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<?xml version="1.0" encoding="UTF-8"?>
<article xmlns:xlink="http://www.w3.org/1999/xlink"
article-type="research"
dtd-version="1.1"
specific-use="production"
xml:lang="en">
<front>
<journal-meta>
<journal-id journal-id-type="publisher">Psychosomatic Medicine and General Practice</journal-id>
<issn>2519-8572</issn>
<journal-title-group>
<journal-title>Psychosomatic Medicine and General Practice</journal-title>
</journal-title-group>
<publisher>
<publisher-name>Private Publisher 'Chaban O. S.'</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">107</article-id>
<article-id pub-id-type="doi">10.26766/pmgp.v3i2.107</article-id>
<article-id pub-id-type="other">616.831-005</article-id>
<article-categories>
<subj-group>
<subject>Reflexotherapy</subject>
<subject>Acupuncture</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Effectiveness of acupuncture for headache in post-stroke patients</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name name-style="western">
<surname>Kovalenko</surname>
<given-names>Olga</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="corresp" rid="cor1"/>
</contrib>
<contrib contrib-type="author">
<name name-style="western">
<surname>Chizhukova</surname>
<given-names>Maryna</given-names>
</name>
<xref ref-type="aff" rid="aff1">2</xref>
</contrib>
<aff id="aff1">
<institution content-type="dept">Shupyk National Academy of Postgraduate Education</institution>
<addr-line>
<named-content content-type="city">Kyiv</named-content>
</addr-line>
<country>Ukraine</country>
</aff>
<aff id="aff1">
<institution content-type="dept">Clinical Hospital "Feofania"</institution>
<addr-line>
<named-content content-type="city">Kyiv</named-content>
</addr-line>
<country>Ukraine</country>
</aff>
</contrib-group>
<author-notes>
<corresp id="cor1">
<email>[email protected]</email>
</corresp>
</author-notes>
<pub-date date-type="pub" iso-8601-date="2018-05-09" publication-format="print">
<day>9</day>
<month>5</month>
<year>2018</year>
</pub-date>
<volume>3</volume>
<issue>2</issue>
<elocation-id>e0302107</elocation-id>
<permissions>
<copyright-statement>© 2017, Kovalenko O., Chizhukova M.</copyright-statement>
<copyright-year>2018</copyright-year>
<copyright-holder>Kovalenko O., Chizhukova M.</copyright-holder>
<license xlink:href="https://creativecommons.org/licenses/by/4.0/">
<license-p>This article is distributed under the terms of the <ext-link ext-link-type="uri"
xlink:href="http://creativecommons.org/licenses/by/4.0/">
Creative Commons Attribution License</ext-link>, which permits unrestricted use and
redistribution provided that the original author and source are credited.
</license-p>
</license>
</permissions>
<abstract abstract-type="section">
<title>Abstract</title>
<sec>
<title>Introduction</title>
<p>Vascular and cerebrovascular diseases remain an actual problem of modern society. More than 70%
of post-stroke patients suffered from different pains. Although a headache is the common
complaint of post-stroke patients it is not described good in specialized literature and its
pathophysiology has not yet been sufficiently studied. In order to relieve headaches, the
patients usually use a lot of medicaments often without an agreement with a doctor. Since
unnecessary polypharmacy is ineffective and leads to a wide range of adverse effects, the search
for pathogenically valid and effective alternative approaches deserves the great attention.
Acupuncture is one of such approaches.
</p>
</sec>
<sec>
<title>Methods</title>
<p>We analyzed 2 groups of patients who had the stroke in anamnesis and suffered from a headache:
the main (acupuncture) group (n = 30) that underwent acupuncture and traditional medications and
the control group that received medication alone (n = 30). The average age of patients in the
main group was 70 (SD 8.06) years. Among them 13 women and 17 men. The average age of
participants in the control group was 70.3 (SD 9.00) years and it included 8 and 22 individuals
of male and female gender. In both groups, the ischemic stroke type predominated. Most patients
in both groups were in residual stroke period. Along with the corporal acupuncture we used a
combined method which included an effect on several microsystems. Evaluation of a headache was
based on 4 criteria: intensity, duration, characteristics, and localization.
</p>
</sec>
<sec>
<title>Results</title>
<p>The data analysis showed that the complex treatment of a headache including combined acupuncture
method statistically significantly (p<0.05) affects three indicators of a headache -
intensity, duration, and characteristics. The pain localization had a tendency to positive
changes (p<0.1). Control group showed good results (p<0.05) only on two headache
indicators - intensity and duration, whereas the effect of treatment on pain characteristics and
localization was not significant. The comparative analysis of the treatment results of the two
groups demonstrated the statistically significant positive effect (p<0,05) in favor to
acupuncture on the four headache criteria: intensity, duration, characteristics, and
localization.
