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        New Message Board Archives >> 2004 Cluster Headache Specific Posts >> Fresh Research - Clusterheads in Taiwan
        
(Message started by: floridian on Jul 22^nd, 2004, 11:28am)

Title: Fresh Research - Clusterheads in Taiwan
Post by floridian on Jul 22^nd, 2004, 11:28am

A study of 104 clusterheads in Taiwan - 86% male, 73% smokers or former smokers, 100% episodic! In addition to an absence of chronics, fewer Taiwanese are restless during an attack and fewer have aura. CH peaks in Taiwan in the winter (the shortest day on that tropical island has around 10 hours of light). It takes the average CH sufferer 8.1 years to get diagnosed there. No word on the overall incidence.

Quote:

Cephalalgia. 2004 Aug;24(8):631-8.

Cluster headache in the Taiwanese - a clinic-based study.

Lin KH, Wang PJ, Fuh JL, Lu SR, Chung CT, Tsou HK, Wang SJ.

Department of Internal Medicine, Chia-I Veterans Hospital, Chia-Yi, Taiwan.

Lin K-H, Wang P-J, Fuh J-L, Lu S-R, Chung C-T, Tsou H-K & Wang S-J. Cluster headache in the Taiwanese - a clinic-based study. Cephalalgia 2004; 24:631-638. London. ISSN 0333-1024Cluster headache has not been fully investigated in Asians. One hundred and four patients (90M/14F; mean age 39.2 +/- 12.2 years) with cluster headache were recruited from two major headache clinics in Taiwan. They filled out a structured cluster headache questionnaire. All participants were diagnosed to have episodic cluster headache. Mean age of onset was 26.9 years; mean latency of diagnosis was 8.1 years. A trend of decrease in male/female ratio with time was noted. Seventy-three percent were ex- or current smokers (M: 79%, F: 36%). Restlessness was reported by 51% patients. Only 1 patient (1%) reported visual aura. Patients responded well to standard acute and prophylactic treatment. The monthly incidence of cluster period was inversely related to sunshine duration. Compared to Western series, our patients were different in several aspects including the absence of chronic cluster headaches and a low prevalence of restlessness and aura. Racial and geographical factors might contribute to these discrepancies.

Title: Re: Fresh Research - Clusterheads in Taiwan
Post by Margi on Jul 22^nd, 2004, 12:16pm

This truly is fascinating, Floridian. I did a quick check and Taiwan has a population of 22 million. They only found just over 100 of those 22 million to be clusterheads. (That's a 0.0000045 rate by my calcs :o) Granted, there are probably more, but I've always found it interesting that we don't have any Asian members in any of our International OUCH groups. Is it genetic? Is it dietary? Is it latitudinal?

How can a clusterhead NOT be restless during attack? That single fact, alone, makes me wonder if they are correctly diagnosed. Doesn't it make you think that as well? Also, the fact that the Taiwanese doctors expect that there should be aura associated with cluster (more normally associated with migraine), it leads me to think that maybe they are diagnosing too quickly.

Thanks for putting this up here.

Title: Re: Fresh Research - Clusterheads in Taiwan
Post by floridian on Jul 22^nd, 2004, 12:48pm

Margi,

I don't think they are claiming that there are only 104 clusterheads in all Taiwan - just that they identified 104 people with clusterheadaches, and then described the composition of that group.

Still lots of questions, as you point out. How did they diagnose? Did they confuse clusters with migraines? What is the overall rate for all Taiwain?

I would guess that the latitude would decrease the total number of cases. Genetics and diet also could play a role. Islands are famous for being genetically unusual - reproductive isolation for thousands of years can amplify some rare genes, or delete others. The modern Taiwanese diet is changing pretty rapidly (for the worse) but is still probably different from a western diet.

Title: Re: Fresh Research - Clusterheads in Taiwan
Post by Samantha_Smith on Jul 22^nd, 2004, 7:51pm

They may view it as "impolite" to be restless during an attack. Just a thought.....maybe there are cultural reasons they don't pace.

