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According to rough estimates, at least one third of the population in developed countries suffers, to varying degrees, from certain forms of primary headache, the modern pharmacotherapy of which is not always effective and has a number of limitations. The non-pharmacological treatment of headache can be an alternative to the prescription of pharmacological agents and the only possible assistance option for patients developing drug-resistant cephalalgias. This review describes various methods of electrical neuromodulation that are used for the management of primary headaches. The authors provide information on current stages in implementation of implantable and non-invasive equipment into clinical practice, which makes possible electrical stimulations of peripheral nerves and of the sphenopalatine ganglion, as well as allows transcranial magnetic stimulation. Also the appearance and usage of portable electrical devices available on the world market are described, and mechanisms that can underlie anticephalgic action of neuromodulation therapy are discussed. Special attention is paid to the methods that are applied for electrostimulation of the vagus nerve and occipital nerves.По приблизительным оценкам не менее трети населения развитых стран в разной степени страдает от тех или иных форм первичных головных болей (ГБ), фармакотерапия которых не всегда эффективна и имеет ряд ограничений. Немедикаментозное лечение ГБ может быть альтернативой назначению фармакологических средств и единственно возможным вариантом оказания помощи пациенту при развитии у него лекарственно-резистентной цефалгии. В обзоре рассмотрены различные методы электрической нейромодуляции, использующиеся в терапии первичных ГБ. Приведена информация об этапах внедрения в клиническую практику имплантируемых и неинвазивных устройств, позволяющих осуществлять электростимуляцию периферических нервов и крылонебного узла, а также выполнять транскраниальное магнитное воздействие. Описаны способы применения доступных на мировом рынке портативных электротехнических устройств и обсуждены механизмы антицефалгического действия нейромодулирующей терапии. Особое внимание уделено методам электростимуляции блуждающего и затылочных нервов.

The goal of this paper is to review the pharmacological profile of betahistine and evidence for using it in the treatment of common vestibular disorders. Betahistine is a weak agonist for histamine H1 receptors and strong antagonist for histamine H3 receptors. It demonstrates the maximum benefit in different types of peripheral vertigo, especially in Meniere's disease. The best results in decreasing intensity of vertigo, frequency of attacks and stimulation of vestibular compensation were obtained in daily dose 48 mg during 3 months. In benign paroxysmal positional vertigo betahistine is used to treat residual dizziness after successful treatment of otolithiasis and to reduce the severity of vertigo during repositioning maneuvers. In vestibular neuritis betahistine stimulates central compensation during vestibular rehabilitation. A new once-daily drug formulation of modified-release betahistine is non-inferior to traditional and has a comparable safety profile, and could improve patient adherence. The implication of betahistine in the treatment of central vestibular disorders is under-researched. The efficacy of betahistine in increasing of vestibular compensation in post-stroke central vestibular disorders, persistent postural-perceptual dizziness and its role in vestibular migraine need further investigation.Данной работы — обзор современных представлений о фармакологических свойствах бетагистина, его месте в лечении наиболее распространенных вестибулярных заболеваний. Бетагистин является частичным агонистом гистаминовых H1-рецепторов и сильным антагонистом гистаминовых H3-рецепторов. Наибольшая эффективность этого препарата продемонстрирована при лечении периферических вестибулярных расстройств, особенно болезни Меньера. Наилучшие результаты лечения в виде уменьшения интенсивности головокружения, снижения частоты приступов, стимуляции вестибулярной компенсации получены при приеме суточной дозы 48 мг в течение 3 мес. При доброкачественном пароксизмальном позиционном головокружении бетагистин используется для лечения резидуального головокружения после купирования отолитиаза и уменьшения выраженности головокружения при выполнении репозиционных упражнений. При вестибулярном нейроните бетагистин назначается для стимуляции центральной компенсации в процессе вестибулярной реабилитации. Повышению приверженности пациентов лечению может способствовать применение новой лекарственной формы бетагистина модифицированного высвобождения, назначаемого 1 раз в сутки, обладающего не меньшей эффективностью по сравнению с традиционной формой и сходным профилем безопасности. Роль бетагистина в лечении центральных вестибулярных расстройств недостаточно изучена. Способность бетагистина ускорять вестибулярную компенсацию при постинсультных центральных вестибулярных расстройствах, персистирующем постуральном перцептивном головокружении, а также его роль при вестибулярной мигрени должны быть изучены в дальнейших исследованиях.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants (MR) are successfully used to relieve pain, both in monotherapy and in combinations. The use of fixed drug combinations not only greatly facilitates daily clinical practice and increases patient adherence, but due to the potentiation of pharmacological effects, it allows to achieve better treatment results. This paper presents 3 clinical cases of successful inpatient use of a fixed combination of diclofenac 75 mg and orphenadrine 30 mg in the form of an infusion solution (NEODOLPASSE) for relief of acute back musculoskeletal pain syndrome.Нестероидные противовоспалительные препараты и мышечные релаксанты успешно используются при купировании болевого синдрома как в монотерапии, так и в комбинациях. Применение фиксированных комбинаций препаратов не только существенно облегчает повседневную клиническую практику и повышает приверженность пациентов лечению, но за счет потенцирования фармакологических эффектов позволяет добиться лучших результатов лечения. В данной работе представлены 3 клинических случая успешного применения в условиях стационара фиксированной комбинации диклофенака 75 мг и орфенадрина 30 мг в форме раствора для инфузии (Неодолпассе) для купирования скелетно-мышечного острого болевого синдрома в спине.

