekureva kwesimba rekuverenga, makumi mapfumbamwe evatori vechikamu anodiwa muRCT. Vatori vechikamu vanozoitwa zvakasarudzika mune rimwe remapoka matatu: CSMT, placebo (sham manipulation) uye kutonga (zvakajairika zvisiri zvemanyorerwo manejimendi). I-RCT ine zvikamu zvitatu: 90? Mwedzi inomhanya-mukati, mwedzi mitatu inopindira uye kuongororwa kwekutsvaga pakupera kwekupindira uye 1, 3 uye 3 mwedzi? Iyo yekupedzisira yekupedzisira poindi ndeye migraine frequency, nepo migraine nguva, migraine kusimba, misoro indekisi (frequency x nguva x kusimba) uye mushonga wekushandisa ndiwo echipiri magumo ekupedzisira. Kuongorora kwekutanga kuchaongorora shanduko mumigraine frequency kubva kune yekutanga kusvika kumagumo ekupindira uye yekutevera, uko mapoka CSMT uye placebo uye CSMT nekutonga zvichaenzaniswa. Nekuda kwekuenzanisa kwemapoka maviri, p kukosha pazasi pe6 ichaonekwa seinokosha. Kune ese ese maperero ekupedzisira uye ongororo, ap kukosha pazasi 12 ichashandiswa. Mhedzisiro yacho ichaunzwa pamwe inoenderana p tsika uye 0.025% CIs.

Maitiro uye Kuparadzirwa

RCT ichatevera mitemo yekuongorora keriniki kubva kuMunyika Yese Inonzi Headache Society. Dare reNorway Regional Committee yeAradic Research Research neNorwegian Social Science Data Services rakagamuchira basa racho. Nzira ichaitwa maererano nehutauriri hweHelsinki. Migumisiro ichabudiswa pamisangano yesayenzi uye mumagazini ekuongorora-peer.

Trial Registration Number

NCT01741714.

Keywords: Statistics & Nzira dzekutsvaga

Simba uye Kukwana kweChidzidzo ichi

Chidzidzo chacho chichava chekutanga katatu-yakagadzirirwa maitiro ekurapa randomised clinical trial (RCT) kuongorora kushanda kwechiropractic spinal manipulative therapy kupfurikidza ne placebo (sham manipulation) uye kudzora (rambai muchigadzirisa mararamiro ekugadzirisa pasina kutora kupindira mubhuku) kune migraineurs.
Yakasimba mukati mekugadzirisa, sezvo imwe chiropractor inenge ichitungamirira matanho ose.
RCT ine mikana yekupa kwete kusarudzwa kwemasvomhu yekugadzirisa migraineurs.
Ngozi yekudonha inowedzerwa nekuda kwekuomeserwa kwakatemwa nzira uye 17? Mwedzi yekureba kweiyo RCT.
Nzvimbo inogamuchirwa yakawanda inogamuchirwa haisati yave yakagadzirirwa kurapwa; saka, kune ngozi yekusapofumadza, apo muongorori anopa maitiro asingagoni kupofumadzwa nekuda kwezvikonzero zviri pachena.

kumashure

Migraine inowanzova noutano hwehutano nehuwandu hwehutano uye hupfumi hwehupfumi. Pachangobva kuitika Global Burden of Disease study, migraine yakarongerwa sechikamu chechitatu chakajairika. [1]

Mifananidzo yemukadzi ane migraine inoratidzwa nemheni inobva mumusoro wayo.

About 15% yehuwandu hwevanhu vane migraine. [2, 3] Migraine inowanzoita unilateral nekupuruzira uye kuenzanisa / kwakanyanya misoro inowedzerwa nekuita kwesekuita, uye inoperekedzwa nefotophobia uye phonophobia, kuda kurutsa uye dzimwe nguva kurutsa. [4] Migraine inowanikwa mumhando mbiri huru, migraine isina aura uye migraine ine aura (pazasi). Aura inodzoserwa kukanganiswa kwehuropi kwemaonero, ekufunga uye / kana ekutaura basa, kunoitika pamberi pemusoro. Zvisinei, kusiyana kwemukati memunhu kubva pakurwisa kuenda kurwisa kwakajairika. [5, 6] Kwakatangira migraine kunopikisana. Izvo zvinorwadza zvinokonzeresa zvinogona kubva kubva kuhutatu hwemitsipa, yepakati uye / kana nzira dzeparutivi. [7, 8] Kuwedzera kwekurwadziwa kwekurwadziwa kwezvimiro kunosanganisira ganda, mhasuru, arteri, periosteum uye majoini. Ganda rinotarisisa kune ese maitiro ehurombo, asi epasi uye emutsipa mhasuru dzinogona kunyanya kuve maronda uye hunyoro mune migraine. [9-11] Saizvozvowo, iyo yekumberi supraorbital, yepamberi temporal, yekumashure uye occipital arteri anonzwa kurwadziwa . [9, 12]

Notes

Rudzi Rwenyika Dzepasi Dzekushaya Matambudziko-II Kuongorora Zvokuongorora Migraine

Migraine pasina Aura

A. Kurwisa kushanu kana kuzadzisa nzira dzeB D
B. Kurwiswa nemusoro kunogara 4 72? H (isina kurapwa kana kurapwa zvisina kubudirira)
C. Musoro unobata zvinhu zviviri zvinotevera:
1. Unilateral nzvimbo
2. Kuchengetedza unhu
3. Kutambura kwakakomba kana kurwadza kwakanyanya
4. Yakasvibiswa kana kuti inokonzera kudzivisa kuita zvekuita nguva dzose
D. Pakati pemusoro musoro pane chimwe cheizvi:
1. Nausea uye / kana kurutsa
2. Photophobia uye phonophobia
E. Hazvirevi kune chimwe chirwere
Migraine ane aura
A. Kurwisa kuviri kunozadzisa nzira dzeB D
B. Aura inosanganisira imwe yeiyo inotevera, asi hapana kushaya simba kwemuti:
1. Zviratidzo zvekuona zvakakwana zvinosanganisira zviratidzo zvakanaka (kureva, zviedza zvinopenya, mavara kana mitsara) uye / kana zvinhu zvisina kunaka (kureva, kurasikirwa kwemaonero). Kutambura kwakakomba kana kurwadza kwakanyanya
2. Zviratidzo zvinoshandiswa zvakakwana zvinosanganisira zviratidzo zvakanaka (kureva, mapini nemasese) uye / kana zvinhu zvisina kunaka (kureva, kushaya simba)
3. Kudzokorora zvakakwana dysphasic mutauriri kukanganisa
C. Zvimwe zviviri zvezvinotevera:
1. Homonymous zviratidzo zvinoratidzika uye / kana kusawirirana kwezviratidzo zvinonzwa
2. Chiratidzo chimwechete cheaura chinokura zvishoma nezvishoma pamusoro pe5? Min uye / kana zvakasiyana zviratidzo zveaura zvinoitika zvichiteedzana pamusoro? 5? Min
3. Chiratidzo chega chega chinogara? 5 uye? 60? Min
D. Musoro kuzadzisa nzira BD ye1.1 Migraine isina aura inotanga panguva yeaura kana kutevera aura mukati me60? Min
E. Hazvirevi kune chimwe chirwere

