小儿偏头痛的临床分型研究

目的提出新的小儿偏头痛临床分型标准。方法从理论及临床研究方面论证:(1)结合临床实践经验及相关流行病学调查,指出第2版头痛病国际分类标准(ICHD-Ⅱ)的不足。(2)选取于2010年10月—2012年5月就诊于南方医院中医科头痛治疗中心的符合ICHD-Ⅱ小儿偏头痛诊断标准患者200例进行病史回顾。(3)从腹型偏头痛(AM)、周期性呕吐(CVS)、良性儿童周期发作性眩晕(BPVC)三方面寻找支持小儿偏头痛新临床分型的文献证据。结果 (1)小儿偏头痛起病阶段临床表现有3种,一是单纯表现为反复腹痛、呕吐、眩晕(前驱综合征);二是起病即以头痛为主症的典型偏头痛症状;三是以反复腹痛、呕吐、眩晕(前驱综合征)为主且伴头痛及其他伴随症状。(2)小儿偏头痛整个自然病程存在3种情况:一是起病时表现为前驱综合征,前驱综合征消失一段时间后,出现先兆型或无先兆型偏头痛症状;二是前驱综合征出现一段时间后(数天至数年不等),出现前驱综合征伴偶发头痛,前驱综合征消失一段时间(常为数年)后,出现典型的先兆型或无先兆型偏头痛症状;三是只表现为典型的先兆型或无先兆型偏头痛症状。(3)腹痛、呕吐、眩晕等前驱症状可单独或合并出现,且出现周期长短不一,短则数天,长则数年。结论小儿偏头痛临床分型应分为完全型、不完全型、成人型等3型。

Study on clinical classification of pediatric migraine

Objective To propose new clinical classification of pediatric migraine.Methods To demonstrate it in theory and clinic：（1）According to the experience of clinic practice and relative epidemiological investigations,indicate the incompleteness of ICHDII.（2）A retrospective investigation was made according to illness history in the 200 patients with pediatric migraine.（3）Track down the best evidence for the new clinical classification of pediatric migraine in the aspects of AM, CVS and BPVC.Results（1）The clinical manifestation in morbidity period of pediatric migraine can be concluded in 3 kinds：①Pure characterized by abdominal migraine,cyclical vomiting and benign paroxysmal vertigo of childhood（the childhood periodic syndromes that are commonly precursors of migraine）.②Pure characterized by typical migraine.③With abdominal migraine,cyclical vomiting and benign paroxysmal vertigo of childhood as the main symptoms,and with a headache and other accompanied symptoms.（2）The natural course of pediatric migraine can be concluded in 3 kinds：①Pediatric migraine begins with the childhood periodic syndromes that are commonly precursors of migraine,then migraine with or without aura appears after the childhood periodic syndromes have disappeared for some time.②After the childhood periodic syndromes that are commonly precursors of migraine have lasted for some times（Several days to a few years）,occasional headache appears,and then the childhood periodic syndromes gradually disappeared and typical migraine with or without aura appears.（3）Abdominal migraine,cyclical vomiting and benign paroxysmal vertigo of childhood can appear individually or at the same time.The duration of the childhood periodic syndromes is different;it lasts for several days to a few years.Conclusion Pediatric migraines should be divided into three types：Complete Type,Incomplete Type and Adult Type.