门诊原发性头痛患者就诊类型研究

目的 应用ICHD-Ⅱ诊断标准分析原发性头痛患者门诊就诊类型。 方法 从2011年7月－2013年3月，对以头痛为主诉的473例患者进行详细的问诊。为排除继发性头痛及其他颅内病变对患者的影响，所有问诊患者均为行CT或MRI扫描并排除颅内有明确病变者。 结果 473例患者平均40.4岁，男女比为1︰2.61。其中，偏头痛者214例（45.2%），紧张型头痛者230例（48.6%），丛集性头痛者1例（0.2%），其他原发性头痛者28例（5.9%）。473例患者中，有29例（6.1%）患者伴有药物过度使用性头痛。 结论 西部地区就诊于头痛门诊的原发性头痛患者以偏头痛和紧张型头痛最多，其中无先兆的偏头痛为最常见的就诊类型。部分患者已存在药物过度使用性头痛，应引起足够的重视。     

101例偏头痛和95例紧张型头痛患者伴发焦虑和/或抑郁临床分析

目的:分析就诊于神经内科门诊的偏头痛和紧张型头痛患者中焦虑抑郁的发生率及特点,旨在提高偏头痛和紧张型头痛患者的诊疗水平。方法:对2009年6月~2010年2月来我院神经内科就诊101例偏头痛和95例紧张型头痛患者,采用汉密顿焦虑和抑郁量表进行焦虑抑郁测定,并同时对性别、年龄、职业、收入状况、病程、头痛程度、发作频率进行分析。结果:44.6%偏头痛患者和55.8%紧张型头痛患者伴发情绪障碍,两者比较无统计学差异(P>0.05)。慢性紧张性头痛患者有情绪障碍的概率较发作性紧张性头痛患者、无先兆偏头痛患者、有先兆偏头痛患者无统计学差异(P>0.05)。有焦虑症状的头痛患者出现抑郁症状显著高于无焦虑症状的患者,反之亦然。女性头痛患者伴发焦虑抑郁显著高于男性(P<0.05)。年龄<40岁患者伴发焦虑抑郁明显高于年龄>40岁患者(P<0.05)。收入<1500(元/月)的头痛患者伴发焦虑抑郁显著高于收入≥1500(元/月)。中、重度头痛患者伴发焦虑抑郁显著高于轻度头痛(P<0.05)。头痛病程>1年患者伴发焦虑抑郁显著高于病程<1年(P<0.05)。结论:偏头痛和紧张型头痛患者经常伴有焦虑抑郁。在头痛患者的诊治中,应加强对偏头痛及紧张型头痛共患焦虑抑郁的认识,提高诊治水平。     

头痛专病门诊患者抑郁焦虑患病特点分析

目的:评估头痛门诊原发性头痛患者的抑郁焦虑共病情况。方法:使用9条目患者健康问卷(patient health questionnaire-9,PHQ-9)和7条目广泛性焦虑量表(generalized anxiety disorder-7,GAD-7)对2012年10月8日至2012年12月29日就诊于解放军总医院头痛门诊的原发性头痛患者进行评估。结果:在225例头痛患者中,偏头痛为58例(25.8%),紧张型头痛为97例(43.1%),丛集性头痛为14例(6.2%),慢性每日头痛为56例(24.9%);头痛患者的抑郁和广泛性焦虑的检出率分别为37.8%和34.2%。慢性每日头痛出现抑郁和广泛性焦虑共病的比例明显高于其他类型头痛(P<0.01,P=0.03)。结论:头痛专病门诊中原发性头痛的抑郁和广泛性焦虑患病比例高,和其他类型头痛相比,慢性每日头痛更容易出现抑郁焦虑共病。     

260例非器质性头痛患者头痛相关因素分析

目的:分析260例非器质性头痛患者头痛的相关因素,为临床上非器质性头痛的诊断和治疗提供科学依据。方法 :用表格对2009年6月~2010年2月在郑州大学第一附属医院神经内科门诊就诊的非器质性头痛患者的资料进行收集,总结患者的一般情况和头痛的相关因素。结果 :260例非器质性头痛患者中,女性多于男性(男:女=1:1.17)。随着收入的增高非器质性头痛的发病人数逐渐降低。发病率较高的职业是农民和学生。所有非器质性头痛患者有50.78%合并焦虑抑郁状态。紧张和压力是诱发头痛加重的最主要因素。其中有9例患者在病程中出现了头痛特点的转换。结论:非器质性头痛患者与性别、年龄、职业、收入等均存在相关性,在临床中要特别关注合并焦虑抑郁状态的非器质性头痛以及头痛特点转换。     