Pharmacological manejimendi ndiyo yekutanga nzira yekurapa kune vane migraineurs. Nekudaro, vamwe varwere havashiviriri akanyanya uye / kana prophylactic mushonga nekuda kwemhedzisiro kana zvinopesana nekuda kwekukanganiswa kwezvimwe zvirwere kana nekuda kwekuda kudzivirira mushonga kune zvimwe zvikonzero. Ngozi yekurapa kunyanyoshandiswa nekuda kwekugara uchirwiswa nemigraine inomiririra njodzi huru yehutano nematambudziko akananga uye asina kunangana. Kuwanda kwemishonga inonyanyisa kushandisa musoro (MOH) ndeye 1 is2% muhuwandu hwevanhu, [13-15] ndiko kuti, inenge hafu yevagari vanotambura nemusoro usingaperi (mazuva gumi nemusoro kana kupfuura pamwedzi) vane MOH. [15] Migraine inokonzeresa kurasikirwa kwemazuva mazana maviri nemakumi manomwe ebasa pagore pavanhu chiuru kubva paguru revanhu. [16] Izvi zvinoenderana angangoita mazana matatu nemazana emakore ekushanda makore akarasika pagore muNorway nekuda kwemigraine. Mari yehupfumi pamigraineur yaifungidzirwa kunge $ 270 muUSA uye 1000 kuEurope pagore. [17, 3700] Nekuda kwekuwanda kwemigraine, mutengo wese pagore waifungidzirwa kunge uri $ 655 bhiriyoni muUSA uye -579 bhiriyoni munyika dzeEU, Iceland, Norway neSwitzerland panguva iyoyo. Migraine inodhura zvakanyanya kupfuura kusagadzikana kwetsinga senge dementia, multiple sclerosis, chirwere chaPasinson nesitiroko. [18] Nekudaro, dzisiri-dzemishonga kurapwa nzira dzakakodzera.

Nzira ye Diversified uye nzira yeGonstead ndiyo inonyanya kushandiswa chiropractic manipulative treatment inhudziro mubasa, yakashandiswa ne91% ne59%, maererano nayo, [21, 22] pamwe chete nedzimwe nzira dzebhuku uye dzisiri dzebhuku, kureva, dzakanaka mararamiro ehutachiona, rupemene uye kuputika kwepachiviri, kugadziriswa, kugadziriswa kwemashure uye kudzidzira pamwe chete nehuwandu hwezvokudya uye dietetic mazano.

Mamwe mashoma emushonga wekurapa (SMT) akasarudzika akaedzwa (RCTs) achishandisa iyo Diversified nzira yakaitiswa migraine, zvichiratidza mhedzisiro pane migraine frequency, migraine nguva, migraine kusimba uye mushonga unoshandiswa. [23-26] Zvisinei, zvakajairika zvekare RCTs ndiyo nzira yekukanganisa kwakadai sekusarongeka kwemusoro kuongororwa, kureva kuti, bvunzo yemibvunzo yakashandiswa haina kujeka, [27] isina kukwana kana isina maitiro ehurongwa, kushomeka kweboka re placebo, uye ekupedzisira uye echipiri magumo ekupedzisira asina kutaurwa. [28-31] Mukuwedzera , maRCT apfuura haana kutevedzera zvakarayirwa kiriniki kubva kuInternational Headache Society (IHS). [32, 33] Parizvino, hapana maRCT akashandisa nzira yeGonstead chiropractic SMT (CSMT). Nokudaro, tichifunga nezvekukanganisa kwemaitiro muRCT dzakapfuura, kliniki ye-placebo-inodzorwa RCT ine yakagadziridzwa nzira yehutano inoramba ichiitirwa migraine.

Iyo SMT mashandiro ekuita pane migraine haina kuzivikanwa. Zvinopikiswa kuti migraine inogona kutanga kubva mukuomarara kweanociceptive afferent mhinduro dzinosanganisira yepamusoro kervical spine (C1, C2 uye C3), zvichitungamira kune hypersensitivity mamiriro enzira yetrigminal inoburitsa ruzivo rwekunzwa kwechiso uye zvizhinji zvemusoro. [34 [35] Tsvagiridzo yakaratidza kuti SMT inogona kukurudzira neural inhibitory masisitimu pamatanho akasiyana emusana, uye inogona kumisikidza akasiyana epakati ekudonhedza nzira dzekudzivirira. [36-40] Zvisinei, kunyange hazvo nzira dzakarongedzwa dzehupenyu dzisinganzwisiswe zvizere, pane mukana nzira dzekuwedzera dzisina kutsvagirwa dzinogona kutsanangudza mhedzisiro yeSMT ine pakurwadziswa kwekurwadziwa.

Chifananidzo chechipiri chemukadzi ane migraine uye mufananidzo unoratidza huropi hwehupenyu panguva yemigraine.

Chinangwa chechidzidzo ichi ndechokuongorora kushanda kweCSMT nekushambabo (sham shampulation) uye kutonga (rambai muchigara mune zvemishonga musarudzo musingawani kupindira kwemashoko) kune migraineurs muRCT.