Background The non-invasive biomarkers of migraine can help to develop the personalized medication of this disorder. In testing of the antimigraine drugs the capsaicin-induced skin redness with activated TRPV1 receptors in sensory neurons associated with the release of the migraine mediator CGRP has already been widely used. Methods Fourteen migraine patients (mean age 34.6 ± 10.2 years) and 14 healthy volunteers (mean age 29.9 ± 9.7 years) participated in the experiment. A new arrangement of imaging photoplethysmography recently developed by us was used here to discover novel sensitive parameters of dermal blood flow during capsaicin applications in migraine patients. Results Blood pulsation amplitude (BPA) observed as optical-intensity waveform varying synchronously with heartbeat was used for detailed exploration of microcirculatory perfusion induced by capsicum patch application. The BPA signals, once having appeared after certain latent period, were progressively rising until being saturated. Capsaicin-induced high BPA areas were distributed unevenly under the patch, forming “hot spots.” Interestingly the hot spots were much more variable in migraine patients than in the control group. In contrast to BPA, a slow component of waveforms related to the skin redness changed significantly less than BPA highlighting the latter parameter as the potential sensitive biomarker of capsaicin-induced activation of the blood flow. Thus, in migraine patients, there is a non-uniform (both in space and in time) reaction to capsaicin, resulting in highly variable openings of skin capillaries. Conclusion BPA dynamics measured by imaging photoplethysmography could serve as a novel sensitive non-invasive biomarker of migraine-associated changes in microcirculation.