</p>
</sec>
<sec>
<title>Conclusion</title>
<p>Acupuncture in the complex treatment of post-stroke patients significantly reduces a headache in
comparison to standard treatment alone. It can allow improving the effectiveness of
rehabilitation and quality of life.
</p>
</sec>
</abstract>
<kwd-group kwd-group-type="author-keywords">
<title>Keywords</title>
<kwd>stroke</kwd>
<kwd>rehabilitation</kwd>
<kwd>reflexotherapy</kwd>
<kwd>headache</kwd>
<kwd>acupuncture</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec>
<title>Introduction</title>
<p>Vascular and cerebrovascular diseases remain an actual problem of modern society. This is explained by
their significant prevalence, as well as high mortality rates.
<fig id="fig3">
<object-id pub-id-type="doi"/>
<label>Figure 0.5</label>
<caption>
<title>This is figure inside paragraph</title>
</caption>
<graphic xlink:href="fig1.jpg"/>
</fig>
According to the Ministry of Health, 100-120 thousand strokes are registered annually in Ukraine, of
which one third is among the working age population. In 2015, the incidence of acute impairment of
cerebral circulation was 274.1 per 100 thousand population (the average rate of morbidity in Europe -
200 cases per 100 thousand population) <xref ref-type="bibr" rid="bib1">1</xref>, <xref ref-type="bibr"
rid="bib2">
2</xref>. The American Association of Cardiologists reported that 795,000 acute impairments of
cerebral circulation are recorded in the United States in 2017 year, that is, a new stroke occurs almost
every 40 seconds <xref ref-type="bibr" rid="bib3">3</xref>.
</p>
<p>Тут вказаний текст кирилицею для перевірки коректної конвертації шрифта.</p>
<p>According to Harrison R.A., more than 70% of patients with a stroke feel pain every day. Pain genesis is
quite varied: pain in the shoulder joint, pain in the paretic limbs due to distinct spasticity, central
or thalamic pain, myofascial and vertebral pain, headache, etc. <xref ref-type="bibr" rid="bib4">
4</xref>.
</p>
<p>According to the literature, headache in the acute phase of stroke occurs in 27-31% of patients, in the
remote period - much less (3.5-11.0%). Overall, about 11% of patients had reported a permanent or a
periodic headache that occurred 3 months before a stroke. A headache, directly related to a stroke, is
noted by more than 30% of patients <xref ref-type="bibr" rid="bib4">4</xref>,<xref ref-type="bibr"
rid="bib5">
5</xref>,<xref ref-type="bibr" rid="bib6">6</xref>.
</p>
<p>It is believed that if a headache was preceded by a stroke, the probability of its appearance as a
symptom after the onset of acute impairment of cerebral circulation is 20% <xref ref-type="bibr"
rid="bib4">
4</xref>,<xref ref-type="bibr" rid="bib6">6</xref>. It was investigated that significantly more
headaches were observed in patients with atherothrombotic and cardioembolic stroke. Association between
a headache in stroke and hemorrhagic stroke was not detected <xref ref-type="bibr" rid="bib5">5</xref>.
</p>
<p>Despite the fact that in clinical practice headache is a frequent complaint of post-stroke patients, it
is not satisfactorily described in the specialized literature, and its pathophysiology has not yet been
sufficiently studied. One of the mechanisms of a headache to date is the stimulation of the trigeminal
vascular system. The causes are various, including lesions of the brain tissue and brain vessels,
followed by inflammation or reinnervation of pain paths, and even medications. Dipyridamole with
extended release, which is utilized for secondary prevention of stroke, is also among the possible
causes of a headache <xref ref-type="bibr" rid="bib5">5</xref>, as well as changes in brain tissue
perfusion, serotonin release, and prostaglandin levels <xref ref-type="bibr" rid="bib7">7</xref>.
</p>
<p>In order to relieve headaches, patients usually use a significant amount of medications, often without a
doctor’s acknowledgement. Because unjustified polypharmacy is ineffective and contributes to a wide
range of adverse effects (increased secretion of hydrochloric acid in the stomach, cardiovascular
effects, allergic reactions, etc.), the search for pathogenetically substantiated, effective alternative
approaches deserves great attention. The addition to the complex therapy of non-pharmacological methods,
which would contribute to the reduction of side effects and accelerate the recovery time, is relevant to
the present day. Among such methods, an important role is played by methods of reflexology <xref
ref-type="bibr" rid="bib8">8</xref>,<xref ref-type="bibr" rid="bib9">9</xref>.