Method uye Yakasikwa

Iyi i-single-blinded-placebo-inodzorwa RCT nemapoka matatu akafanana (CSMT, placebo uye kutonga). Pfungwa yedu yekutanga ndeyekuti CSMT inopa yakaderera 25% muvhareji nhamba yemigraine mazuva pamwedzi (30? Mazuva / mwedzi) zvichienzaniswa ne placebo uye kutonga kubva pekutanga kusvika kumagumo ekupindira, uye isu tinotarisira kuti kudzikiswa kumwe kuve inochengetwa pa3, 6 uye 12? mwedzi yekutevera. Kana iyo CSMT kurapwa ichishanda, ichapihwa kune vatori vechikamu vakagamuchira placebo kana kutonga mushure mekupedzisa kudzidza, ndiko kuti, mushure megumi nemaviri? Mwedzi yekutevera. Chidzidzo ichi chinotevedzera marongedzero ekurapwa emakiriniki kubva kuIHS, 12 32 uye nzira dzeCONSORT neMOIR. [33, 41]

Vagari vevarwere

Vatori vechikamu vanozotorwa munguva yaNdira kusvika Nyamavhuvhu 2013 kuburikidza neAkershus University Hospital, kuburikidza nevevashandi vese uye kushambadzira kwevezvenhau, kureva kuti, mapepa ane ruzivo rwakazara achaiswa kumahofisi evashandi vese pamwe neruzivo rwemumuromo kumatunhu eAkershus neOslo. , Noweyi. Vatori vechikamu vanogashira ruzivo rwakatumirwa nezve chirongwa chinoteverwa nehurukuro pfupi yefoni. Avo vakanyoreswa kubva kumahofisi evashandi vese vanofanirwa kutaura nemuongorori wezvekuchipatara uyo ane ruzivo rwekutaurirana rwakapihwa pamaposita kuti vawane ruzivo rwakawanda nezve chidzidzo ichi.

Vanokodzera vatori vechikamu vari pakati pegumi nemasere kusvika makumi manomwe emakore ezera uye vane imwe chete migraine yekurwiswa pamwedzi. Vatori vechikamu vanoonekwa maererano nemaitiro ekuongororwa kweInternational Classification ye Headache Disorders (ICHD-II) nachiremba wezvehutano muAkershus University Hospital. [18] Ivo vanongobvumidzwa kuve neco-kuitika kweye tension-mhando misoro uye kwete mamwe epamoyo ekutanga.

Maitiro ekuregedza anopesana neSMT, musana radiculopathy, nhumbu, kushushikana uye CSMT mukati memwedzi yapfuura 12? Vatori vechikamu avo panguva yeRCT vanogashira chero epamberi maitiro nema physiotherapists, chiropractors, osteopaths kana vamwe vashandi vehutano kurapa musculoskeletal marwadzo nekuremara, kusanganisira kurapa kwekuswadzisa, kubatana pamwe nekubata, [44] akachinja yavo yekurapa musoro musoro mushonga kana nhumbu inozobviswa kubva kudzidza panguva iyoyo uye kutorwa sekusiya chikoro. Ivo vanobvumidzwa kuenderera uye nekuchinja avo akajairwa acute migraine mishonga mukati mese kuyedzwa.

Mukupindura pakusangana kwekutanga, vatori vechikamu vanozadzisa zvinyorwa zvekubatanidza vachakokwa kuti vawedzere kuongororwa nechiropractic muongorori. Kuongorora kunosanganisira kubvunzurudzwa uye kuongorora kwepanyama nekusimbiswa kwakanyanya pamutsara wose wemutsara. Mashoko ehurukuro uye akanyorwa pamusoro pechirongwa achagoverwa mberi uye kutaura uye muromo uye kubvumwa kwakanyorwa kuchawanikwa kune vose vanobvumirwa nevatori vechikamu panguva yekubvunzurudzwa uye nechekuongorora kliniki. Maererano nehutano hwakanaka, varwere vose vachaudzwa nezvekuvhiringidza uye kubatsirwa pamwe chete nekukanganiswa kwakashata kwekupindira kunosanganisira kunyanya kunzwira tsitsi uye kuneta pazuva rekurapa. Hapana zviitiko zvakakomba zvakashata zvakave zvataurwa nezvechiropractic Gonstead nzira. [45, 46] Vavatori vechikamu vanosarudzwa mumashandisirwo anobatsira kana kuti placebo vachawana ruzivo rwakakwana rwekuongorora kwemashoko uye inorongwa nokuda kwemasangano ekupindira e12. Boka rinodzora harifaniri kutaridzirwa kuongororo iyi.

Clinical RCT

Iko kliniki RCT inosanganisira 1 mwedzi kumhanya-mukati uye 3? Mwedzi kupindira. Nguva yenguva ichaongororwa kubva kune yekutanga kusvika kumagumo ekutevera kune ese magumo nzvimbo (Mufananidzo 1).

Mufananidzo 1 Chidzidzo Chekuyerera Chidzidzo

Mufananidzo 1: Chidzidzo chekuyerera chati. CSMT, chiropractic spinal manipulative therapy; Placebo, sham manipulation; Kudzora, ramba uchiita zvekushandiswa kwemasvomemasi pasina kutora kupindira.

Run-In

Vatori vechikamu vanozadza yakagadziriswa diagnostic bepa musoro dhayari 1? Mwedzi usati wapindira iyo inozoshandiswa sedata rekutanga kune vese vatori vechikamu. [47, 48] Iyo dhayari yakavimbiswa inosanganisira mibvunzo yakanangana neakananga kune ekutanga uye echipiri magumo ekupedzisira. X-ray inotorwa yakamira yakamira munzvimbo yeanterioposterior uye yekupedzisira ndege yemuzongoza wese. I-X-ray ichaongororwa nechiropractic muongorori.

Randomisation

Yakagadzirirwa yakavharwa mijenya pamwe neaya matatu maitiro, ndiko kuti, kushingaira kurapwa, placebo uye iro rinodzora boka, rinogovaniswa muzvikamu zvina zvikamu nezera uye murume, kureva, 18 39 uye 40-70? Makore ezera uye varume nevakadzi, zvichiteerana. Vatori vechikamu vanozogoverwa zvakaenzana kumapoka matatu nekubvumira iwo anotora mukana kutora rimwe mugove chete. Iyo block randomisation ichaitwa nevekunze vakarovedzwa bato pasina kubatanidzwa kubva kuchipatara muongorori.

Kupindira

Kushanda kwakasimba kunosanganisira CSMT kushandisa nzira yeGonstead, [21] kureva, kushamwaridzana kwakanyanya, yakakwirira-velocity, pasi-amplitude, pfupi-yever spinal pasina chekugadziriswa kwekugadziriswa kunotungamirirwa kumusana weropachanical kusagadzikana (full spine approach) sezvinoonekwa nehuwandu chiropractic tests.