I ,also, found it interesting that all participants were found to be episodic. Statistically, somewhere around 10% of them should have been chronic--at least that's how it is in the West. Were they exclusively seeking out episodics? Were the chronics misdiagnosed? Or are there truly no chronics in Tiawan? Hmmmm......

Makes me wonder. Floridian, great article! Thanks! Good brain food. Samantha

Title: Re: Fresh Research - Clusterheads in Taiwan
Post by don on Jul 22^nd, 2004, 7:58pm

You have just purchased a 100% clusterheadache.

(Made in Taiwan)

Title: Re: Fresh Research - Clusterheads in Taiwan
Post by Kevin_M on Jul 23^rd, 2004, 10:49am

Quote:

Cluster headache has not been fully investigated in Asians.

Quote:

They filled out a structured cluster headache questionnaire.

Quote:

mean latency of diagnosis was 8.1 years.

Makes you wonder if they know what to look for. The questionnaire would be interesting to see. Eight years, at least four cycles undiagnosed, on average, seems unusual and slow if knowledge is current.

Quote:

Patients responded well to standard acute and prophylactic treatment

This is unusual too, responding "well" is not often accomplished, unless "well" means, "at last, medication!", after eight years undiagnosed. I'd be happy too. Responding "well" is unspecific, otherwise I'd like to know the treatment if they all responded well.
Overall, hard to figure but that lack of restlessness was a stickler. Many people edure pain in different ways, but for a whole race to refrain from expressions of pain when things are at Kip 8-10 undiagnosed for eight years....there is scepticism. Restlessness is an important factor in this level of pain.

Kevin M

Title: Re: Fresh Research - Clusterheads in Taiwan
Post by floridian on Jul 23^rd, 2004, 11:05am

The 8.1 years part doesn't surprise me - here is a quote from a recent article by Dr. Goadsby, and it reflects progress in the UK, where lots of progress has been made. In other countries, it may still take a long time.

Quote:

The mean time to diagnosis has dropped from 22 years in the 1960s to 2.6 years in the 1990s, although the mean number of GPs seen before a diagnosis was made remains at three.

Some of the progress may be cultural/institutional - it still takes an average of 3 doctors to spot clusters, although westerners seem to be seeking out new doctors faster if the first doctor doesn't provide a diagnosis that makes sense. Maybe the Taiwanese don't switch doctors as frequently as we do, or are less likely to be referred to a specialist? And if clusters are less common there, fewer doctors will have the proper experience.

Title: Re: Fresh Research - Clusterheads in Taiwan
Post by forgetfulnot on Jul 23^rd, 2004, 11:16am

I am not very good at math but......................................

Quote:

Seventy-three percent were ex- or current smokers (M: 79%, F: 36%).

= 115%? You would think that they would double check the math before publishing a medical study. ::)

Lee

Title: Re: Fresh Research - Clusterheads in Taiwan
Post by floridian on Jul 23^rd, 2004, 11:29am

on 07/23/04 at 11:16:55, forgetfulnot wrote:

I am not very good at math but......................................

= 115%? You would think that they would double check the math before publishing a medical study. ::)

Lee

I think its 73 percent of the total (104), with additional breakdowns for gender.

all participants .73 x 104 = 76 people total

men who smoke: .79 x 90 = 71 men
women who smoke: .36 x 14 = 5 women

That checks out.

(It should add up to 200% - 100% of men + 100% of women.)

Title: Re: Fresh Research - Clusterheads in Taiwan
Post by ave on Jul 23^rd, 2004, 2:21pm

It is a shame the archives of the old message board are no longer complete.

I remember a post from a Japanese sufferer, who told
about co-sufferers who were too ashamed to come "out of the closet" with their ailment; because having headaches was not done, for males....

Title: Re: Fresh Research - Clusterheads in Taiwan
Post by Ueli on Jul 23^rd, 2004, 3:26pm

The 8.1 years is not surprisingly long, considering the fact that probably many wasted a few years with Chinese hanky-panky.