To study the parameters of vestibular evoked myogenic potentials (VEMPs) in different types of vertigo.Seventy-seven patients, 35 men and 42 women, aged 43.7±12.5 years, with vestibular vertigo and unsteadiness were examined. The activity of the stemocleidomastoid muscle in response to auditory stimulation of the ipsilateral ear was recorded using surface electromyography.There were a trend towards the increase in the N2 latency, the significant reduction of the P1-N2 amplitude (p0,005) on both sides and significant changes in the coefficient of asymmetry. Compared to healthy people, the P1 latency and asymmetry in P1 latency were significantly increased in patients with peripheral type of vertigo (p0,005 and р=0,0007, respectively). There were no differences in the P1 latency and N2 in patients with unsteadiness.In patients with peripheral vertigo, central vertigo and unsteadiness, vestibular-spinal reflex was disturbed at different levels of vestibular analyzer.Цель исследования. Изучение параметров вестибулярных миогенных вызванных потенциалов у пациентов с различными типами головокружения. Материал и методы. Обследовали 77 пациентов, 35 мужчин и 42 женщины, в возрасте 43,7±12,5 года с вестибулярным головокружением и постуральной неустойчивостью. С помощью метода поверхностной электромиографии регистрировали активность грудиноключично-сосцевидной мышцы, возникавшую в ответ на звуковую стимуляцию ипсилатерального уха. Результаты и обсуждение. У пациентов с признаками поражения центрального отдела вестибулярного анализатора выявлялась тенденция к увеличению по сравнению с контролем латентного периода N2, а также достоверное снижение амплитуды комплекса P1-N2 с двух сторон (p0,005) без значимых изменений коэффициента асимметрии. У больных с признаками поражения периферического отдела вестибулярного анализатора было выявлено значимое увеличение латентного периода Р1 по сравнению со здоровыми (p0,005). Кроме того, обнаружено статистически значимое (р=0,0007) увеличение коэффициента асимметрии латентного периода Р1. У пациентов с постуральной неустойчивостью достоверных различий латентности P1 и N2 по сравнению с контролем выявлено не было. Заключение. Результаты исследования показали, что у пациентов с головокружением как периферического, так и центрального генеза нарушено формирование вестибулоспинального рефлекса на разных уровнях вестибулярного анализатора.

These recommendations on the diagnosis and treatment of migraine were elaborated by Russian headache experts in accordance with the evidence-based practice. Together with the latest classification, diagnostic principles and criteria of different clinical sub-forms the consensus contains basic data on migraine epidemiology, pathophysiological mechanisms, differential diagnosis and most effective and evidence based approaches to pharmacological and non-pharmacological management of migraine patients.Представленные рекомендации по диагностике и лечению мигрени составлены на основании принципов доказательной медицины. Приведена Международная классификация мигрени последнего пересмотра. Методы диагностики и диагностические критерии ориентированы на различные формы мигрени. Рекомендации даны на основе сведений об эпидемиологии и патофизиологических механизмах мигрени. Охарактеризованы наиболее эффективные лекарственные и немедикаментозные подходы к ведению пациентов с мигренью.

Recurrent episodes of vertigo are one of the most frequent reasons of referrals for medical help. In the Russian medicine, the development of vertigo is traditionally associated with a cerebral vascular pathology. It is suggested that correctly planned clinical neurovestibular study may identify the signs of a balance disorder of peripheral and central genesis.To increase the effectiveness of the differential diagnosis of peripheral and central vertigo in patients with recurrent episodes of balance disorders using the protocol of neurovestibular examination ALGORITM.The study included 120 outpatients with preliminary diagnoses of cerebral ischemia and autonomic vascular dystonia.Signs of lesion of peripheral and central regions of the vestibular system were found in 43.5 and 17.5% patients, respectively. Benign positional vertigo was the most frequent cause of vertigo while chronic cerebral ischemia was identified in 16.5% of the patients.Neurovestibularexamnation using the protocol ALGORITM is important for assessment of the level of vestibular system lesion. Iitis necessary to use it in complex examination of patients with complaints of vertigo.Рецидивирующие приступы головокружения - одна из наиболее частых причин обращения за медицинской помощью. В отечественной медицине возникновение головокружения традиционно связывают с сосудистой патологией мозга. Высказывается мнение, что правильно спланированное клиническое нейровестибулярное обследование может выявить признаки расстройств равновесия периферического и центрального генеза. Цель исследования. Повышение эффективности дифференциальной диагностики периферического и центрального головокружения у пациентов с рецидивирующими эпизодами расстройств равновесия с помощью протокола нейровестибулярного обследования АЛГОРИТМ. Материал и методы. Обследованы 120 амбулаторных пациентов с предварительными диагнозами 'дисциркуляторная энцефалопатия' и 'вегетососудистая дистония'. Результаты. Установлено, что признаки поражения периферической и центральной вестибулярной системы имелись в 43,5 и 17,5% случаев соответственно. Самой частой причиной головокружения оказался отолитиаз, а хроническая ишемия мозга установлена у 16,5% пациентов. Результаты исследования свидетельствуют, что нейровестибулярное обследование с помощью протокола АЛГОРИТМ имеет важное прикладное значение для установления уровня поражения вестибулярной системы и его необходимо использовать при комплексном обследовании пациентов с жалобами на головокружение.

