紧张型头痛国际诊断标准测试及预防性治疗评价

发布时间：2018-06-04 00:39

本文选题：紧张型头痛 + 诊断标准　；参考：《重庆医科大学》2016年硕士论文

【摘要】：背景在原发性头痛中常遇到的诊断方面的困难是鉴别紧张型头痛(TTH)和轻度无先兆偏头痛,因为标准版诊断标准可能会纳入具有偏头痛特征的患者,因此在国际头痛疾病分类第二版(ICHD-II)和国际头痛疾病分类第三版测试版(ICHD-IIIβ)附录部分均提出了更为严格的替代版诊断标准。目的本研究旨在通过重庆地区13家医院参与的多中心研究,对紧张型他国际诊断标准进行测试;同时了解紧张型头痛非干预性预防性治疗的有效性及安全性。方法1.2014年8月到2016年2月,从重庆13家医院的神经内科门诊入组18-65周岁的头痛患者,通过填写调查问卷、面诊、记录头痛日记及随访,获得其头痛特征、伴随症状等临床数据,最终确立诊断。2.对频繁发作性紧张型头痛(ETTH)及慢性紧张型头痛(CTTH)患者进行预防性治疗。治疗1月后通过门诊回访或电话随访对头痛情况进行回访。结果共纳入116例根据标准版诊断标准诊断为紧张型头痛的患者,其中104(89.7%)例患者符合替代版诊断标准。如果没有标准版诊断标准,12(10.3%)例患者将被诊断为未分类的头痛。与标准版诊断标准诊断的患者相比,符合替代版诊断标准的患者无恶心、畏光、畏声等伴随症状。符合替代版诊断标准的患者中,伴颅周肌肉压痛者(45例,43.3%)的头痛程度视觉模拟评分(VAS)较不伴颅周肌肉压痛者(59例,56.7%)高,差别有统计学意义。6例(12天/年)接受了生活方式调整,另外110例接受了养血清脑颗粒、阿米替林或两者联合治疗。其中5(4.5%)例脱失,22(29.7%)例无缓解,28(25.5%)例未接受治疗,3(2.7%)例不能耐受阿米替林副作用,余52(70.3%)例在1月随访时,头痛缓解50%,即头痛天数或头痛程度下降超过50%。无严重不良反应。结论在我们神经内科门诊就诊的符合标准版诊断标准的紧张型头痛患者,绝大部分都符合替代版的诊断标准,部分根据标准版诊断的紧张型头痛患者可能有偏头痛的一些特征,因此建议在临床及科研工作中推行紧张型头痛的替代版诊断标准,以便更好的鉴别症状不典型的轻度偏头痛。另外,预防性治疗,包括中药治疗,对改善患者症状有效,安全性高。
[Abstract]:Background the difficulty in the diagnosis of primary headache is the differential diagnosis of TTHs and mild migraine without aura, as the standard diagnostic criteria may be included in patients with migraine characteristics. Therefore, in the appendix part of ICHD-III 尾 and ICHD-III 尾, the ICHD-IIs and the third edition of ICHD-IIs, more stringent diagnostic criteria have been proposed for the ICHD-III 尾 (ICHD-III 尾) in the International Classification of headache Diseases (ICHD-IIII). Objective the purpose of this study was to test the international diagnostic criteria of stress type other through a multicenter study in 13 hospitals in Chongqing, and to understand the efficacy and safety of non-interventional preventive treatment of tension headache. Methods 1. From August 2014 to February 2016, the headache patients aged 18 to 65 years old from neurology outpatient department in 13 hospitals in Chongqing were investigated. The clinical data of headache characteristics and accompanying symptoms were obtained by filling out questionnaire, face diagnosis, recording headache diary and following up. Finally, diagnosis. 2. Patients with frequent paroxysmal tension headache (ETTHs) and chronic tension headache (CTTHs) were treated with prophylactic treatment. After 1 month of treatment, the headache was followed up by outpatient visit or telephone follow-up. Results A total of 116 cases of tension headache were diagnosed according to the diagnostic criteria of the standard version, of which 104 cases (89.7%) were in accordance with the diagnostic criteria of the substitute version. In the absence of a standard diagnostic standard 12 / 10. 3) patients will be diagnosed as unclassified headache. Patients who met the alternative criteria had no accompanying symptoms of nausea, photophobia, and fear of sound, as compared with those diagnosed with the standard version of the diagnostic criteria. The visual analogue score of headache degree in 45 patients with pericranial muscle tenderness was higher than that in 59 patients without pericranial muscle tenderness. The difference was statistically significant in 6 patients (12 days / year). Another 110 cases were treated with Yangxuannao granule, amitriptyline or both. There were 5 cases of amitriptyline in which there were 222.75 cases of amitriptyline) and 2 22 cases of amitriptyline). In the follow-up of 1 month, there were 50 cases of headache relief, that is, the number of days of headache or the degree of headache decreased by more than 50%, and the cases of amitriptyline were not able to tolerate the side effects of amitriptyline. There were no serious adverse reactions. Conclusion most of the tension headache patients in our department of neurology who meet the diagnostic criteria of the standard version, most of them accord with the diagnostic criteria of the alternative version, and some of the patients diagnosed according to the standard edition may have some characteristics of migraine. It is suggested that the alternative diagnostic criteria of tension headache should be applied in clinical and scientific research in order to differentiate atypical mild migraine. In addition, prophylactic treatment, including traditional Chinese medicine, is effective and safe in improving patients' symptoms.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R741

【相似文献】