And it is not a whole lot more than the 6.6 years that the Robbins Headache Clinic gathered from 789 useres of a message board at some website (if I remember right it was www.clusterheadache.com): :)

The Misdiagnosis of Cluster Headache (July 2000) (http://www.headachedrugs.com/archives/misdiagnosis.html)

Ave, the archives of the old massageboard are still intact, and what's more, they can be searched using Google.

Archives of old CH.com msb (http://www.clusterheadaches.com/archives.html)

The thread of the Italian Japanese you can find at:

www.clusterheadaches.com/wwwboard/messages/76670.html (http://www.clusterheadaches.com/wwwboard/messages/76670.html)

PFNADs
Ueli [smiley=smokin.gif]

Title: Re: Fresh Research - Clusterheads in Taiwan
Post by floridian on Jul 23^rd, 2004, 3:50pm

on 07/23/04 at 15:26:44, Ueli wrote:

The 8.1 years is not surprisingly long, considering the fact that probably many wasted a few years with Chinese hanky-panky.

PFNADs
Ueli

Chinese Hanky panky?? Is that a bit of a blanket statement?

Quote:

Zhongguo Zhong Xi Yi Jie He Za Zhi. 1996 May;16(5):280-2.

[Effect of new zhengtian pill on 5-hydroxytryptamine content in platelet and plasma of migraine patients]

[Article in Chinese]

Wang DN, Chen BT, Zhou YL.

252 Hospital of PLA, Baoding.

Changes of 5-hydroxytryptamine (5-HT) content in platelet and plasma before and after New Zhengtian Pill (NZTP) therapy in migraine patients were assayed with fluorospectrophotometry. Results showed that during the period of attack, the platelet 5-HT level of patients in comparing with normal control group, was increased (P < 0.05) but the plasma 5-HT level decreased (P < 0.01) and the ratio of the platelet and plasma 5-HT was abnormal P < 0.01. While during the intermittent period the 5-HT was increased both in platelet and plasma and the ratio of intra- and extra-platelet 5-HT was normal. Also, in comparing with before treatment, the post-treatmental plasma levels of 5-HT in patients with or without acute attack were all increased, the above-mentioned 5-HT ratio was also resumed obviously (P < 0.05). This study revealed that both the plasma 5-HT and platelet 5-HT levels and their ratio of patients in acute attack period were abnormal, which might be the pathogenetic basis of migraine. It suggested the mechanism of NZTP in treating migraine might be through its action on absorption, releasing and metabolism of 5-HT by platelet and maintaining a physiologic balance in them.

Quote:

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2001 Nov;21(11):822-4.

[Effect of new zhengtian pill on expression of whole blood platelet membrane adhesion molecules in patients of migraine]

[Article in Chinese]

Zhu CQ, Xie W, Chan BT.

Department of TCM, Nanfang Hospital, First Military Medical University, Guangzhou 510515.

OBJECTIVE: To investigate the effect of New Zhengtian Pill (NZTP) on expression of whole blood platelet membrane adhesion molecules (PMAM) in patients of migraine. METHODS: Sixty-eight patients were divided into two groups, the 35 patients in the treated group treated by NZTP orally and the 33 patients in the control group treated by Fuguiqin Capsule with a therapeutic course of 30 days for both groups. Changes of PMAM GP II b/III a(CD41) and P-selectin (CD62P) were observed by flow-cytometry and compared with those in healthy persons. RESULTS: The markedly effective rate and total effective rate in the treated group was higher than those in the control group respectively (P < 0.05 and P < 0.01). The PMAM expression was also higher in patients, both at onset stage and intermittent stage, than in healthy persons (P < 0.01), NZTP treatment could reduce their increased expression significantly (P < 0.01). CONCLUSION: NZTP could reduce the PMAM expression and inhibit the activation of platelet.

Zheng tian contains Angelica, Ligusticum, Asiasari, Carthami, Ledebouriella, and Aconite - which have demonstrated biological activity. Zheng tian is also recommended for trigeminal nerve pain.

