Case-Based Diagnosis and Management of Headache Disorders学习笔记

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今年开始学习、翻译国外神经病学电子书,个人水平有限,望各位大神指点一二

这是Case-Based Diagnosis and Management of Headache Disorders目录:

1 Migraine Without Aura 无先兆性偏头痛

2 Migraine with Typical Aura 先兆性偏头痛

3 Aura Without Migraine 先兆不伴有偏头痛

4 Hemiplegic Migraine 偏瘫性偏头痛

5 Chronic Migraine Complicated by Medication Overuse Headache 慢性偏头痛伴有药物过度使用性头痛

6 Refractory Chronic Migraine Therapy with Botulinum Toxin A 肉毒毒素治疗顽固性慢性偏头痛

7 Complicated Migraine  复杂偏头痛

8 Migraine with Aura: A CADASIL Case 先兆性偏头痛:CADASIL病例

9 Syndrome of Transient Headache andNeurological Deficits with Cerebrospinal Fluid Lymphocytosis (HaNDL)

短暂头痛、神经功能缺损伴脑脊液淋巴细胞增多综合征(HaNDL)

10 Migraine Patient with MRI Lesions 有MRI病灶的偏头痛患者

11 Migraine and Patent Foramen Ovale 偏头痛和卵圆孔未闭

12 Refractory Chronic Migraine: Therapy with Combined Peripheral Neurostimulation 顽固性慢性偏头痛:联合局部外周神经刺激疗法

13 When Headache Becomes “Troublesome” in a Child:What May Be Behind Chronification of Pediatric Migraine?当儿童头痛变得麻烦:儿童偏头痛迁延化背后的可能因素

14 Headache in the Pediatric Patient 儿童头痛

15 Abdominal Pain Associated with Migraine 偏头痛相关腹痛

16 Migraine in the Elderly 老年人偏头痛

17 Is It Migraine Aura in the Elderly or Transient Ischaemic Attack? 是老年人偏头痛先兆还是TIA?

18 Migraine Without Aura, with a Discussionof Trigger Factors无先兆性偏头痛及其诱发因素

19 Migraine Patients with Comorbid Disorders and Their Management偏头痛患者伴发疾病及其治疗

20 Tension-Type Headache 紧张型偏头痛

21 Tension-Type Headache 紧张型偏头痛

22 Chronic Tension-Type Headache 慢性紧张型偏头痛

23 Treatment-Resistant Chronic Cluster Headache 难治性慢性丛集性头痛

24 Headache Resembling Hemicrania Continua Caused by Pituitary Adenoma 由垂体瘤引起的貌似持续性偏侧头痛的头痛

25 Primary Cough Headache 原发性咳嗽性头痛

26 Emergency Room Headache: A Case with Primary Thunderclap Headache Including Differential Diagnosis from Secondary Ones 急诊室头痛:1例原发性霹雳性头痛及与继发性头痛的鉴别诊断

27 Hypnic Headache睡眠性头痛

28 Headache Attributed to Paracranial Inflammatory Disorders颅外炎性疾病所致头痛

29 Headache Attributed to Paracranial Inflammatory Disorders 颅外炎性疾病所致头痛

30 Tumor-Related Headache 肿瘤相关性头痛

31 Migraine in the Emergency Department 急诊科偏头痛

32 Headache Attributed to Nontraumatic Subarachnoid Hemorrhage (SAH) 非创伤性SAH所致头痛

33 Headache in Systemic Diseases 系统性疾病相关性头痛

34 Headaches in Patients with Idiopathic Intracranial Hypertension 特发性颅高压患者的头痛

35 Headache in Patients with Intracranial Pressure Changes: Intracranial Hypotension Headache 颅内压改变患者的头痛:低颅压头痛

36 Headache Attributed to Psychiatric Disorders 精神疾病相关性头痛

37 Headache Attributed to Somatization Disorders: Is It Tension-Type Headache, Is It “Somatization Headache,” or Both?躯体化障碍相关性头痛:是紧张性头痛,还是躯体化头痛,或者是两者兼有有之

38 Trigeminal Neuralgia 三叉神经痛

39 Central Neuropathic Pain: Multiple Sclerosis- Related Headaches 中枢性神经痛:MS相关性头痛

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1无先兆性偏头痛

病例

39岁女性,1月内3次伴有恶心的头痛发作。因其母几月前卒中病逝而焦虑。首次头痛发作急性起病,呈爆炸性疼痛,持续约6小时。患者头痛可因行走加剧而不敢活动,卧床休息,畏光而拉上窗帘。短暂睡眠后症状有所改善,但患者更为焦虑,因而求助家庭医生而住院治疗。相关检查未见明显异常(CT及化验等),因其持续中度头痛,予止痛处理(阿司匹林500mg及1g安乃近)。1-2小时头痛缓解,患者回家睡了12小时。次日,患者再发头痛,除了恶心,患者明显畏光和畏声,变得焦虑,有点头晕。患者再次住院治疗,相关检查未见明显异常(MRI及VEP等),诊断为无先兆性偏头痛,2天后出院。一周后患者出现严重搏动性头痛,眩晕,恶心,畏光畏声,症状因行走或头部活动而加剧。阿司匹林330mg未能改善症状。头痛持续约15小时。

鉴别诊断及处理

患者头痛急性起病,呈爆炸性疼痛,虽无定位体征,应注意颅内病变的可能;因而对该患者应行颅脑CT检查。

诊断

首次无先兆性偏头痛发作,建议行颅脑CT检查。偏头痛通常持续数小时至数天,平均每月发作1次。应与紧张型头痛(TTH)相鉴别。TTH呈慢性过程,头痛比不头痛的时间更多。还要与丛集性头痛鉴别,本病相对罕见,表现为反复单侧头痛伴有自主神经功能紊乱。与药物过度使用性头痛(MOH)的鉴别比较难。MOH使偏头痛复杂化,偏头痛表现为慢性每日头痛,类似慢性TTH,但偏头痛通常有其特征。偏头痛的发作频率及周期性是很重要的。每周超过2次的偏头痛样头痛不大可能是单纯的无先兆性偏头痛,可能是伴有MOH和(或)TTH的无先兆性偏头痛(表1)。

表1 ICHD(国际头痛疾病分类)3 beta版关于无先兆性偏头痛的定义

A至少5次发作,符合B-D标准

B头痛发作持续4-72小时(未治疗或未成功治疗)

C头痛至少以下2个特征:

1单侧头痛

2搏动性头痛

3中到重度头痛

4头痛因日常活动而加剧或头痛而导致不能进行日常活动(行走或爬楼梯等)

D头痛至少有以下1个伴随症状:

1恶心和(或)呕吐

2畏光和畏声

E不适用ICHD3的其它诊断

疾病简要

十分之一的人有偏头痛。患者的病史是重要的诊断手段。生活方式的改变可能对病情有帮助。曲普坦比普通止痛药疗效好一些。麦角生物碱类对于急性期治疗也有用。急性期后应完善药物预防性治疗方案、停止药物过度使用、改变生活方式、记录偏头痛日记。通常每月发作少于3次不予预防性治疗。

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