Kupindira kwe placebo kunosanganisira kunyadzisa, kureva, yakawandisa isiri-yakanangana nekubatana, yakaderera-velocity, yakaderera-amplitude sham push maneuver mune isiri-yechinangwa uye isiri yekurapa nzira yekuraira. Ese asiri ekurapa ekutaurirana anozoitwa kunze kwepamuviri mbiru pamwe neakakwana majoini slack uye pasina zvinyoro zvinyengeri kunyepedzera kuitira kuti pasave nekubatana kwakabatana kunoitika Mune zvimwe zvikamu, anenge achitora chikamu akarara akarerekera pabhenji reZenith 2010 HYLO pamwe nemuongorori akamira kurudyi kwemubatanidzwa neruoko rwake rweruboshwe rwakaiswa kurudyi rwemuchina wekutora chikamu nerumwe ruoko rwuchisimbisa. Mune zvimwe zvirongwa, mupfuri achamira kuruboshwe kwemubatirwi oisa ruoko rwake rwerudyi pamusoro pemucheto wemubatanidzi kuruboshwe ruoko rworuboshwe rwuchisimbisa, achiendesa isiri-yechinangwa yekumanikidza yekufambisa. Neimwe nzira, iwo anotora chikamu akarara munzvimbo imwechete yekumira seboka rinoshanda rekurapa negumbo repazasi rakatwasuka uye gumbo repamusoro rakachinjika negumbo repamusoro pegumbo pakazorora pabvi repazasi regumbo, mukugadzirira danho rekumira kusunda kusunda, izvo kununurwa sechinhu chisiri-chemaune munzvimbo ine gluteal. Dzimwe nzira dzekunyepedzera dzekunyepedzera dzinochinjaniswa zvakaenzana pakati pevatori vechikamu venzvimbo dzinoenderana neprotocol mukati megumi nemaviri-vhiki yekurapa nguva yekusimbisa kudzidza kwechokwadi. Iwo anoshanda uye mapoka epa placebo achagamuchira iyo yakafanana dhizaini uye yekufamba kuongororwa pamberi uye mushure mekupindira kwega kwega. Hapana chekuwedzera kubatanidza kana kuraira kuchapihwa kune vatori vechikamu panguva yekutongwa. Nguva yekurapwa ichasanganisira kubvunzana gumi nembiri, ndiko kuti, kaviri pavhiki mumavhiki ekutanga matatu? Anoteverwa kamwechete pasvondo mumasvondo maviri anotevera uye kamwe pasvondo rechipiri kusvika mavhiki gumi nemaviri asvika. Maminetsi gumi neshanu achagoverwa kubvunzana kune mumwe nemumwe anenge achipinda. Zvese zvekupindira zvichaitiswa kuAkershus University Hospital uye inotarisirwa nechiropractor ane ruzivo (AC).

Mufananidzo wemurume akwegura achigamuchira chiropractic kuchengetedza migraine relief.

Dr Jimenez anoshanda pane wrestler's neck_preview

Iboka rinodzora rinozoenderera mberi nekuchengetedza, kureva, kurapa kwemishonga pasina kupiwa rubatsiro rwechipatara nemucherechedzi wekliniki. Izvozvi zvingabviswa zvinoshandisa boka rinodzora panguva yose yekudzidza.

Kupofumadza

Mushure mega chega chikamu chekurapa, vatori vechikamu vanogashira inoshanda kana placebo kupindira vanozadza de-blinding questionnaire inotungamirwa neyekunze yakadzidziswa yakazvimirira bato isina kubatanidzwa kubva kune yekiriniki muongorori, ndiko kuti, kupa dichotomous yes kana no mhinduro se kuti kurapa kuri kushomeka kwakagamuchirwa here. Iyi mhinduro yakateverwa nemubvunzo wechipiri maererano nezvekuti vaive nechokwadi sei chekuti kurapa kwakashanda kwakagamuchirwa pa 0 10 nhamba yekuyera chiyero (NRS), apo 0 inomiririra kusava nechokwadi zvachose uye gumi inomiririra chokwadi. Boka rinodzora uye muongorori wezvekurapa anogona nekuda kwezvikonzero zviri pachena kuti asapofomadzwa. [10, 49]

Tevera

Kuongorora kwekutevera kuchaitwa pamatanho ekupedzisira akayerwa mushure mekuguma kwekupindira uye pa3, 6 uye 12? Mwedzi yekutevera. Munguva iyi, vese vatori vechikamu vacharamba vachizadza iyo yekuongorora bepa musoro wedhayari uye voidzosera pamwedzi. Panyaya yetsamba isina kudzoserwa kana kushaikwa kwetsika mudhayari, vatori vechikamu vanofonerwa nekukasira pakuona kuti kudzikisira kurangarira kusarura. Vatori vechikamu vanofonerwa nefoni kuchengetedza kuchengetedzwa.

Pfungwa Dzakapera uye Sekondari

Iwo ekutanga uye echipiri magumo ekupedzisira akanyorwa pazasi. Magumo ekupedzisira anonamira kune yakakurudzirwa IHS kiriniki yekuyedza nhungamiro. [32, 33] Isu tinotsanangura huwandu hwemazuva emigraine senzira yekupedzisira yekupedzisira uye tinotarisira kudzikisira 25% muvhareji yemazuva kubva pakuvamba kusvika kumagumo ekupindira, ne iyo yakafanana nhanho yekudzikiswa iri kuchengetwa pakutevera. Pamusoro peongororo dzakapfuura pamusoro pemigraine, 25% kuderedzwa kunoonekwa sekufungidzira kwakachengetedza. [30] A 25% kuderedzwa kunotarisirwawo mune yechipiri magumo ekupedzisira kubva pakutanga kusvika kumagumo ekupindira, kuchengetedza pakutevera kwehurefu hwemigraine, migraine kusimba uye nemusoro index, uko indekisi inoverengerwa sehuwandu hwemazuva emigraine (30 mazuva?) avhareji migraine kwenguva (maawa pazuva) verageavhareji kusimba (0 10 NRS). Iko 50% kuderedzwa mumushonga wemushonga kubva kune yekutanga kusvika kumagumo ekupindira uye yekutevera-inotarisirwa.

Notes

Pfungwa Dzakapera uye Sekondari

Pasi Pfupi Pfungwa

1. Nhamba yemazuva emigraine mukushanda kwakashandukirana newe placebo boka.
2. Nhamba yemazuva emigraine mukushanda kwakashandukirana neboka rinodzora.