</p>
<p>
<italic>Reflexotherapy</italic>
(RT) - it is a medical diagnostic system that includes a complex of various ways of influencing the
acupuncture points (AP) and zones of the body through the skin, musculoskeletal and nervous movements
with a sanogenetic purpose. Clinical experience proves the high efficiency of the therapeutic effect of
reflexology in patients with organic lesions of the nervous system, in particular in the case of stroke
effects <xref ref-type="bibr" rid="bib9">9</xref>,<xref ref-type="bibr" rid="bib10">10</xref>,<xref
ref-type="bibr" rid="bib11">11</xref>. Many studies have shown that due to the effect that begins
with the stimulation of the receptor apparatus in AP develops a complex cascade of neuroendocrine
reactions, which, in addition to the peripheral, extends to the segmental and supra-segmental levels of
the nervous system. RT affects nociceptive and anti-nociceptive systems due to indirect stimulation of
secretion of opioid and non-opioid peptides (vasopressin, oxytocin, neurotensin, etc.) <xref
ref-type="bibr" rid="bib9">9</xref>,<xref ref-type="bibr" rid="bib10">10</xref>,<xref
ref-type="bibr" rid="bib11">11</xref>,<xref ref-type="bibr" rid="bib12">12</xref>,<xref
ref-type="bibr" rid="bib13">13</xref>,<xref ref-type="bibr" rid="bib14">14</xref>,<xref
ref-type="bibr" rid="bib15">15</xref>.
</p>
<p>In modern reflexology most often are used corporal classical acupuncture (acupuncture), auricular
therapy, and scalp therapy. The place of influence is the point of acupuncture (TA) - the area of soft
tissues of the body, which is anatomically and physiologically different from the surrounding tissues.
</p>
<p>The effectiveness of acupuncture is controversial. Also it was a subject to extensive studying,
acupuncture’s evidence base remains low. In this study the acupuncture effectiveness as evaluated as a
part of complex rehabilitation of post-stroke. The main hypothesis is that the use of this method can
contribute to disability reducing and quality of life improving.
</p>
<p><bold>Aim</bold>: to evaluate the effectiveness of reflexology, in particular, acupuncture, in the
complex treatment of a headache in patients after stroke.
</p>
</sec>
<sec>
<title>Material and methods</title>
<sec>
<title>Sample description</title>
<p>To solve this goal, we analyzed the parameters of 2 groups of stroke patients suffered from a
headache: acupuncture group (n = 30, acupuncture with traditional medication treatment) and control
group ( n = 30, only medications).
</p>
<p>The average age of patients in the main group was 70 (SD=8.06) years. Among them: women - 13 (66.8
years; SD = 6.96), men - 17 (72.75 years; SD=7.95).
</p>
<p>The average age of the control group was 70.3 (SD=9.0) years. Among them, there were 8 women (68.7
years; SD = 9.7) and 22 men (70.8; SD=8.4).
</p>
<p>Most of the patients had ischemic stroke type (<xref ref-type="fig" rid="fig1">Fig. 1</xref>).
</p>
<fig id="fig1">
<object-id pub-id-type="doi"/>
<label>Figure 1</label>
<caption>
<title>Distribution in groups of patients by the stroke type.</title>
</caption>
<graphic xlink:href="fig1.jpg"/>
</fig>
<p>Regarding the distribution of patients by the period of the stroke (<xref ref-type="fig" rid="fig2">
Fig. 2</xref>), the largest number of participants were recruited at the residual stroke period.
Only small amount of patients had early stroke stage at the baseline.
</p>
<fig id="fig2">
<object-id pub-id-type="doi"/>
<label>Figure 2</label>
<caption>
<title>Distribution of patients by stroke period.</title>
</caption>
<graphic xlink:href="fig2.jpg"/>
</fig>
</sec>
<sec>
<title>Headache evaluation</title>
<p>A headache among the main complaints was observed in 70% of patients in the main group and 84% of
patients in the control group. The headache evaluation was based on 4 criteria:
</p>
<list list-type="ordered">
<list-item>
<p>Criterion A - intensity (estimated using the Visual Analogue Scale (VAS), where "0" is taken
to be the absence of pain, and "10" - unbearable pain);
</p>
</list-item>
<list-item>
<p>Criterion B - duration (estimated in hours based on the time of occurrence during the day);
</p>
</list-item>
<list-item>
<p>Criterion C - characteristics (namely, the presence of diffuse, dull, cluster, one-sided,
bandaging compression pain, etc.);
</p>
</list-item>
<list-item>
<p>Criterion D - localization (forehead, temple, vertex, neck).</p>
</list-item>
</list>
<p>Reflexotherapy, in particular, acupuncture, was performed daily, the number of sessions on average
was 8-10 procedures, the average duration of the procedure per patient was 40 minutes. In order to
increase the effectiveness of the effect, we proposed the modification of the method, which included
a combined effect on the microsystem (ear, scalp area, brush area, foot, and abdomen) simultaneously
with corporeal acupuncture.