Title: Re: Fresh Research - Clusterheads in Taiwan
Post by Ueli on Jul 23^rd, 2004, 6:57pm

on 07/23/04 at 15:50:12, floridian wrote:

Chinese Hanky panky?? Is that a bit of a blanket statement?

No, I'm sure the average Chinese CH sufferer tries first to redirect chi, with needles an burning herbs.

The two abstracts you quoted only show that a few Chinese doctors got disloyal to the traditions of their ancestors (shame on them) and started researching similar fields as the long noses. Maybe, someday their research will bring relieve to meegrainers, and even clusterheads, but at the present it does not speed up the diagnosis of a clusterhead at large.

PFNADs
Ueli [smiley=smokin.gif]

Title: Re: Fresh Research - Clusterheads in Taiwan
Post by floridian on Jul 23^rd, 2004, 9:18pm

on 07/23/04 at 18:57:22, Ueli wrote:

...

The two abstracts you quoted only show that a few Chinese doctors got disloyal to the traditions of their ancestors (shame on them) and started researching similar fields as the long noses.

PFNADs
Ueli

I don't see it as an either/or situation - there are many evidence-based empirical researchers who draw from the Chinese tradition. For example, the UN WHO is in the process of approving artemisinin for the treatment of malaria; this herbal extract has long been used in the orient for treating a variety of parasite diseases. The original 'western' malaria drug was derrived from the bark of the cinchona tree after Jesuits learned of the process from Amazon Indians.

Are you familiar with neural networks?? Neural networks solve a problem (or 'learn') by iteratively adjusting to the inputs. A rational understanding of the problem is not necessary, and the training process creates internal hybrid or artificial variables which may intuitively correspond to real world phenomena, but often do not. Apart from their overt beliefs and doctrines, most indigenous medical systems do contain a great deal of information from trial and error.

Concepts that seem strange or anti-scientific at first may in fact be completely logical and in agreement with science - the trick is to get beyond the confusion of words. Case in point - foods considered 'heating' by traditional chinese medicine (litchee, longan) have been shown to stimulate prostaglandin E2 production and Cox2 metabolism, while 'cooling' foods (chrysanthemum flower, bitter gourd, and lotus seed plumule) inhibit PGE2 and COX2. With no kowledge of the underlying biochemistry, these substances were classified according to their effect on the human metabolism, and they are now prescribed or avoided in response to particular conditions. The Taiwanese researchers who studied this are in no way 'dishonoring their ancestors.'

Second case in point - while western researchers look for a CGRP inhibitor to treat cluster headaches, several traditional Chinese/Japanese herbal formulas have been shown to supress the paroxysmal production of CGRP that causes hot flashes in menopausal women. Whether or not it helps with cluster headaches remains to be seen. But it should grab the attention of anyone who really wants to develop an effective, affordable treatment. I have corresponded with a number of western trained scientists, who seem quite uninterested in such a primitive therapy which they apparently deem to be incompatible with their modernist approach to reality.

Quote:

Chen JT, Shiraki M.
Menopausal hot flash and calciotonin gene-related peptide; effect of Keishi-bukuryo-gan, a kampo medicine, related to plasma calciotonin gene-related peptide level.
Maturitas. 2003 Jul 25;45(3):199-204.

Noguchi M, Ikarashi Y, Yuzurihara M, Kase Y, Takeda S, Aburada M.
Effects of 17 beta-estradiol and the Japanese herbal medicine Keishi-bukuryo-gan on the release and synthesis of calcitonin gene-related peptide in ovariectomized rats.
J Pharmacol Sci. 2003 Sep;93(1):80-6.

Noguchi M, Ikarashi Y, Yuzurihara M, Kase Y, Chen JT, Takeda S, Aburada M, Ishige A.
Effects of the Japanese herbal medicine Keishi-bukuryo-gan and 17beta-estradiol on calcitonin gene-related peptide-induced elevation of skin temperature in ovariectomized rats.
J Endocrinol. 2003 Mar;176(3):359-66.
PMID: 12630921 [PubMed - indexed for MEDLINE]