Secondary End Points

3. Migraine muhupenyu mumaawa mashoma mukushanda kwakashandura kusvika kune placebo group.
4. Migraine muhupenyu mumaawa mashoma mukushanda kwakashandura kunoenderana neboka rinodzora.
5. Kuzvidavirira kunonzi VAS mukushanda kwakashandura kunopesana ne placebo boka.
6. Kuzvidzivirira kwezvakaitwa VAS mukushanda kwakashandura kune boka rinodzora.
7. Headache index (frequency x nguva x intensity) mukushanda kwakashandukirana newe placebo group.
8. Musoro wehurukuro inoshandiswa pakushandura kunoenderana neboka rekutonga.
9. Musoro wemishonga inoshandiswa muhutano mukushanda kunoitwa pamwe ne placebo boka.
10. Musoro wemishonga inorapa muhutano hwehutano nehutungamiri hweboka.

* Iyo data ongororo yakavakirwa pane yekumhanyisa-mwaka nguva maringe nemagumo ekupindira. Pfungwa 11 40 ichave yakadzokororwa poindi 1 10 pamusoro pa3, 6 uye 12? Mwedzi yekutevera, zvichiteerana.

Data Processing

A flow flow chati yevatori vechikamu inoratidzwa mumufananidzo 2. Baseline demographic uye zvipatara zviratidzo zvichave zvakarongwa semari uye SD dzezvipembenene zvinopfuurirana uye zviyero uye zvikamu zvezvikamu zvakasiyana. Rimwe nerimwe mapoka matatu richarondedzerwa zvakasiyana. Pfungwa dzekupedzisira uye dzepamweya dzicharatidzwa nemhando dzakakodzera dzinotsanangura muboka rimwe nerimwe uye nguva imwe neimwe. Chimiro chemagumo ekupedzisira chichaongororwa zvakajeka uye kushandurwa kunofungidzirwa kana zvichidiwa.

Mufananidzo 2 Anotarisirwa Mutevedzeri Wemufananidzo

Mufananidzo 2: Anotarisirwa muganhu wekuyerera. CSMT, chiropractic spinal manipulative therapy; Placebo, sham manipulation; Kudzora, ramba uchiita zvekushandiswa kwemasvomemasi pasina kutora kupindira.

Kuchinja munharaunda yepamusoro uye yepamweya kubva kumucheto kusvika kumagumo ekupindira uye kutevera-kuenzaniswa kuchaenzaniswa pakati pemapoka akashanda uye placebo uye mapoka anoshingaira uye anoronga. Izvo zvisingaoneki zvinotaura kuti hapana misiyano yakakura pakati pemapoka muhuwandu hwekushanduka, asi imwe nzira inofananidzira inotaura kuti kusiyana kweiyo 25% iripo.

Kubva pane nguva yekutevera, kudzokororwa zvakanyorwa kwepfungwa dzepakutanga uye dzechipiri dzichawanikwa, uye kuongororwa kwemaitiro mumashure ekutanga uye okupedzisira achave ekukosha. Intra-individual correlations (cluster effect) inogona kunge iripo mune deta uye inodzokorora zviyero. Cluster effect ichazoongororwa nekuverenga kukosha kwekubatana kwehuwandu huwandu hwehuwandu hwehuwandu hwehuwandu hwehuwandu hwakasiyana hunokonzerwa nekusiyana kwevanhu. Izvo zvinowanikwa mumagumo ekupedzisira zvichaongororwa nekodzero yekuregeresa yemuenzaniso weiyo longitudinal data (yakasanganiswa yakasanganiswa mufananidzo) kuti iite nhoroondo yakakodzera yeboka rinogona kuitika. Iyo mienzaniso yakasanganiswa yakasiyana inobata zvisingabatsiri dheta, zvichiita kuti ruzivo rune ruzivo ruvepo kubva kune varwere vasina maitiro kuti vaverengwe, pamwe nekubva kuendesa. Kuzvidzora mitemo uye zvakagadziriswa kwenguva yenguva uye kugoverwa kweboka pamwe chete nekubatana pakati pezviviri kuchafungidzirwa. Kukurukurirana kuchafananidza kukanganisa kunokonzerwa pakati pemapoka maererano nenguva yekufamba mumagumo ekupedzisira uye kushanda semunibus test. Zvimwe zvinokonzerwa nevarwere zvichabatanidzwa kurongedza kuongororwa kwehutano hwehutano. Nenzira dzisina maturo dzichafungidzirwa. Nzira dzakasanganiswa dzakasiyana dzichafungidzirwa neSAS PROC MIXED nzira. Kuenzanisa kwezviviri zviviri kuchaitwa kuburikidza nekutora nguva imwe nguva paya kusiyana mukati memapoka ega ega neenhamba yep p yakafanana ne 95% CIs.

Zvose puro-protocol uye chinangwa-che-kubata zvinongororwa zvichaitwa kana zvakakodzera. Zvose zvinongororwa zvichaitwa nenhamba dzevanhu, dzakapofumadzwa nekuda kweboka nekugoverwa. Migumisiro yose yakaipa ichave yakanyoreswa uye inoratidzwa. Vatori vechikamu vanotarisana nemhando ipi neipi yemigumisiro yakaipisisa munguva yekuedzwa vachave nekodzero yekushevedza muchengeti wekliniki purojekiti yefaira. Iyo data ichaongororwa neSPSS V.22 uye SAS V.9.3. Nokuda kwekuenzanisa kweboka maviri mumugumo wekutanga, p values pasi peC0.025 ichaonekwa seanotaridzika. Pamusoro pezvikamu zvose zvekupedzisira kumagumo uye kuongororwa, kukosha kwehuwandu hwe0.05 kuchashandiswa. Kushaya maitiro kunogona kuonekwa musina kukwana mapurisa emubvunzurudzo, asina kukwana misoro yepamusoro, kusapindirwa kwemasangano ekupindira uye / kana nekuda kwekusiya. Nzira yekushayikwa ichaongororwa uye kushayikwa kwehutano kunogadziriswa zvakakwana.

Power Calculation

Muenzaniso masvomhu kuverenga akavakirwa pamhedzisiro mune ichangobva kuburitswa yeboka rekuenzanisa kudzidza pane topiramate. [51] Isu tinofungidzira kuti iwo wepakati mutsauko mukuderedzwa kwemazuva mazhinji ne migraine pamwedzi pakati pemapoka anoshanda uye e placebo mazuva 2.5 mazuva. Musiyano iwoyo unofungidzirwa pakati pemapoka anoshanda uye ekudzivirira. SD yekudzikisa muboka rega rega inofungidzirwa kuti yakaenzana ne2.5. Pasi pekufungidzira kwe, paavhareji, 10 migraine mazuva pamwedzi pakutanga pane rimwe boka uye pasina shanduko mu placebo kana boka rinodzora panguva yekudzidza, 2.5 mazuva mazuva ekuderedzwa anoenderana nekuderedzwa ne25%. Sezvo kuongorora kwekutanga kunosanganisira kuenzanisa kwemapoka maviri, isu tinoseta yakakosha nhanho pa0.025. Muenzaniso wekukura wevarwere makumi maviri unodiwa muchikwata chega chega kuti vaone musiyano wakakura musiyano mukuderedzwa kwe20% ine 25% simba. Kuti vabvumire kusiira chikoro panzira, vaongorori vanoronga kutora vechikamu zana nemakumi maviri.