原发性头痛与抑郁焦虑障碍共病的临床研究

目的:分析原发性头痛与抑郁焦虑障碍共病的临床特点及疗效评估.方法:纳入符合标准的105例门诊原发性头痛患者,分为共病组和非共病组,予以药物治疗并完成8周随访.分别于治疗前及治疗后4周、8周应用SF-12健康调查问卷及HIT-6量表评估患者生活质量,并记录头痛持续时间、频率、疼痛程度.结果:抑郁焦虑障碍在高、低频率头痛发作组中的OR值为3.277,95%置信区间(1.48,7.27).治疗前共病组的精神健康部分评分(MCS-12)较非共病组低(P<0.01),HIT-6评分比非共病组高(P<0.01);治疗后两组的生活质量和临床症状都较前明显改善(P<0.01),且治疗后2周共病组的头痛发作频率下降较非共病组慢(P<0.05).结论:原发性头痛患者其头痛频率的增加与抑郁焦虑障碍共病密切相关.合并有抑郁焦虑使头痛患者生活质量差,症状缓解慢,治疗疗程长.     

不同类型头痛的肌肉压痛及其与焦虑、抑郁的关系

为了评估阵发性及慢性偏头痛和紧张性头痛患者中肌肉压痛与焦虑和抑郁的相关程度，对459名头痛患者进行了记录，其中阵发性偏头痛患者125名，慢性偏头痛患者97名，阵发性紧张性头痛患者82名，慢性紧张性头痛患者83名，阵发性偏头痛与阵发性紧张性头痛叠加患者72名。这些诊断均参照国际头痛疾病分类的指南进行，     

A型肉毒毒素治疗原发性头痛的新进展

原发性头痛发病率较高 ,药物治疗效果欠佳 ,存在不可避免的副反应 ,A型肉毒毒素的应用为原发性头痛的治疗提供了新方法。本文简要介绍A型肉毒毒素治疗原发性头痛 (包括偏头痛、紧张性头痛、丛集性头痛 )的研究进展及其治疗机制、安全性和远期效应     

文拉法辛与帕罗西汀治疗共患焦虑或抑郁状态的紧张型头痛临床研究

目的:评价文拉法辛与帕罗西汀治疗紧张型头痛共患焦虑或抑郁的疗效及不良反应.方法:将符合ICHD-II诊断标准的35例共患焦虑或抑郁状态的紧张型头痛门诊患者随机分为两组,分别给予文拉法辛(n=18)75mg和帕罗西汀(n=17)20mg,疗程8周.用视觉模拟量表(VAS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定疗效并观察两组的不良反应.结果:文拉法辛组1例服药后头痛加重停药,帕罗西汀组1例头痛加重停药、1例不能忍受副反应改服其它药物.治疗后2、4、8周两组VAS、HAMD、HAMA评分无统计学意义,但治疗前后以上指标两组均有显著差异.结论:文拉法辛和帕罗西汀在治疗紧张型头痛共患焦虑、抑郁时安全有效,不良反应少.     

慢性偏头痛和慢性紧张型头痛临床特征分析

目的:分析比较慢性偏头痛(CM)和慢性紧张型头痛(CTTH)的临床特征.方法:回顾性研究66例CM和CTTH的人口学特征及临床特征.结果:CM 46例,CTTH 20例.单因素分析显示CM组与CTTH组患者间的发病年龄,病程均有显著性差异(P＜0.05);CM组头痛程度多为中到重度,过度服用止痛药物的情况在CM组也更常见(P＜0.001);两组患者的性别和年龄没有差异.结论:CM患者的发病年龄早于CTTH患者,同时CM患者的头痛严重程度以及止痛药物过度使用情况均高于CTTH患者,CM患者应该与CTTH患者区别对待.在临床工作中,全面评估慢性头痛的临床特征,明确头痛的严重程度,正确诊断慢性头痛的类型,可以有效提高CDH患者的预后.     

