慢性紧张性头痛和慢性偏头痛的症状学临床研究

发布时间：2018-08-20 12:29

【摘要】：[目的]比较慢性紧张性头痛(chronic tension-type headache,CTTH)和慢性偏头痛(chronic migraine,CM)的症状学特点;明确慢性紧张性头痛和慢性偏头痛症状特点的临床影响因素。[方法]收集2016年12月到2017年3月解放军昆明总医院神经内科门诊以头痛为主诉的连续就诊患者的信息;采用自制头痛资料采集问卷,对头痛患者的一般资料、临床症状、辅助检查、既往就诊情况、既往服药情况进行详细收集,然后由头痛研究组成员依据国际头痛分类标准第三版试用版(The International Classification of Headache Disorders,3rd edition(beta version),ICHD-3-beta)对慢性紧张性头痛和慢性偏头痛进行诊断。对收集到的数据进行录入,计量资料符合正态分布采用均值±标准差来表示,组间比较采用t检验,偏态分布用中位数和四分位间距表述,组间比较采用秩和检验;计数资料用频数(N)与百分比(%)表示,组间比较用卡方检验,比较CM和CTTH的症状学差异,P0.05表示差异有统计学意义。针对CM、CTTH和头痛危险因素的相关性进行逐步向后法Logistics回归分析,明确CM和CTTH的临床影响因素。所有数据统计分析采用SPSS 20.0软件进行统计分析。[结果](1)本研究共收集门诊病人6684例,其中以头痛为主诉的患者584例,符合CTTH的患者124例,平均年龄为46.44±11.51岁,女性患者87(70.16%)例;符合CM的患者155例,平均年龄43.43±12.11岁,女性患者107(69.03%)例;CTTH组患者的平均就诊年龄大于CM患者组(P0.05)。(2)CTTH的症状学特征有:CTTH患者头痛发作时更多伴有头昏(20.96%vs.10.96%,OR=2.15,95%CI,1.11-4.18),头痛部位多见于全头痛(24.19%vs.5.80%,OR=5.17,95%CI,2.35-11.39)、后枕部疼痛(21.77%vs.12.25%,OR=1.99,95%CI,1.05-3.78)、前额部疼痛(19.35%vs.7.09%,OR=3.14,95%CI,1.47-6.70)、头顶部疼痛(15.32%vs.7.09%,OR=2.37,95%CI,1.08-5.18)为主;CTTH 的头痛性质以闷痛胀痛(66.12%vs.25.16%,OR=5.81。95%CI,3.45-9.76)、紧缩样疼痛(15.32%vs.1.93%,OR=9.16,95%CI,2.64-31.77)更多见;CTTH 患者的头痛持续时间以72小时较CM更多见(19.35%vs.10.32%,R=2.08。95%CI,1.05-4.12),并且常常不能自行缓解(49.19%vs.35.48%,OR=0.56,95CI,0.35-0.92)。CM的症状学特征有:CM患者比CTTH患者头痛发作时更多伴有听觉症状(25.16%vs.13.70%,OR=0.47,95%CI,0.25-0.88);头痛部位以一侧头痛更多见(68.38%vs.14.51%,OR=0.078,95%CI,0.04-0.14);头痛性质以搏动性跳痛更多见(74.83%vs.4.83%,OR=0.017,95%CI,0.007-0.042);发作形式更多以间断性发作为主(93.54%vs.81.45%,OR=3.30,95%CI,1.51-7.24);并且CM患者更多伴有头痛家族遗传病史(21.29%vs.8.87%,OR=0.36,95%CI,0.17-0.74)。(3)多因素Logistics回归分析结果显示伴有头晕、头昏、轻度头痛、中度头痛是紧张性头痛发展为CTTH的独立预测因素。伴有头晕的紧张性头痛患者较伴有其他症状的紧张性头痛患者发展为CTTH风险增加2.47倍(OR=2.47,95%CI,1.22-5.01);伴有头昏症状的紧张性头痛患者较伴有其他症状的紧张性头痛患者发展为CTTH的风险增加2.37倍(OR=2.37,95%CI,1.19-4.73);轻度疼痛的紧张性头痛患者发展为CTTH的风险增加2.43倍(OR=2.43,95%CI,1.05-5.60);中度疼痛的紧张性头痛患者发展为CTTH的风险增加2.03倍(OR=2.03,95%CI,1.04-3.95)。头痛能自行缓解、伴有听觉症状、家族史是偏头痛发展为CM的独立预测因素。头痛能自行缓解的患者发展为慢性偏头痛的风险增加2.34倍(OR=2.34,95%CI,1.37-3.98);伴有听觉症状(耳鸣)的患者较伴有其他症状的偏头痛患者发展为CM的风险增加2.64倍(OR=2.64,95%CI,1.32-5.29);头痛家族史的偏头痛患者发展为CM的风险增加 2.82 倍(OR=2.82,95%CI,1.30-6.11)。[结论](1)慢性紧张性头痛患者的平均年龄较慢性偏头痛的平均年龄大。(2)慢性紧张性头痛患者的头痛部位主要以全头痛、后枕部疼痛、前额部疼痛、头顶痛为主;头痛性质主要以紧缩样疼痛、闷胀痛为主;CTTH较CM更多伴随头昏;且持续大于72小时、不能自行缓解者较CM更多见。(3)慢性偏头痛患者的头痛部位主要以一侧颞部多见;头痛性质主要以搏动性跳痛多见;CM患者较CTTH患者更多伴随听觉症状;头痛多以间断发作为主;且更多伴有头痛家族遗传病史。(4)伴有头晕、头昏,轻度、中度疼痛是紧张性头痛发展为CTTH的独立预测因素。(5)能自行缓解、伴有听觉症状、有头痛家族史是偏头痛发展为CM的独立预测因素。
[Abstract]:[Objective] To compare the symptomatic characteristics of chronic tension-type headache (CTTH) and chronic migraine (CM), and to identify the clinical influencing factors of the symptoms of chronic tension headache and chronic migraine. The headache data collection questionnaire was used to collect the general information, clinical symptoms, auxiliary examinations, previous visits and medications of the patients with headache, and then the headache team members were asked to use the third edition of the International Classification of Headache. Chronic tension headache and migraine were diagnosed by on-of-Headache Disorders, 3rd Edition (beta version), ICHD-3-beta. The collected data were entered and the measurements were expressed by mean (+) standard deviation, t-test, median and quartile spacing, and inter-group ratio. Compared with rank sum test, counting data were expressed by frequency (N) and percentage (%). Chi-square test was used to compare the symptomatic differences between CM and CTTH, and P 0.05 was statistically significant. [Results] A total of 6 684 outpatients were collected in this study, including 584 patients with headache as the main complaint, 124 patients with CTTH, with an average age of 46.44 [11.51], 87 (70.16%) women, 155 patients with CM, with an average age of 43.43 [12.11], and 107 (67 (66.16%) women. The