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight

“Ndakakurudzirwa kutsvaga kurapwa kwechiropractic yemusoro wangu werudzi rwemigraine. Chiropractic spinal manipulative therapy inoshanda kune migraine here? " Mhando dzakasiyana dzakasiyana dzesarudzo dzekurapa dzinogona kushandiswa kunyatso kurapa migraine, zvisinei, chiropractic kuchengetedza ndiyo imwe yenzira dzakakurumbira dzekurapa nzira dzekurapa zvakasikwa migraine. Chiropractic spinal manipulative therapy iyo yechinyakare yakakwira-velocity yakaderera-amplitude (HVLA) kukanda. Iyo inozivikanwawo sekugunun'una kwepamuviri, chiropractor inoita iyi chiropractic maitiro nekushandisa inodzorwa kamwe kamwe simba kune mubatanidzwa apo muviri wakamira mune imwe nzira. Zvinoenderana nechinyorwa chinotevera, chiropractic spinal manipulative Therapy inogona kubatsira kubata migraine.

hurukuro

Mhedziso dzeMitemo

Ikozvino SMT RCTs pane migraine inoratidza kurapa kubudirira pamusoro pemagraine nguva, nguva uye simba. Kunyange zvakadaro, mhedziso yakasimba inoda kliniki isina kuporeswa iyo-placebo-inodzorwa RCTs nemitemo shoma shomanana. [30] Kudzidza kwakadaro kunofanira kutevedzera kune yakakurudzirwa yeHS clinical trial mirayiridzo ne migraine nguva yakawanda sepokupedzisira kuguma uye migraine nguva, migraine simba, headache index uye kushandiswa kwemishonga sechipiri kumagumo. [32, 33] Musoro wemusoro, uyewo kusanganiswa kwemaitiro, nguva uye simba, inopa chiratidzo chehuwandu hwekutambudzika. Pasinei nekushaikwa kwekubvumirana, nhungamiro yemusoro yakakurudzirwa seyakagamuchirwa yepamusoro-soro yekuguma. [33, 52, 53] Pfungwa dzekutanga uye dzekupedzisira dzichaunganidzwa zvichibudirira mune kugadziriswa kuongororwa musoro wezvinyorwa zvekare kune vose vatori vechikamu kuitira kuti vaderedze yeuka hukama. [47, 48] Pakukwanisa kweruzivo rwedu, iyi ndiyo yekutanga inotarisirwa nzira yekurapa mune imwe nhatu-yakashongedzwa-yakasungwa nzvimbo ye-placebo-inodzorwa RCT inofanira kuitwa nekuda kwemigraine. Dzidziso yekugadzirisa inoteerera kune mazano ekurapa maRTMs zvakanyanya. RCTs dzinosanganisira boka re placebo uye boka rinodzora zvinobatsira kuvargmatic RCTs iyo inofanidza maitiro maviri anoshandiswa ekurapwa. RCTs inopawo nzira yakanakisisa yekuunza kuchengetedzwa pamwe chete nedhiyabhorosi yedhesi.

Mufananidzo wemukadzi ane migraine akabata musoro wake.

Kusapofumadza kupofumadza ingangove njodzi yeRCT. Kupofumadza kunowanzooma sezvo pasina imwe yakagadziriswa yakagadzirwa chiropractic sham inopindira iyo inogona kushandiswa seboka rinodzora rezuva rino. Izvozvi, zvisinei, zvakakosha kuisanganisira boka re placebo kuitira kuti rive nehutano hwechokwadi hwekuita kupindira. Kubvumirana nezvenzvimbo yakakodzera yekuchengetedza kliniki ye SMT pakati pezvenyanzvi dzinomiririra vanachiremba nevadzidzisi, zvisinei, hazvina kuwanikwa. [54] Hapana zvidzidzo zvekare zvakapfuura, kune zvakanakisisa zvezivo yedu, yakagadziriswa kubudirira kwekuporesa kwechirongwa chechipatara cheCSMT ne multiple sessions treatment. Tine chinangwa chokuderedza dambudziko iri nekutevera purogiramu yakarongwa yeboka re placebo.

Nzvimbo yebhenekeri inowedzera zvakare mune zvepamusoro pemasvomhu uye inofungidzirwa zvakadai semasvomhu ekuongorora zvipatara; zvisinei, zvingatove zvakakwirira mumabhuku ekurapa RCTs zvakanyatsotarisirwa uye kubatana kwepanyama kunobatanidzwa. [55] Saizvozvowo, kunetseka kwepanyama pamusoro pekufungisisa kunenge kuchibatanidzwa kuboka rekutonga sezvo risingaonekwe nemunhu kana kuti risingaoneki zvakanyanya nechechipatori anoongorora semamwe mapoka maviri.

Iko kunogara kune njodzi dzekudonha nekuda kwezvikonzero zvakasiyana. Sezvo nguva yekuyedzwa iri 17? Mwedzi iine gumi nemaviri-mwedzi yekutevera-nguva, njodzi yekurasikirwa nekutevera inowedzerwa. Kubatanidzwazve kwekumwe kupindira kwebhuku panguva yekutongwa ndiyo imwe njodzi inogona kuitika, nekuti avo vanogamuchira kumanikidza kana mamwe marapirwo emuviri kumwe kunhu mukati menguva yekutongwa vachabviswa kubva muchidzidzo uye voonekwa sevanosiiwa panguva yekutyorwa.