Recent studies indicate that migraine is associated with increased risk of cardiovascular diseases. However, links between autonomic cardiovascular regulation, arterial hypertension (AH) and migraine are still little explored. In this study, we evaluated autonomic regulation in migraine patients with and without hypertension. We studied 104 patients with migraine, aged 34±10 y, including 28 with and 76 without hypertension (M+AH and M-AH groups, respectively). The control group consisted of 88 healthy volunteers matched by age and sex. The autonomic regulation of circulation was examined with the tilt-table test, deep-breathing and Valsalva Maneuver, handgrip test, cold-stress induced vasoconstriction, arterial baroreflex, and blood pressure variability measurements. We found that migraine patients with concomitant hypertension demonstrated reduced arterial baroreflex, whereas other parameters of cardiac autonomic regulation were unchanged. In contrast, most indicators of vasomotor reactivity (blood pressure response to the hand-grip, Valsalva maneuver and cold vasoconstriction) were enhanced in migraine patients with no significant differences between migraine patients with and without hypertension. Patients from both M+AH and M-AH groups more commonly had a family history of cardiovascular disorders. Our data revealed increased vasomotor reactivity in migraine patients, with or without concomitant hypertension. This was associated with the family history of cardiovascular diseases.

Article, Background The autonomous cardiovascular control can contribute to progression of migraine. However, current data on cardiovascular reactivity in migraine, especially severe forms, are essentially contradictory. The main aim of this study was to compare the autonomous regulation of circulation in patients with episodic and chronic migraine and healthy subjects. Methods Seventy three migraine patients (mean age 35 ± 10) including episodic migraine (51 patients, 4–14 headache days/months) and chronic migraine (22 patients, ≥15 headache days/month) along with age-match control (71 healthy voluntaries) were examined. The autonomic regulation of circulation was examined with the tilt-table test, a deep breathing and Valsalva Maneuver, handgrip test, cold-stress vasoconstriction, arterial baroreflex and blood pressure variability. Results The changes in heart rate induced by deep breathing, Valsalva Maneuver, and blood pressure in tilt-table test in patients with migraine did not differ from the control group. In contrast, the values of cold-stress-vasoconstriction forearm blood-flow reactivity (p, published version, peerReviewed

Migraine is the third most common disease in the world. The overall prevalence of migraine in the Russian Federation is estimated at 20% with an estimated global prevalence of 14.7%. Migraine affects mostly people of working age and has a significant negative impact on the quality of life, the level of adaptation, ability to work, social functioning. Migraine represents a significant social and economic burden for patients and society as a whole. A team of national experts on migraine offers a program to prioritize quality of management of patients with headache.Мигрень является третьим по распространенности заболеванием в мире. Общая распространенность мигрени в Российской Федерации составляет 20%, а глобальная распространенность - 14,7%. Заболевание поражает в основном лиц трудоспособного возраста, оказывает существенное негативное влияние на качество жизни, уровень адаптации, трудоспособность, социальное функционирование больных и является значительным социальным и экономическим бременем для пациентов и общества в целом. В статье представлена программа российских экспертов по вопросам мигрени по приоритизации качества ведения пациентов с головной болью.

Noopept is a neuroprotector and nootropics. Literature data revealed the treatment effect of noopept on mild cognitive impairment in patients with discirculatory encephalopathy. The present open prospective study included 60 patients with stroke treated with noopept during 12 months. Cognitive functions were assessed before and after treatment using neuropsychological tests. An analysis of MMSE scores and lateral and categorical associations revealed the significant improvement of cognitive functions after 2 months in patients of the main group compared to the controls. The global assessment of efficacy revealed the mild improvement in the main group while no changes were found in the control group. The results have demonstrated that noopept, used in dose 20 mg daily during 2 months, improves cognitive functions in stroke patients and has a high level of safety.