</p>
<p>Statistical data were processed according to Student's criterion for dependent and independent
samples using the statistical package "Microsoft Office Excel 2007" and "Statistica for Windows
6.0".
</p>
</sec>
</sec>
<sec>
<title>Results</title>
<p>The effectiveness of the applied effect on the manifestation of a headache was assessed in the dynamics
in the main (<xref ref-type="table" rid="tbl1">Table 1</xref>) and control (<xref ref-type="table"
rid="tbl2">Table
2</xref>) groups, after which the performance indicators of treatment were compared in groups among
themselves.
</p>
<p>Comprehensive treatment of post-stroke patients with a headache with acupuncture (main group) showed
positive clinical results (<xref ref-type="table" rid="tbl1">Table 1</xref>).
</p>
<table-wrap id="tbl1" specific-use="rules">
<label>Table 1</label>
<caption>
<title>Analysis of the results of the combined effect on headache in post-stroke patients in the
main (acupuncture) group (n = 30). Baseline vs. end of treatment.
</title>
</caption>
<table>
<thead>
<tr>
<th colspan="1" rowspan="2">Criterion</th>
<th colspan="2" rowspan="1">Mean</th>
<th colspan="2" rowspan="1">SD</th>
<th colspan="1" rowspan="2">SD</th>
<th colspan="1" rowspan="2">t</th>
<th colspan="1" rowspan="2">р</th>
</tr>
<tr>
<th colspan="1" rowspan="1">Before treatment</th>
<th colspan="1" rowspan="1">After treatment</th>
<th colspan="1" rowspan="1">Before treatment</th>
<th colspan="1" rowspan="1">After treatment</th>
</tr>
</thead>
<tbody>
<tr>
<td colspan="1" rowspan="1">A</td>
<td colspan="1" rowspan="1">3.733333</td>
<td colspan="1" rowspan="1">1.383333</td>
<td colspan="1" rowspan="1">2.899861</td>
<td colspan="1" rowspan="1">1.617167</td>
<td colspan="1" rowspan="1">1.917029</td>
<td colspan="1" rowspan="1">6.714286</td>
<td colspan="1" rowspan="1"><0.05</td>
</tr>
<tr>
<td colspan="1" rowspan="1">B</td>
<td colspan="1" rowspan="1">1.566667</td>
<td colspan="1" rowspan="1">1.006667</td>
<td colspan="1" rowspan="1">1.515059</td>
<td colspan="1" rowspan="1">1.365065</td>
<td colspan="1" rowspan="1">1.485934</td>
<td colspan="1" rowspan="1">2.064187</td>
<td colspan="1" rowspan="1"><0.05</td>
</tr>
<tr>
<td colspan="1" rowspan="1">C</td>
<td colspan="1" rowspan="1">0.481481</td>
<td colspan="1" rowspan="1">0.333333</td>
<td colspan="1" rowspan="1">0.509175</td>
<td colspan="1" rowspan="1">0.480384</td>
<td colspan="1" rowspan="1">0.362014</td>
<td colspan="1" rowspan="1">2.126438</td>
<td colspan="1" rowspan="1"><0.05</td>
</tr>
<tr>
<td colspan="1" rowspan="1">D</td>
<td colspan="1" rowspan="1">12.75</td>
<td colspan="1" rowspan="1">1.111538</td>
<td colspan="1" rowspan="1">32.53226</td>
<td colspan="1" rowspan="1">1.495146</td>
<td colspan="1" rowspan="1">31.81698</td>
<td colspan="1" rowspan="1">1.865191</td>
<td colspan="1" rowspan="1">0.07</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>Analysis of the results of treatment of patients in the main group showed that complex therapy with the
use of acupuncture allowed to obtain a positive effect on the three characteristics: the intensity,
duration, and nature of pain. In addition, there was a tendency to affect D crtiterion (localization, p
= 0.07), which is logical, since the reflexological approach itself, besides the general, suggests a
specific topical effect on the zone of pain manifestation. The indicator did not reach the level of
significance but equals 0.07, which means a "tendency" for change (p <0.1). It can be speculated that
the bigger sample and follow-up period will give enough statistical power to make the difference
significant.
</p>
<p>As a result of the statistical processing of the control group indices, for the Student test for
dependent samples, the following data were obtained (<xref ref-type="table" rid="tbl2">Table 2</xref>).
</p>
<table-wrap id="tbl2" specific-use="rules">
<label>Table 2</label>
<caption>
<title>Analysis of the results of traditional headache treatment in post-stroke patients in the
control group (n = 30). Baseline vs. end of treatment.