Izvo zvekunze kwekodzero yeRCT inogona kunge iine utera sezvo kune mumwe chete anoongorora. Zvisinei, takaona kuti zvinobatsira kune vatsvakurudzi vakawanda, kuitira kupa ruzivo rwakafanana kune vatori vechikamu mumapoka ose matatu uye kupindira kwebhuku muna CSMT uye mapoka e placebo. Nokudaro, isu tinoda kupedza kuparadzanisa kwemukati-mutsva unogona kuvapo kana kune vaviri kana vanopfuura vapfuri. Kunyange zvazvo nzira yeGonstead ndiyo yechipiri inowanzoshandiswa netsika pakati pechiropractors, hationi nyaya yekutinhira kana ine chokuita nekugadzirisa uye kunze kwekuita. Uyezve, iyo nhamba ye randomisation ichapa shanduro yakafanana mumapoka matatu.

Iko mukati maitiro, zvisinei, yakasimba kuburikidza nekuva nechiremba mumwe chete wokurapa. Iyo inoderedza ngozi yekusarudzwa kusarudzwa, ruzivo uye kuedza kushandiswa. Uyezve, kuongororwa kwevadzidzi vose kunoitwa nevanoziva nezvemagetsi uye kwete nemibvunzo. Kubvunzurudzwa kwakananga kune huwandu hwekunzwisisa uye huwandu hwakaenzaniswa nekuenzanisa nemibvunzo yemibvunzo. [27] Zvimwe zvinokurudzira zvinokonzera zvinogona kuita kuti munhu anenge aine chikamu aone uye zvaanofarira paanenge achitarisa zvose zviri kuderedzwa nokuva nemutsvaga mumwe. Mukuwedzera, kubvumirana kwemukati kunowedzera kusimbiswa nevanenge vakavanzwa vachigadziriswa nzira. Sezvo makore nemakore evanhu vangave nechinzvimbo mukugadzirisa migwagwa, kuvharidzira randomisation kwakawanikwa zvakakosha kuenzanisa zvombo nezera uye hutano kuitira kuti kuderedze kukwanisika kwepabonde uye / kana yehutano hwakabatana.

Mufananidzo we X-rays kuratidzira kurasikirwa kwekervical lordosis sechikonzero chinokonzera migraine.

X-rays kuratidza kurasikirwa kwechibereki lordosis sechikonzero chinokonzera migraine.

Kuitisa maX-ray pamberi peanoshanda uye ekuisa placebo akawanikwa achishandiswa kuitira kuona mamiriro, kubatana uye disc kuvimbika. [56, 57] Sezvo iyo yakazara X-ray radiation mwero ichisiyana kubva pa0.2-0.8? MSv, mwaranzi kuratidzwa kwaifungidzirwa kuve kwakaderera. [58, 59] X-ray kuongororwa kwakawanikwawo kuve kwakakosha kuitira kuti uone kana izere musana X-rays inobatsira muzvidzidzo zvenguva yemberi kana kwete.

Sezvo isu tisingazivi nzira dzekugona kushanda zvakanaka, uye zvose zviri mumutsipa wepelinha uye pakati nepakati pakadzika nzira dzisina kudzivirirwa dzakagadziriswa, hationi zvikonzero zvekusiya kusungirirwa kwepine mushonga wekupindira kweboka rinopindira. Izvi zvakaratidza zvakare kuti marwadzo akasiyana-siyana mumasipireti haafaniri kuonekwa sematambudziko akasiyana asi asi senhengo imwe chete. [60] Saizvozvowo, kusanganisira zvizere zvepfungwa zvinokonzera kukanganisa pakati peCSMT nemapoka e placebo. Nokudaro, inogona kusimbisa mikana yekubudirira kupofumadza muboka re-placebo riri kuwanikwa. Mukuwedzera, mahofisi ese e-placebo achaitwa kunze kwemukona wepelinha, nokudaro kuderedza kunogona kweropa rwonzivo rwemagetsi.

Innovative uye Scientific Value

Iyi RCT ichasimbisa nekusimbisa Gonstead CSMT ye migraineurs, iyo isina kumbobvunzwa. Kana CSMT ichiratidza kuti inoshanda, inopa hutachiona hwekurapa. Izvi zvinonyanya kukosha sevamwe vashandisi vasina hutano hwezvinyorwa zvakajeka uye / kana prophylactic mishonga, asi vamwe vane zvisingagoneki zvinokonzerwa nemigumisiro kana kukanganiswa kwevamwe zvirwere zvinopesana nemishonga apo vamwe vanoda kuvhara mishonga nokuda kwezvikonzero zvakasiyana-siyana. Nokudaro, kana CSMT inoshanda, inogona kuva nemigumisiro yekurapa kwemigraine. Chidzidzo chacho chinokonzerawo kubatana pakati pechiropractors uye vanachiremba, izvo zvinokosha kuitira kuti utano hwehutano huve hunobudirira. Pakupedzisira, nzira yedu inogona kushandiswa mune ramangwana chiropractic uye mamwe mabhuku eRCTs pamusoro wemusoro.

Maitiro uye Kuparadzirwa

Ethics

Chidzidzo chakabvumidzwa neNorway Regional Committee yeMedical Research Ethics (REK) (2010/1639 / REK) neNorway Social Science Data Services (11-77). Kuzivisa kwaHelsinki kunoteverwa neimwe nzira. Yese data ichave isingazivikanwe nepo vatori vechikamu vachifanira kupa nemuromo uye nekunyora zivo ruzivo. Inishuwarenzi inopihwa kuburikidza neNorway System yeCompensation to Patients (NPE), inova nyika yakazvimiririra yenyika yakagadzirirwa kugadzirisa zvichemo kubva kuvarwere vakakuvara nekuda kwekurapwa pasi pebasa rezvehutano reNorway. Mutemo wekumisa wakatsanangurwa wekubvisa vatori vechikamu kubva muchidzidzo ichi zvinoenderana nezvakakurudzirwa muCONSORT yekuwedzera kweKunaka Kuzivisa kweHarms. [61] Kana mukwikwidzi akamhan'arira kuchiropractor kana kune vanotsvaga chiitiko chakakomba, anozobviswa pachidzidzo oendeswa kunavanachiremba vese kana dhipatimendi rekukurumidzira kuchipatara zvichienderana nemamiriro echiitiko ichi. Yekupedzisira data seti ichave ichiwanikwa kune wekiriniki muongorori (AC), akazvimiririra uye akapofomadzwa statistician (JSB) uye Study Director (MBR). Dhata richachengetwa mukabati rakavharirwa kuResearch Center, Akershus University Hospital, Norway, kwemakore mashanu?