Efficacy of antidepressants fluvoxamine, amitriptyline and transcranial electrostimulation of the brain in the treatment of chronic daily headache has been studied. Amitriptyline had the highest effect in dosage 50 mg daily but was not well tolerated by patients that resulted in that only 50% of them finished the study. Fluvoxamine had high efficacy and good tolerability in the treatment of chronic daily headache and medication overuse headache. Small dosages of amitriptyline and fluvoxamine potentiated the analgesic effect of transcranial electrostimulation of the brain. The combination of antidepressants with transcranial electrostimulation of the brain alleviated the negative effect of the withdrawal of overused analgesics and may be recommended for out-patient use.

Efficacy and safety of the following antidepressants: amitryptiline (tricyclic antidepressant), escitalopram (selective inhibitor of serotonin reuptake), milnacipran (selective inhibitor of serotonin and noradrenalin reuptake) and maprotiline (selective inhibitor of noradrenalin reuptake) have been compared during the treatment of 120 patients with chronic daily headache. A positive effect was found for all drugs, in particular in the presence of depressive and anxiety symptoms. Most effective proved to be milnacipran and amitryptiline. Escitalopram and milnacipran were more tolerable and had less side-effects. The authors suggested that the combination of noradrenergic and serotoninergic components appears to be most effective in treatment of chronic daily headache.

The study of efficacy of ozone therapy (OT) in preparation of patients with prostatic adenoma (PA) and cystostoma for transurethral resection (TUR) of PA included 20 PA patients with cystostomic drainage who had undergone PA TUR and preoperative preparation with OT sessions. The control group consisted of similar patients but without ozone pretreatment. OT efficacy was assessed by the rate of pyoinflammatory complications (PIC), results of immunological examination, positive changes in prostatic secretion, urine analysis, total blood count, degree ofbacteriuria. In the study group PIC (acute urethritis) developed in 1 patient, in the control--in 6 patients (3 cases of acute urethritis, 2 cases of acute prostatitis and 1 case of acute epididymitis). OT led to lowering of mean values of leukocyturia from 18.1 +/- 0.6 to 14.3 +/- 0.7 on the day of operation, to 10.9 +/- 0.7 after 4 days and to 8.7 +/- 0.6 on postoperative day 8 versus from 18.8 +/- 0.8 to 15.4 +/- 0.7, to 15.8 +/- 0.6 and 13.5 +/- 0.6, respectively. Mean control count of leukocytes in prostatic secretion fell in both groups. OT reduced bacteriuria. Number of bacteria to the day of operation decreased in both groups, but complete elimination of the agent from urine on day 8 was not achieved in the controls. The study group exhibited a rise in the absolute count of blood leukocytes, lymphocytes and ESR diminishing. OT raised significantly the phagocytic count and activity, concentration of mature T-lymphocytes (CD3), T-helpers (CD4), cytotoxic T-lymphocytes (CD8), B-lymphocytes (CD20), T-NK-cells (CD16), T-lymphocyte activation markers (CD3+, CD16+, CD56+, CD3+, CD25+, HLADR+, CD3+. The concentration of IgG, IgM, IgA remained high. Thus, the results of ozone application before PA TUR appeared promising in prevention of postoperative PIC.

Efficacy of 4 medications--topiramate, valproate, gabapentine and carbamazepine--was studied in 180 patients: 84 with chronic migraine, 63 with chronic headache of tension and 33 with a combination of the above types of headache. Mean age of the patients was 40,4+/-11,7 (from 19 to 65 years), most patients were female (n=152). The treatment was conducted during 12 weeks with assessment of efficacy every 2 weeks and 4 weeks after the end of the treatment. The response was high for all anticonvulsants, with the highest efficacy in chronic migraine. Among antidepressants used topiramate proved to be most effective. The use of anticonvulsants allows the reduction of the dosage of analgetics as much as twice and the complete withdrawal of the latter in 20% of cases.