average age of CTTH patients was older than that of CM patients (P 0.05). (2) The symptoms of CTTH patients were characterized by dizziness (20.96% vs. 10.96%, OR = 2.15, 95% CI, 1.11-4.18) and headache (24.19% vs. 5.80%, OR = 5.17, 95% CI, 2.35-11.39), occipital pain (21.77% vs. 12.25%, OR = 1.99, 95% C.99). I, 1.05-3.78, I, 1.05-3.78, prefrontal pain (19.35% vs. 7.09%, OR = 3.14, 95% CI, 1.14, 95% CI, 1.47-6.70), headache (15.32% vs. 7.09%, OR = 2.09%, OR = 2.37, 95% CI, 95% CI, 1.08-5.18) was predominant; CTTHheadachewas characterized by stuffpain (66.12% vs. 25.16%, OR = 5.25.16%, OR = 5.81.95% CI, 3.45-95% CI, 3.45-9.76), constrict-like pain (15.32% vs. 1.32%, vs. 1.1.93%, OR = 1.93%, OR = 1.93%, OR 31.77) More common; headache in CTTH patients The duration of 72 hours was more common than that of CM (19.35% vs. 10.32%, R = 2.08.95% CI, 1.05-4.12), and it was often unable to relieve itself (49.19% vs. 35.48%, OR = 0.56, 95 CI, 0.35-0.92). The symptoms of CM were more accompanied by hearing symptoms (25.16% vs. 13.70%, OR = 0.47, 95% CI, 0.25-0.88) than that of CTTH. More frequent (68.38% vs. 14.51%, OR = 0.078, 95% CI, 0.04-0.14); more frequent headache was pulsatile bouncing pain (74.83% vs. 4.83%, OR = 0.017, 95% CI, 0.007-0.042); more frequent episodes were intermittent attacks (93.54% vs. 81.45%, OR = 3.30, 95% CI, 1.51-7.24); and CM patients had more family history of headache (21.29% vs. 0.87%, OR = 95% CI, 0.36% CI, 1.51-7.24). (3) Multivariate logistic regression analysis showed that dizziness, dizziness, mild headache and moderate headache were independent predictors of the development of tension headache into CTTH. Patients with tension headache with dizziness had a 2.37-fold increased risk of developing CTTH (OR = 2.37, 95% CI, 1.19-4.73); patients with tension headache with mild pain had a 2.43-fold increased risk of developing CTTH (OR = 2.43, 95% CI, 1.05-5.60); and patients with moderate pain had a 2.37-fold increased risk of developing CTTH (OR = 2.43, 95% CI, 1.05-5.60). Headache relief, with auditory symptoms, and family history were independent predictors of migraine progression to CM. Patients with headache relief had a 2.34-fold increased risk of developing chronic migraine (OR = 2.34, 95% CI, 1.37-3.98); those with auditory symptoms (tinnitus) were more likely to develop migraines with other symptoms than those with other symptoms (OR = 2.34, 95% CI, 1.37-3.98). Patients with headache had a 2.64-fold increased risk of developing CM (OR = 2.64, 95% CI, 1.32-5.29); migraine patients with family history of headache had a 2.82-fold increased risk of developing CM (OR = 2.82, 95% CI, 1.30-6.11). [Conclusion] (1) The average age of patients with chronic tension headache was older than that of patients with chronic migraine. (2) Patients with chronic tension headache had a headache. Headache is mainly characterized by constrictive pain and stuffy pain; CTTH is more often accompanied by dizziness than CM; and persists for more than 72 hours, more often than CM. 3) The headache of chronic migraine patients is mainly located in one side of the temple; headache is mainly characterized by headache. Pulsatile bouncing pain was more common in CM patients than in CTTH patients; headaches were more frequent with auditory symptoms; headaches were predominantly intermittent; and more frequent with family history of headache. (4) Dizziness, dizziness, mild, moderate pain was an independent predictor of the development of tension headache into CTTH. (5) Self-relief, auditory symptoms, family history of headache was migraine. Pain development is an independent predictor of CM.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R741;R747.2

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