Kuparadzirwa

Iyi purojekiti inofanirwa kupedzwa 3? Makore mushure mekutanga. Mhedzisiro ichave yakaburitswa mune vezera-vakaongorora epasi rese esainzi magazini zvinoenderana neCONSORT 2010 Chirevo. Mhedzisiro yakanaka, yakaipa, pamwe neyakajeka ichaburitswa. Uye zvakare, pfupiso yakanyorwa yakaiswa yemhedzisiro ichave iripo yekudzidza vatori vechikamu pachikumbiro. Vanyori vese vanofanirwa kukodzera kunyorwa zvinoenderana neInternational Committee yeMedical Journal Editors, 1997. Munyori wega wega aifanirwa kutora chikamu chakaringana pabasa rekutora ruzhinji kuita zvemukati. Sarudzo yekupedzisira pakurongeka kwemunyori ichagadziriswa kana chirongwa chapera. Mhedzisiro kubva mukudzidza inogona, zvakare, kuunzwa semaposta kana mutauri mutaurwo kumusangano wenyika uye / kana wepasi rese.

Kutenda

Akershus University Hospital nemutsa vakapa zvivako zvekutsvakurudza. Chiropractor Clinic1, Oslo, Norway, yakaita X-ray kuongorora.

Mashoko Omuzasi

Vabatsiri: AC uye PJT vaiva nemuongorori wekutanga wekudzidza. AC uye MBR yakawana mari. MBR yakaronga huwandu hwekugadzira. AC yakagadzirira kutanga kwepurogiramu uye PJT yakataura pamusoro pekupedzisira shanduro yechirongwa. JSB yakaita nhamba dzose dzinoongorora. AC, JSB, PJT uye MBR vakapindira mukududzirwa uye vakabatsirwa mukugadzirisa nekugadzirisa kwemavara. Vose vanyori vakaverenga uye vakabvuma magwaro ekupedzisira.

Mariro: Chidzidzo chacho chakagamuchira mari kubva kuAddstiftelsen (nhamba yekupa: 2829002), chiNorwegian Chiropractic Association (nhamba yepaeni: 2829001), Akershus University Hospital (nhamba yekupa: N / A) uye Yunivhesiti yeOslo kuNorway (nhamba yekupa: N / A) .

Kukwikwidzana: Hapana chakaziviswa.

Kubvumirwa nemwoyo murefu: Akawanikwa.

Kugamuchirwa kwemitemo: Dare reNorway Regional Committee reMitambo yekutsvakurudza yezvokurapa rakagamuchira basa (ID yekubvumirwa: 2010 / 1639 / REK).

Provenance uye peer review: Haana kutumirwa; kunze kwezera rekuongorora.

A Randomized Controlled Trial of Chiropractic Spinal Manipulative Therapy for Migraine

ngovepo

Chinangwa: Kuongorora kubatsira kwechiropractic spinal manipulative therapy (SMT) mukurapa migraine.

Design: Muedzo unongorongedzwa usinganzwisisiki wemwedzi we6. Chiyero chacho chaive nematanho e3: mwedzi 2 yekuunganidza deta (musati watapwa), mwedzi 2 yekurapa, uye mamwe mwedzi 2 yekuunganidza data (mushure mekurapa). Kuenzaniswa kwemigumisiro kune zvisikwa zvekutanga zvekutanga zvakagadzirwa pamagumo emwedzi ye6 kune boka re SMT uye boka rekutonga.

Kuisa: Chiropractic Research Center yeMacquarie University.

Vadzidzi: Vane zana makumi maviri nemanomwe vanozvipira pakati pemakore e10 nemakore 70 vakanyoreswa kuburikidza nekutengeswa kwemashizha. Kuongororwa kwemigraine kwakagadzirwa pamusana peStendered Headache International Society, ine uwandu hwekunge imwechete migraine pamwedzi.

Zvinyorwa: Mwedzi miviri ye chiropractic SMT (diversified technique) pamagadzirirwo emagetsi anotsanangurwa nevadzidzisi (huwandu hwehutano hwe16).

Mitezo mikuru Mitezo: Vatori vemapurisa vakapedzisa zviyero zvepamusoro zvemashoko munguva yekutongwa kwose kucherechedza nguva, kuwedzerwa (inooneka analogue score), nguva, kuremara, zviratidzo zvinobatana, nekushandiswa kwemishonga kune umwe neumwe migraine episode.

Results: Ivhareji yekupindura yeboka rekurapa (n = 83) yakaratidza kuwanda kwakakosha mukuwedzera kwemigraine frequency (P <.005), nguva (P <.01), kuremara (P <.05), uye kushandiswa kwemishonga (P <.001 ) kana ichienzaniswa neboka rinodzora (n = 40). Vanhu vana vakatadza kupedzisa kutongwa nekuda kwezvikonzero zvakasiyana siyana, zvinosanganisira shanduko yekugara, tsaona yemotokari, uye kuwedzerwa kwemigraine kuwanda. Yakatsanangurwa mune mamwe mazwi, 22% yevatori vechikamu vakashuma kudarika 90% kuderedzwa kwemigraines semhedzisiro yemwedzi miviri yeSMT. Vanoda kusvika makumi mashanu kubva muzana vatori vechikamu vakazivisa shanduko yakakosha mukukanganiswa kwechikamu chega chega.

mhedziso: Mhedzisiro yeichi chidzidzo inotsigira mhedzisiro yapfuura inoratidza kuti vamwe vanhu vanotaura kuvandudzwa kwakanyanya mumigraines mushure mechiropractic SMT. Chikamu chepamusoro (> 80%) chevatori vechikamu chakaratidza kushushikana sechinhu chakakonzera migraines yavo. Zvinotaridzika sezvingabvira kuti chiropractic kuchengetedza ine zvainoita pamamiriro epanyama ane chekuita nekushushikana uye kuti mune vanhu ava mhedzisiro yemigraine inoderedzwa.

Mukupedzisa, chiropractic spinal manipulative therapy inogona kushandiswa zvakajeka kubatsira kubata migraine, maererano nekuongorora kwekuongorora. Uyezve, chiropractic yakagadzirisa hutano hwehutano uye hukama hwakakwana. Utano hwemuviri womunhu wose hutendwa humwe humwe hukuru hwezvikonzero nei chiropractic kutarisira kunobatsira migraine. Mashoko anotsanangurwa kubva kuNational Center for Biotechnology Information (NCBI). Kuwanda kweruzivo rwedu kunogumira kune chiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota ivai vakasununguka kubvunza Dr. Jimenez kana kuti tibvunzei kwatiri 915-850-0900 .

Yakarongedzwa naDkt Alex Jimenez

Mimwe Misoro: Neck Pain

blog chinyorwa chekartoon paperboy makuru makuru