We studied diagnostic potentialities of conventional clinical, device, x-ray and ultrasonic methods including current Doppler technology in differentiation of serous and purulent stages of acute pyelonephritis (AP) in 50 patients (mean age 25.5 +/- 5.5 years). Energetic dopplerangiography (EDA) showed the highest diagnostic significance. EDA was highly informative in renal carbuncle and total purulent destruction of the kidney and low informative in serous and apostematous AP, renal abscess. Conventional ultrasonic, x-ray, clinical and device investigations as well as impulse dopplerography and color Doppler mapping of blood flow are of secondary importance in AP.

On the basis of comprehensive experimental and clinical research the authors defined a variety of migraine-related mechanisms and schemes of migraine-correction by drugs, which should be both of the vascular- and general-actions to ensure an effective medication.

Headache and vertigo often emerge simultaneously. Fifty six (40%) out of 140 patients complaining of vertigo were studied. Emerging in the aura and/or in headache phases, vertigo was more frequently registered in patients suffered from migraine with aura (57%). Vertigo associated with migraine was diagnosed in 25% of the cases. The patients were randomized into 2 equal identical groups, one of which was treated by betaserc (16 mg, 3 times daily before meal) and the other one was given cinnarizine (25 mg, 3 times daily). Treatment duration was 12 weeks. Reduction of vertigo attacks frequency and headache by 50% and over, in comparison to the baseline period, was considered as beneficial. Fifty three (95%) patients completed the treatment course. Decrease of a risk for negative results and a frequency of positive effect of vertigo therapy were significantly higher in the group receiving betaserc. Reduction of monthly relapses by 50% and over was detected in 79% of the patients of betaserc group and in 52% of those of cinnarizine one. Migraine attacks monthly frequency was diminished by 43% and 64%, respectively. Therefore, betaserc is considered for using as vertigolytic medication and for migraine attacks prevention.

53 patients (31 males and 22 females, age 16-82 years) suspected to have a papillary tumor of the upper urinary tract (UUT) underwent transurethral uretheronephroscopy (n = 49) and percutaneous nephroscopy (n = 4). Preoperative examination included clinical, x-ray, radionuclide, CT and cytological investigations. 11 patients with solitary papillary UUT tumors were studied endoscopically. Transurethral uretheronephroscopy and percutaneous nephroscopy detected UUT tumors in 31 (58.5%) patients. Postoperative period was uneventful. 3, 6, 12 months and later after endoscopic removal of UUT tumors a control examination was made (excretory urography, ultrasound examination, repeated rigid or fibrouretheroscopy, urinary cytological test). 2-8 years after endoscopic removal of the tumors 5 patients were free of the tumors, 5 patients withdrawn from the study. One woman with a recurrent tumor was reoperated endoscopically. The conclusion is that endoscopic methods are most precise and specific for diagnosis of papillary UUT tumors and should terminate preoperative examination to determine therapeutic policy. In indications for organ-saving therapy, endoscopic methods can serve as a method of choice in the treatment of the above patients.