</title>
</caption>
<table>
<thead>
<tr>
<th colspan="1" rowspan="2">Criteria</th>
<th colspan="2" rowspan="1">Mean</th>
<th colspan="2" rowspan="1">SD</th>
<th colspan="1" rowspan="2">SD</th>
<th colspan="1" rowspan="2">t</th>
<th colspan="1" rowspan="2">р</th>
</tr>
<tr>
<th colspan="1" rowspan="1">Before treatment</th>
<th colspan="1" rowspan="1">After treatment</th>
<th colspan="1" rowspan="1">Before treatment</th>
<th colspan="1" rowspan="1">After treatment</th>
</tr>
</thead>
<tbody>
<tr>
<td colspan="1" rowspan="1">А</td>
<td colspan="1" rowspan="1">3.266667</td>
<td colspan="1" rowspan="1">2.6</td>
<td colspan="1" rowspan="1">1.720732</td>
<td colspan="1" rowspan="1">1.499425</td>
<td colspan="1" rowspan="1">0.922266</td>
<td colspan="1" rowspan="1">3.959252</td>
<td colspan="1" rowspan="1">< 0.05</td>
</tr>
<tr>
<td colspan="1" rowspan="1">B</td>
<td colspan="1" rowspan="1">2.516667</td>
<td colspan="1" rowspan="1">1.996667</td>
<td colspan="1" rowspan="1">1.68279</td>
<td colspan="1" rowspan="1">1.478695</td>
<td colspan="1" rowspan="1">1.07588</td>
<td colspan="1" rowspan="1">2.647282</td>
<td colspan="1" rowspan="1">< 0.05</td>
</tr>
<tr>
<td colspan="1" rowspan="1">C</td>
<td colspan="1" rowspan="1">0.689655</td>
<td colspan="1" rowspan="1">0.689655</td>
<td colspan="1" rowspan="1">0.470824</td>
<td colspan="1" rowspan="1">0.470824</td>
<td colspan="1" rowspan="1">0</td>
<td/>
<td/>
</tr>
<tr>
<td colspan="1" rowspan="1">D</td>
<td colspan="1" rowspan="1">2.426087</td>
<td colspan="1" rowspan="1">2.286957</td>
<td colspan="1" rowspan="1">1.723954</td>
<td colspan="1" rowspan="1">1.609998</td>
<td colspan="1" rowspan="1">0.696575</td>
<td colspan="1" rowspan="1">0.957895</td>
<td colspan="1" rowspan="1">> 0.05</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>So, as can be seen from the statistical calculations presented in <xref ref-type="table" rid="tbl2">Table
2</xref>, it has been proved that traditional drug therapy significantly reduces a headache in
poststroke patients (p <0.05) only in two indicators - intensity and duration. However, the effect of
treatment on the nature and localization of a headache was not significant.
</p>
<p>Comparative statistical estimation of treatment of patients in two clinical groups showed that the use of
acupuncture in the complex treatment of a headache in poststroke patients was significantly (p <0.05)
positively influenced the manifestations of a headache compared with the control group for 4 criteria:
intensity, duration, character, localization (<xref ref-type="table" rid="tbl3">Table 3</xref>).
</p>
<table-wrap id="tbl3" specific-use="rules">
<label>Table 3</label>
<caption>
<title>Comparative analysis of the treatment results in post-stroke patients with a headache in the
main and control groups (n = 60).
