Anatomical and physiological contributions of nasal turbinate vessels and lymphatics to the pathogenesis of nasal congestion in recurrent headaches: a pilot study.
Jacob M Chmielecki, Aishwarya Vemula, Joyce G Schwartz, Jonathan A Gelfond, William T Phillips
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引用次数: 0
Abstract
Introduction: The aim of this study was to determine if specific anatomical changes were present in patients with recurrent headaches including patients with chronic migraines, chronic tension-type headaches, and daily persistent headaches. A retrospective study of 200 patients was performed to evaluate the potential of measuring the amount of nasal blood pool activity (nasal congestion) as a predictive marker for recurrent headaches.
Methods: A cohort analysis was performed involving patients who had been referred to the Nuclear Medicine Clinic over a 3-year period for whole-body blood pool scans. The scans were evaluated by region of interest (ROI) analysis of nasal and heart max pixel count ratios (NHMRs) to determine an association between nasal blood pooling activity and recurrent headaches at the time of the initial scan and in follow-up evaluations over a period of 3-6 years.
Results: Significantly greater NHMRs were observed in 122 patients with chronic headaches at the time of referral for their initial whole-body blood pool scan when compared with those patients without recurrent headaches (p = 0.004; OR 10.5; 95% CI 2.22-56.7). An additional 15 patients, for a total of 137, developed recurrent headaches following their initial scan and before their follow-up evaluation. NHMRs were also significantly increased in the additional patients when compared to those without recurrent headaches (p = 0.004; OR 12.3; 95% CI 2.34-75.5).
Conclusion: Patients with recurrent headaches have significantly increased nasal activity as observed on 99mTc-MDP whole-body blood pool scans, supporting the hypothesis that nasal lymphatic dysfunction plays a role in the etiology of recurrent headaches. This research highlights a novel diagnostic use of the whole-body blood pool scan for the assessment of nasal turbinate vasodilation as well as a possible new target for the treatment of recurrent headaches.
本研究的目的是确定复发性头痛患者是否存在特定的解剖改变，包括慢性偏头痛、慢性紧张性头痛和日常持续性头痛患者。对200例患者进行了回顾性研究，以评估测量鼻血池活动性（鼻塞）作为复发性头痛预测指标的潜力。方法：对在核医学诊所就诊的患者进行了为期3年的全身血库扫描队列分析。通过鼻腔和心脏最大像素计数比（NHMRs）的感兴趣区域（ROI）分析来评估扫描结果，以确定初次扫描时鼻腔血池活动与复发性头痛之间的关系，并在3-6年的随访评估中进行评估。结果：122例慢性头痛患者转诊进行首次全身血库扫描时的NHMRs明显高于无复发性头痛患者(p = 0.004；或10.5;95% ci 2.22-56.7)。另外有15名患者（共137名）在初次扫描后和随访评估前出现了复发性头痛。与没有复发性头痛的患者相比，额外患者的NHMRs也显著增加(p = 0.004；或12.3;95% ci 2.34-75.5)。结论：99mTc-MDP全身血池扫描显示，复发性头痛患者鼻活动明显增加，支持鼻淋巴功能障碍与复发性头痛病因相关的假说。这项研究强调了一种新的诊断使用全身血池扫描来评估鼻甲血管舒张，以及治疗复发性头痛的可能的新靶点。
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