? Headaches are a headache for everyone! According to WHO statistics, headache is the most common disease in neurology. Compared with all diseases, the number of disabled people caused by headache ranks second in the world every year. But our understanding of headache is not thorough enough, and many people even think that taking painkillers is good, and headache is not a disease.

"Headache is a disease, and it has a certain physiological mechanism. Taking painkillers is not the best way for people who often have headaches. Chen Shibin, a neurologist at Taipei Veterans General Hospital and a professor at the Institute of Clinical Medicine, said.

Chen Shibin joined the headache research group in Yang Rong about 17 years ago to solve the headache mystery. He is an internationally renowned expert in cranial nerve research with outstanding research achievements. He won the "Mr. Wu Dayou Memorial Award" from the Ministry of Science and Technology on 18.

He mainly studies two most painful and intractable headaches-RCVS (Reversible Cerebrovascular Contraction Syndrome) and migraine. RCVS is the most serious and dangerous type of headache. If it is found too late, it is very likely to have a stroke (ischemic cerebral infarction or cerebral hemorrhage). Migraine is the most disabling neurological disease in the world.

However, the operation of cranial nerves is quite complicated, and everyone's reaction to drugs is different. Therefore, Chen Shibin's role is not only to see a doctor and prescribe medicine, but also to invest in research and solve the headache mystery, so as to prescribe the right medicine.

Chen Shibin is an internationally renowned expert in cranial nerve research, with outstanding research achievements. He was awarded the "Mr. Wu Dayou Memorial Award" by the Ministry of Science and Technology 108. (Photo/provided by Chen Shibin)? The first symptom of lightning headache was found in Taiwan Province. The pain caused by RCVS is the king of headaches. Patients will have an instant explosive headache during the onset, also known as lightning headache. Chen Shibin said: "This kind of pain is a terrible headache, which will make you roll on the ground, scream and ask for help. 」

This kind of headache is usually induced by defecation, sexual behavior, bathing or emotional excitement, which brings great trouble to the patient's life. Usually, patients are afraid of taking a bath or defecating. 1-2% of the patients in Beirong Headache Clinic belong to this category.

But before 2007, the world was not familiar with this disease, and only three research teams from Beirong, the United States and France paid attention to it. The name of rcv was also decided by experts at that time. Chen Shibin said that this series of studies will be started, mainly because at first, a patient had a headache that could not be solved by drugs, and then he suffered a stroke in the visual cortex and became blind. The team began to study this mysterious disease.

The research team found that in the cerebral angiography of RCVS patients, the traces of blood vessels contracting one after another can be seen, and the contraction gradually moves from small blood vessels to the central vascular area, so it is difficult to see at the beginning of the examination. RCVS can cause serious complications, such as reversible posterior white matter lesions or brain edema as high as 9-38%, ischemic cerebral infarction as high as 4-54% and cerebral hemorrhage as high as 20%, which must be diagnosed as soon as possible.

? On the left is a picture of cerebral vasoconstriction. The white arrow indicates vasoconstriction, and the black arrow indicates that vasodilation is sometimes accompanied by vasoconstriction, so the blood vessels look like beads, while the right side returns to normal. (Photo/provided by Chen Shibin)? Yang Rong Headache Research Team is the first team in China to clarify the clinical manifestations of RCVS, establish standard procedures for examination and treatment, find complications, develop new imaging technology to assist diagnosis and treatment, and explore the physiological mechanism of diseases. The research results in rcv field can be said to be the first in the world.

Why do blood vessels contract? Chen Shibin admitted that the physiological mechanism of RCVS is not comprehensive at present, but only the headache research team in Yang Rong has studied and published the paper on the physiological mechanism of RCVS. It is now known that patients' sympathetic nerves are easily overactivated, resulting in excessive oxidative stress and vasoconstriction. These phenomena are related to patients with certain genes. In addition, the number of endothelial progenitor cells in blood is small, and the function of repairing cerebral vessels is weak, which is also a prone patient of RCVS.

Recently, the team has also made new discoveries through the study of genome-wide association. Chen Shibin said that the distribution of gene loci in RCVS patients is very different from others, and these genes are also related to cerebrovascular diseases such as blood-brain barrier damage, stroke and cerebral hemorrhage. ? On the left is the normal brain, and from left to right is the appearance of cerebral hemorrhage, stroke and brain edema. (Photo/provided by Chen Shibin)? "That is to say, it is not a single gene that controls RCVS, but many genes contribute a part. If your gene locus (the position of the gene on the chromosome) is very bad, just like having a bad hand, it is easy to get these diseases. Chen Shibin said.

At present, the treatment of RCVS will use cerebrovascular specific "calcium blockers", that is, vasodilators. Chen Shibin mentioned that interestingly, it can immediately relieve headaches, but it can't immediately improve vasoconstriction. When the patient's headache disappears, it is the most serious vasoconstriction, and it is necessary to continue taking medicine until the blood vessels recover. At present, no one knows why, and no one knows why bathing will trigger rcv.