</title>
</caption>
<table>
<thead>
<tr>
<th colspan="1" rowspan="2">Criteria</th>
<th colspan="2" rowspan="1">Control group (n = 30)</th>
<th colspan="2" rowspan="1">Main group (n = 30)</th>
<th colspan="1" rowspan="2">t</th>
<th colspan="1" rowspan="2">р</th>
</tr>
<tr>
<th colspan="1" rowspan="1">m1</th>
<th colspan="1" rowspan="1">Std Dev</th>
<th colspan="1" rowspan="1">m2</th>
<th colspan="1" rowspan="1">Std Dev</th>
</tr>
</thead>
<tbody>
<tr>
<td colspan="1" rowspan="1">A</td>
<td colspan="1" rowspan="1">2.6</td>
<td colspan="1" rowspan="1">1.499425</td>
<td colspan="1" rowspan="1">1.383333</td>
<td colspan="1" rowspan="1">1.617167</td>
<td colspan="1" rowspan="1">3.021743</td>
<td colspan="1" rowspan="1">< 0.05</td>
</tr>
<tr>
<td colspan="1" rowspan="1">B</td>
<td colspan="1" rowspan="1">1.996667</td>
<td colspan="1" rowspan="1">1.478695</td>
<td colspan="1" rowspan="1">1.006667</td>
<td colspan="1" rowspan="1">1.365065</td>
<td colspan="1" rowspan="1">2.694458</td>
<td colspan="1" rowspan="1">< 0.05</td>
</tr>
<tr>
<td colspan="1" rowspan="1">C</td>
<td colspan="1" rowspan="1">0.689655</td>
<td colspan="1" rowspan="1">0.470824</td>
<td colspan="1" rowspan="1">0.310345</td>
<td colspan="1" rowspan="1">0.470824</td>
<td colspan="1" rowspan="1">3.067753</td>
<td colspan="1" rowspan="1">< 0.05</td>
</tr>
<tr>
<td colspan="1" rowspan="1">D</td>
<td colspan="1" rowspan="1">2.241667</td>
<td colspan="1" rowspan="1">1.590165</td>
<td colspan="1" rowspan="1">1.067857</td>
<td colspan="1" rowspan="1">1.453999</td>
<td colspan="1" rowspan="1">2.77949</td>
<td colspan="1" rowspan="1">< 0.05</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>Thus, as shown in <xref ref-type="table" rid="tbl3">Table 3</xref>, the effectiveness of acupuncture in
the complex treatment of a headache in patients after a stroke is significant in compare to medications
alone. In addition, we have received interesting results that refer to the age and sexual aspects of the
patients being studied. Consequently, in a correlation analysis of age and gender, it was found that a
headache was more intense in female subjects (R = 0.34); there was a reverse correlation between the
severity of pain and age of patients (R = 0.39), which is consistent with the findings of other
researchers <xref ref-type="bibr" rid="bib4">4</xref>,<xref ref-type="bibr" rid="bib6">6</xref>. The
complaints on a headache were less pronounced in more older age group and vice versa, the younger age
was associated with more pronounced headache intensity, which may be explained by the exhaustion of the
nociceptive system as a result of both acute and chronic cerebral ischemia in older people <xref
ref-type="bibr" rid="bib4">4</xref>,<xref ref-type="bibr" rid="bib19">19</xref>.
</p>
</sec>
<sec>
<title>Conclusions</title>
<p>Thus, by analyzing the dynamics of therapeutic effects of reflexotherapy on a headache in post-stroke
patients, the following conclusions can be drawn:
</p>
<list list-type="ordered">
<list-item>
<p>The complex treatment of a headache using reflexotherapy according to our proposed method of
combined use of corporative acupuncture with microsystems statistically significantly (p <
0.05) influenced on three indicators: intensity, duration, and pain characteristics. The
"localization" indicator had a tendency to positive changes (p < 0.1).
</p>
</list-item>
<list-item>
<p>The traditional therapy significantly reduces headache in post-stroke patients (p < 0.05) only
for two criteria - intensity and duration, whereas the treatment effects on pain characteristics
and localization were not significant.
</p>
</list-item>
<list-item>
<p>Comparative analysis of the treatment results of patients in the two groups shown statistically
signifiant differences (p < 0.05) in favor of reflexotherapy for headache management.
</p>
</list-item>
</list>
<p>Thus, the use of reflexotherapy in the complex treatment of post-stroke patients allows to significantly
reduce the headache that can lead to improvement of qulaity of life and increase the effectiveness of
the rehabilitation; these results outlines the prospects for further researches on reflexotherapy
effects in this group of patients.
