半结构性问询在儿童复发性头痛诊断中的运用

目的探讨半结构性问询在儿童复发性头痛诊断中的运用。方法对2007年10月至2010年10月门诊及病房诊治的90例复发性头痛病人进行半结构性问询、随访、全面的体格检查及神经系统检查并辅以必要的辅助检查。结果①90例复发性头痛患者中88例(97.8%)为原发性头痛,63例偏头痛,其中3例合并紧张性头痛,22例为可能的偏头痛,2例癔病性头痛;继发性头痛2例(2%),分别为颅内肿瘤1例、屈光不正1例;②疑诊为窦性头痛的复发性头痛患者经抗生素及中成药治疗鼻窦炎后头痛无缓解;③实验室检查中经颅多普勒超声检查显示的血管痉挛或扩张的部位与头痛部位无相关性,EEG检查多无明显异常。结论偏头痛是复发性头痛的常见原因;慢性鼻窦炎无急性发作不会导致窦性头痛。在复发性头痛诊断中应用结构性问询,并加强随访,既提高了诊断率,又避免了不必要的检查。

Use of the semi-structured interview in the diagnosis of pediatric recurrent headaches

Objective To study the use of the semi-structured interview in the diagnosis of pediatric recurrent headaches.Methods 90 children with recurrent headaches participated in the semi-structured interviews.The clinical data of 90 children,including the information from the interviews,physical and laboratory examination were studied.Results ①Migraine was found in 63 of the 90 patients,nervous headache in 3,hysteria in 2.secondary headache was 2 / 90,intracranial tumor in 1,ametropia in 1;②Some patients with chronic sinusitis were suspected to have sinus headache.But they were not respond to antibiotics;③There was no relativity between the part of cerebrovascular spasm or vasodilation in TCD and the part of headache;most EEGs were normal.Conclusions Recurrent headaches occur commonly in children and are diagnosed on a clinical basis rather than by any testing.Migraine is the common reason of childhood recurrent headaches.The use of the semi-structured interview in the diagnosis of pediatric recurrent headaches may obtain a more thorough evaluation of headaches.