There are still many mysteries about this disease, waiting for the research team to solve them!

? There is no pain in the brain, so how did migraine come from? ? Compared with RCVS, migraine is a disease neglected by the public.

Chen Shibin said that migraine is a disease, but sometimes it is mistaken for a simple cold or menstrual syndrome. Clinically, he saw many patients with headaches, which lasted more than 15 days a month. They take injections and medicines everywhere. After taking them, their liver, kidneys and stomach are all broken, but their headaches are still incurable. According to Beirong's statistics, at present, the patients with severe chronic migraine are about 1.7%, which is quite high.

Chen Shibin warned that migraine is not necessarily a headache on one side. It can be pain on both sides, pain on the top of the head, and sometimes even pain on the shoulder, neck or the whole head. There are symptoms such as nausea, vomiting, photophobia, and fear of noise. Some people will have visual signs before the attack, and there will be flashes or blind spots in front of them, but they can't see clearly the situation ahead.

? The visual omen will present a vague vision in front of him. (Photo/provided by Chen Shibin)? The pathophysiological mechanism of migraine is also quite complicated, and the most important hypothesis is trigeminal neurovascular theory. Chen Shibin explained that there are no pain nerves in the brain itself, but there are pain nerves in the meninges. Headache comes from trigeminal nerve endings around meninges. When these nerve fibers are activated, it will cause local neuroinflammation, and then activate the endings of pain nerves. After the signal reaches the brain center, we will feel pain.

? One of the causes of migraine is the chain reaction caused by the activation of trigeminal nerve endings around meninges. (Photo/provided by Chen Shibin)? Why is someone's trigeminal nerve more easily activated? Chen Shibin said that genes are one of the factors that affect migraine. Parents have migraine, and children are prone to migraine. In recent years, European and American countries have conducted large-scale research on genome-wide association, and found 44 gene loci related to migraine, while Beirong's research team found 4 loci, two of which are consistent with those found in Europe and America, and the other two are endemic to people in Taiwan Province Province, China.

Chen Shibin said that there is a migraine gene locus "TRPM8" which is universal, and it is responsible for ion channels, and it is related to the pain caused by cold * * *, which indicates that weather changes or temperature changes, such as suddenly entering a cold room on a hot day, are indeed related to headaches. Therefore, it is possible to design drugs for this ion channel in the future to achieve the effect of prevention beforehand.

Chen Shibin believes that for patients with severe migraine, the future goal is to see which genes cause headaches through screening, and then prevent symptoms, adjust physical fitness and reduce the frequency of headaches, instead of just taking painkillers to treat the symptoms.

? Postscript: Doctors are the happiest.

? Despite his excellent research, Chen Shibin still likes being a doctor best. "Doing a lot of research may not have results, but curing patients is a sense of accomplishment, so I prefer clinical practice. 」

He was very impressed. Shortly after he was promoted to attending physician, he received a young patient who was in a coma for a month or two, but her CT and MRI were normal. At this time, the director of the department just went abroad and gave it to him. At that time, no one could find the reason. He felt that the course of the patient was very similar to a case reported by the American research group of the International Neurological Society.

"At that time, no one in Taipei Rongzong had been diagnosed with this disease, so I decided to write to the United States and ask the doctor who found this disease to help me test the patient's antibody, and then send the patient's blood to the United States, which later proved to be anti-NMDA receptor encephalitis, an immune disease (note: this disease was written into a novel and made into a movie" Burning the Brain "). Chen Shibin said that at that time, there was an emergency plasma exchange, and only half of the patients were awake for an hour, and then they continued to be unconscious. Later, after a period of treatment, the patient left the hospital happily with his family.

This incident made him very excited, and he made up his mind to do a good job in research and benefit patients. Although "there are many difficulties in the research and I don't know where to start", he admits that he has gained a lot after breaking through the difficulties. Moreover, if he hadn't been appointed by the professor to do animal experiments when he was a doctor, he wouldn't have got another research weapon and could do research outside epidemiology.

? Chen Shibin went to Harvard University Neurovascular Laboratory for further study. He smiled and said that he walked five kilometers to and from work every day, so he got very dark. (Photo/provided by Chen Shibin)? Chen Shibin said with a smile that neuroscience is based on numerous mistakes and breakthroughs made by scientists. In the past, neuroscience was ridiculed as "knowing everything and doing nothing", but with the efforts of scientists, many degenerative diseases, such as dementia, Parkinson's disease or some rare diseases, such as freezing people and multiple sclerosis, have made some new therapeutic inventions, and I believe that in the foreseeable future, they will no longer be terminal diseases. With this in mind, Chen Shibin felt that all the efforts were worthwhile.