</p>
</sec>
<sec>
<title>Additional information</title>
<sec>
<title>Competing interests</title>
<p>The authors declare that no competing interests exist.</p>
</sec>
</sec>
</body>
<back>
<ref-list>
<title>References</title>
<ref id="bib1">
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mishchenko</surname>
<given-names>TC</given-names>
</name>
</person-group>
<article-title>Epidemiology of cerebrovascular diseases and organization of assistance to patients
with cerebral stroke in Ukraine
</article-title>
<source>Ukrainian Psychoneurology Herald</source>
<year>2017</year>
<volume>25</volume>
<issue>9</issue>
<fpage>22</fpage>
<lpage>24</lpage>
<ext-link ext-link-type="uri">
http://uvnpn.com.ua/upload/iblock/871/8710f7dfba63e16a500a82d17123f077.pdf
</ext-link>
</element-citation>
</ref>
<ref id="bib2">
<element-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Zinchenko</surname>
<given-names>OM</given-names>
</name>
<name>
<surname>Mishchenko</surname>
<given-names>TS</given-names>
</name>
</person-group>
<source>The state of the neurological service in Ukraine in 2015: a statistical and analytical
guide
</source>
<publisher-loc>Kharkiv</publisher-loc>
<year>2016</year>
</element-citation>
</ref>
<ref id="bib3">
<element-citation publication-type="journal">
<person-group person-group-type="author">
<collab>American Heart Association</collab>
</person-group>
<article-title>Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart
Association
</article-title>
<source>Circulation</source>
<year>2017</year>
<volume>135</volume>
<fpage>146</fpage>
<lpage>60</lpage>
<ext-link ext-link-type="uri">https://doi.org/10.1161/CIR.0000000000000485</ext-link>
</element-citation>
</ref>
<ref id="bib4">
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Harrisson</surname>
<given-names>RA</given-names>
</name>
<name>
<surname>Field</surname>
<given-names>TS</given-names>
</name>
</person-group>
<article-title>Post stroke pain: identification, assessment and therapy</article-title>
<source>Cerebrovascular diseases</source>
<year>2015</year>
<volume>39</volume>
<fpage>190</fpage>
<lpage>201</lpage>
<pub-id pub-id-type="doi">10.1159/000375397</pub-id>
</element-citation>
</ref>
<ref id="bib5">
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cherenko</surname>
<given-names>T</given-names>
</name>
</person-group>
<article-title>Postnatal pain syndrome</article-title>
<source>Ukrainian Neurological Journal</source>
<year>2014</year>
<volume>1</volume>
<fpage>11</fpage>
<lpage>18</lpage>
</element-citation>
</ref>
<ref id="bib6">
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hansen</surname>
<given-names>AP</given-names>
</name>
<name>
<surname>Marcussen</surname>
<given-names>NS</given-names>
</name>
<name>
<surname>Klit</surname>
<given-names>H</given-names>
</name>
<name>
<surname>Andersen</surname>
<given-names>G</given-names>
</name>
<name>
<surname>Finnerup</surname>
<given-names>NB</given-names>
</name>
<name>
<surname>Jensen</surname>
<given-names>TS</given-names>
</name>
</person-group>
<article-title>Pain following a stroke: a prospective study</article-title>
<source>European Journal of Pain</source>
<year>2012</year>
<volume>16</volume>
<issue>8</issue>
<fpage>1128</fpage>
<lpage>1136</lpage>
<pub-id pub-id-type="pmid">https://www.ncbi.nlm.nih.gov/pubmed/22407963</pub-id>
<pub-id pub-id-type="doi">10.1002/j.1532-2149.2012.00123</pub-id>
</element-citation>
</ref>
<ref id="bib7">
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Raghunathan</surname>
<given-names>S</given-names>
</name>
<name>
<surname>Richard</surname>
<given-names>B</given-names>
</name>
<name>
<surname>Khanna</surname>
<given-names>P</given-names>
</name>
</person-group>
<article-title>Causes and clinical features of headache in ischemic stroke</article-title>
<source>Progress in Neurology and Psychiatry</source>
<year>2008</year>
<volume>12</volume>
<fpage>21</fpage>
<lpage>23</lpage>
<pub-id pub-id-type="doi">10.1002/pnp.80</pub-id>
</element-citation>
</ref>
<ref id="bib8">
<element-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Dzhuzha</surname>
<given-names>TV</given-names>
</name>
<name>
<surname>Fedorov</surname>
<given-names>SM</given-names>
</name>
<name>
<surname>Gubenko</surname>
<given-names>VP</given-names>
</name>
</person-group>
<source>Pain musculoskeletal syndromes in older people: pathogenesis, clinic, therapeutic agents
</source>
<publisher-loc>Ternopil</publisher-loc>
<publisher-name>Textbooks and manuals</publisher-name>
<year>2017</year>
</element-citation>
</ref>
<ref id="bib9">
<element-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Macheret</surname>
<given-names>EL</given-names>
</name>
<name>
<surname>Korkushko</surname>
<given-names>AO</given-names>
</name>
</person-group>
<source>Basics of Traditional Chinese Medicine in Reflexology</source>
<publisher-loc>Kiev</publisher-loc>
<publisher-name>Action</publisher-name>
<year>2005</year>
</element-citation>
</ref>
<ref id="bib10">
<element-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Bossy</surname>