Headache Care in China

Headache disorders are problematic worldwide. China is no different. A population‐based door‐to‐door survey revealed that the 1‐year prevalence of primary headache disorders in China was 23.8%, constituting a major societal burden. Many headache centers and clinics have been established in China, and headache disorders (and associated stress) are receiving an increased level of expert attention. This review summarizes the outcomes of the epidemiological survey and the progress of clinical and basic research in China, describes the present situation in terms of headache diagnosis and treatment, and discusses the future of headache care in China.     

Epidemiology of Headache Disorders in the Asia‐Pacific Region

Headache disorder is a major public health issue and is a great burden for the person, the health care system, and society. This article reviews epidemiological surveys of primary headache disorders including migraine and tension‐type headache (TTH) among adults in the Asia‐Pacific region using the International Classification of Headache Disorders (ICHD), first or second edition. Chronic daily headache (CDH), which is not an official diagnosis in the ICHD, was also reviewed. In the Asia‐Pacific region, the median (range) 1‐year prevalence of primary headache disorders was 9.1% (1.5‐22.8%) for migraine, 16.2% (10.8‐33.8%) for TTH, and 2.9% (1.0‐3.9%) for CDH. The 1‐year prevalence of migraine and TTH were rather consistent; however, the extremes in the 1‐year prevalence of migraine in earlier studies from Hong Kong (1.5%) and South Korea (22.3%) were not repeated in later surveys (Hong Kong: 12.5%; South Korea: 6%). According to the United Nations, the estimated population of the Asia‐Pacific region was 3.85 billion in 2010, equaling to headache suffers of 350 million patients with migraine, 624 million with TTH, and 112 million with CDH; many remain to be treated. The prevalence of headache disorders has remained stable over the last 2 decades in this region, where the diversity of geography, race, and development is wide. Thus, the pursuit of better headache care in this region might be our next challenge.     

Prevalence of Primary Headache Syndrome in Adults in the Qassim Region of Saudi Arabia

Background and Purpose: Headache occurs worldwide, but documentation on the burden of headache in Saudi communities is quite limited. The aim of this study was to determine the prevalence of primary headache in a rural community in the Qassim region of Saudi Arabia.
Methods: A door-to-door survey of subjects older than 15 years of age was used for completion of a structured questionnaire to determine headache types based on defined criteria. Physical examination was used to exclude secondary causes.
Results: Of 5891 inhabitants, 473 suffered from headaches. The crude lifetime prevalence rate was 8% (95% CI, 7.3% to 8.7%) and with age adjustment was 9.3% (8.6% to 10%). Headache sufferers were predominantly women. The age-specific rate increased progressively, peaking in the sixth decade. Tension-type headache diagnosed in 185 subjects predominated (3.1%), while the prevalence of migraine was 2.6%.
Conclusion: The findings agree with the reported prevalence of 10% to 12% in other communities in the Kingdom of Saudi Arabia, but lower than the rates in Western countries. The lower rates are probably related to sociocultural factors.     

Retracted: Prevalence and Burden of Headache Disorders: A Comparative Regional Study in China

Background.— Since the early 1990s, no study has been undertaken examining the prevalence and burden of headache disorders in China. Objective.— We conducted a one‐year survey on the prevalence and burden of primary headache in the Chinese provinces of Guangdong and Guangxi. Our study also evaluated the factors behind similarities and differences affecting prevalence in the 2 regions of study. Methods.— Random samples of 372 local residents in Guangdong and 182 local residents in Guangxi aged 18‐65 years were invited to a face‐to‐face interview. Results.— The one‐year prevalence of primary headache was 22.6% (84/372) in Guangdong and 41.2% (75/182) in Guangxi. The prevalence of migraine (14.3%, n = 26) in Guangxi was higher than prevalence of migraine (8.3%, n = 31) in Guangdong (P = .03). The ratio of headache cost and household income was 2.1% in Guangdong and 3.7% in Guangxi, the ratio in Guangdong was less than that in Guangxi (P = .001). The diagnostic confirmation rate of migraine was low. No migraineur used triptans drugs to treat migraine in either region. Conclusion.— Migraine prevalence was higher in the lower‐income region that also contains a higher proportion of ethnic minorities. Although there was no difference of headache cost between the 2 regions, the headache populations in the lower‐income region would relatively suffer a greater financial burden if taking the economic differences between the 2 regions into account. The improvement of diagnostic and therapeutic levels for the treatment of headache, especially migraine, in the 2 regions may be a matter of urgency.