Transurethral endoscopic incision of the urinary bladder's diverticular neck has been performed in 29 patients aged 44 to 90 years (mean age 65 years). 25(86.2%) patients had verified concomitant diseases and high anesthesia risk prohibiting radical surgery. According to preoperative diagnosis, the volume of the diverticula ranged from 20 to 700 ml, the diameter of the neck--from 0.3 to 2.0 cm. 10 patients had multiple diverticula. Uroflowmetry registered the maximal urinary flow rate (Qmax) within 2.1-5.3 ml/s. In all the patients surgery was performed under epidural anesthesia, simaltaneously with transurethral resection (TUR) of benign prostatic hyperplasia in 18 patients, with TUR of the urinary bladder neck or incision of the prostate because of its sclerosis in 11 patients. In 2 cases there was also TUR of the bladder for papillary cancer involving the bladder wall and the diverticulum, in 6 cases one-stage pneumatic or mechanical cystolithotripsy was performed. No intraoperative complications occurred. After the operation all the patients resumed normal micturition. Control examination after 6-48-month follow-up Qmax rose to 14.1-23.0 ml/s. Neither ultrasound investigation nor cystography detected diverticulum in 13 patients. The size of the diverticulum diminished in size in 16 patients. Residual urine in large diverticula (14 patients) was 50 ml maximum. 12 months after the operation 1 patient developed recurrent sclerosis of the prostate with reappearance of residual urine. He was reoperated (TUR of the prostate) without incision of the neck of the diverticulum. Postoperative complications were the following: mild electric burn of the thigh (1 case), acute epididimitis treated conservatively (1 case) and early postoperative bleeding which required endoscopic revision of the bladder and coagulation of the bleeding vessel from the cut neck of the diverticulum (1 case). Thus, transurethral incision of the bladder's diverticular neck is effective and low-traumatic intervention which in patients with severe somatic pathology is an alternative to the open surgery, while in patients without such pathology it does not complicate open operation (diverticulectomy) if it becomes necessary.

To reduce frequency and severity of the attacks, migraine was treated preventively between the attacks. The most effective drugs were beta-blockers and antidepressants. In a single-blind study we estimated comparative efficiency of amitriptiline (inhibitor of noradrenaline and serotonin reuptake and 5-HT2-receptor antagonist) 12.5-25 mg/daily, fluoxetine (a selective serotonin reuptake inhibitor) 10-20 mg/daily, and maprotiline (a selective noradrenaline reuptake inhibitor) 10-25 mg/daily. The duration of the therapy of migraine between the attacks was 12 weeks. Each group included 20 patients. 46 patients completed the whole course of therapy: 14 patients received amitriptyline, 16 patients--fluoxetine, and 16 patients--maprotiline. Positive results of the treatment (a reduction of the frequency of the migraine attacks during a treatment by 50% as compared with the baseline period) were observed in 71% of the patients treated with amitriptyline, in 56% of the patients treated with fluoxetine, and in 38% of the patients treated with maprotiline. All the drugs were able to reduce both intensity and duration of a headache. Index of the Quality of Life in the patients with migraine was increased in the groups treated with either amitriptyline or fluoxetine, but not in a group treated with maprotiline. The results obtained agree with the notion about high efficiency of antidepressants given between migraine attacks. Amitriptyline and fluoxetine were more efficient in preventive therapy than maprotiline. These findings suggested indirectly, that the efficiency of antidepressants in treatment of migraine is explained by inhibition of serotonin reuptake and by 5-HT2-receptor antagonism, while influence on the inhibition of noradrenaline reuptake was not so significant.

91 patients with migraine were examined in terms of quantitative evaluation of the severity of the attacks. Efficiencies of application of step-by-step or stratification ways of therapy were compared. Indications for the administration of the drugs for "specific" therapy of the attacks of migraine were determined.

The nociceptive flexor reflex (NFR, R3) was tried for quantitative assessment of pain in patients with various forms of primary and secondary headaches. Amitriptyline and acupuncture elevated the threshold of R3-reflex emergence, though the threshold of subjective pain sensitivity increased only in response to amitriptyline. NFR is adequate for assessing anesthesia efficacy and investigating the mechanisms of action of analgesics in patients with headache.

The effects of antidepressants amitriptyline and pyrazidol on the analgesic action of acupuncture in patients with lumbosacral radiculitis was studied by the double blind control method. The combined use of acupuncture with antidepressants was shown to enhance the effectiveness of the treatment, to increase on the average by 5-6 hours the duration of analgesia within 24 hours after each procedure, to reduce the duration of the treatment on the average by 4-5 days, that indicates the expediency of clinical use of the proposed combination.