<given-names>Y</given-names>
</name>
</person-group>
<source>Bases for neurobiologiques des reflexotherapies</source>
<publisher-loc>Paris</publisher-loc>
<publisher-name>Masson</publisher-name>
<year>1983</year>
</element-citation>
</ref>
<ref id="bib11">
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kendall</surname>
<given-names>DE</given-names>
</name>
</person-group>
<article-title>A Scientific Model for Acupuncture</article-title>
<source>American Journal of Acupuncture</source>
<year>1989</year>
<volume>17</volume>
<issue>3</issue>
<fpage>251</fpage>
<lpage>268</lpage>
</element-citation>
</ref>
<ref id="bib12">
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Pomeranz</surname>
<given-names>B</given-names>
</name>
</person-group>
<article-title>Brain opiates work in acupuncture</article-title>
<source>New Scientist</source>
<year>1997</year>
<volume>73</volume>
<issue>1033</issue>
<fpage>12</fpage>
<lpage>13</lpage>
</element-citation>
</ref>
<ref id="bib13">
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zhang</surname>
<given-names>JH</given-names>
</name>
<name>
<surname>Wang</surname>
<given-names>D</given-names>
</name>
<name>
<surname>Liu</surname>
<given-names>M</given-names>
</name>
</person-group>
<article-title>Overview of systematic reviews and meta-analyzes of acupuncture for stroke
</article-title>
<source>Neuroepidemiology</source>
<year>2014</year>
<volume>42</volume>
<issue>1</issue>
<fpage>50</fpage>
<lpage>58</lpage>
<pub-id pub-id-type="pmid">https://www.ncbi.nlm.nih.gov/pubmed/24356063</pub-id>
<pub-id pub-id-type="doi">10.1159/000355435</pub-id>
</element-citation>
</ref>
<ref id="bib14">
<element-citation publication-type="conference">
<person-group person-group-type="author">
<name>
<surname>Kovalenko</surname>
<given-names>OE</given-names>
</name>
</person-group>
<source>Neuroplasticity as a basis of sanogenesis in reflexology</source>
<conf-name>XV International Conference Basic Directions of Pharmacotherapy in Neurology</conf-name>
<conf-loc>Sudak, Ukraine</conf-loc>
<conf-date>April 24</conf-date>
<year>2013</year>
</element-citation>
</ref>
<ref id="bib15">
<element-citation publication-type="book">
<person-group person-group-type="author">
<name>
<surname>Guo</surname>
<given-names>CQ</given-names>
</name>
<name>
<surname>Fan</surname>
<given-names>YS</given-names>
</name>
</person-group>
<source>Acupuncture and moxibustion for headache (Clinical Practice of Acupuncture and Moxibustion
Series)
</source>
<publisher-loc>Beijing</publisher-loc>
<publisher-name>PMPH</publisher-name>
<year>2010</year>
</element-citation>
</ref>
<ref id="bib16">
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Vodyanoy</surname>
<given-names>V</given-names>
</name>
<name>
<surname>Pustovyy</surname>
<given-names>O</given-names>
</name>
<name>
<surname>Globa</surname>
<given-names>L</given-names>
</name>
<name>
<surname>Sorokulova</surname>
<given-names>I</given-names>
</name>
</person-group>
<article-title>Primo-Vascular System as Presented by Bong Han Kim</article-title>
<source>Evidence-Based Complementary and Alternative Medicine</source>
<year>2015</year>
<volume>2015</volume>
<fpage>361974</fpage>
<pub-id pub-id-type="doi">10.1155/2015/361974</pub-id>
</element-citation>
</ref>
<ref id="bib17">
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Stefanov</surname>
<given-names>M</given-names>
</name>
<name>
<surname>Kim</surname>
<given-names>J</given-names>
</name>
</person-group>
<article-title>Visualizing the Peripheral Primo Vascular System in Mice Skin by Using the Polymer
Mercox
</article-title>
<source>Journal of Pharmacopuncture</source>
<year>2015</year>
<volume>18</volume>
<issue>3</issue>
<fpage>75</fpage>
<lpage>79</lpage>
<pub-id pub-id-type="pmid">https://www.ncbi.nlm.nih.gov/pubmed/26389004</pub-id>
<pub-id pub-id-type="doi">10.3831/KPI.2015.18.028</pub-id>
</element-citation>
</ref>
<ref id="bib18">
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kovalenko</surname>
<given-names>OE</given-names>
</name>
<name>
<surname>Chizhikova</surname>
<given-names>ME</given-names>
</name>
</person-group>
<article-title>Modern views on the substrate and mechanisms of action of acupuncture</article-title>
<source>International Neurological Journal</source>
<year>2017</year>
<volume>6</volume>
<issue>92</issue>
<fpage>120</fpage>
<lpage>126</lpage>
</element-citation>
</ref>
<ref id="bib19">
<element-citation publication-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kovalenko</surname>
<given-names>OE</given-names>
</name>
</person-group>
<article-title>Pain in the syndrome complex of vertebro-basilar insufficiency of cervicogenic
genesis
</article-title>
<source>Collection of scientific works of employees of the KMAPO named after PL Shupika</source>
<year>2003</year>
<volume>12</volume>
<fpage>449</fpage>
<lpage>457</lpage>
</element-citation>
</ref>
<ref id="bib20">
<element-citation publication-type="journal">
<person-group person-group-type="author">