老年人头痛的临床特点及其治疗现状分析

发布时间：2018-09-05 19:05

【摘要】：目的：分析老年科65岁以上老年患者的头痛患病情况，并比较不同类型头痛的临床特点、其诊断和治疗现状，以期为老年人群头痛的研究提供一定的参考价值。方法：收集2012年10月~2014年~2月之间连续在老年科住院的患者。根据入组标准，对所有符合入组标准的患者进行头痛筛查，诉过去一年里至少有过一次引起过自己注意的头痛的病人进行头痛评估。头痛评估数据采集使用自制头痛量表。头痛诊断采用ICHD-II标准及其2006修订版，头痛程度的评估采用疼痛视觉模拟评分（VAS）。结果：共对529名患者进行了评估，其中共有134（25.3%）名患者诉在过去一年里至少有过一次头痛。所有头痛患者中，26名（19.5%）诊断为偏头痛，64名（48%）诊断为紧张性头痛，49名（34.6%）为其他类型头痛。头痛的临床特点：分别有73.1%偏头痛和84.7%紧张性头痛为双侧头痛。偏头痛和其他类型头痛最常见疼痛性质的均为搏动性痛（61.5%37.8%），紧张性头痛最常见的疼痛性质为胀痛（52.4%）。偏头痛患者中62.5%患者在头痛发作期间伴有畏光、畏声，23.1%患者伴有恶心，11.5%患者伴有呕吐。紧张性头痛患者中16%患者伴有畏声，其他类型的头痛伴随症状较少见。疼痛程度以偏头痛最重，，其次是其他类型头痛（p0.05）。偏头痛的头痛发作频率明显少于紧张性头痛和其他类型头痛（p0.05）。治疗现状：77.0%偏头痛患者，57.2%紧张性头痛患者及51.0%其他类型头痛患者在过去一年里曾因头痛就诊过，其中23.1%偏头痛患者，6.5%紧张性头痛患者，16.2%其他类型头痛患者得到过确切诊断。所有头痛患者中有61.9%患者在过去一年里因头痛使用过药物，复合型止痛药、中成药、非甾类药物是最常用三类药物，仅有8.2%的患者为遵医嘱服药。结论：老年科65岁人群中头痛患病率约25%，紧张性头痛是最常见的头痛类型，其次为偏头痛。头痛偏头痛在老年人中主要表现为双侧的、中度、搏动性头痛，畏光、畏声是常见的伴随症状，恶心、呕吐较少见。紧张性头痛的临床特点主要表现为双侧的、轻-中度、非搏动性头痛，伴随症状较少见。超过三分之二的头痛患者曾因头痛就诊过，这些患者中仅有少量患者得到过确切诊断。约60%头痛患者使用过急性止痛药，不到10%患者在医生指导下使用药物。复合型止痛药、非甾类消炎药、中成药是最常使用的三类止痛药。
[Abstract]:Objective: to analyze the prevalence of headache in elderly patients over 65 years of age in geriatrics, and to compare the clinical characteristics, diagnosis and treatment of different types of headache, in order to provide some reference value for the study of headache in elderly people. Methods: the patients in geriatric department from October 2012 to February 2014 were collected. According to the admission criteria, all patients who met the admission criteria were screened for headache, and headache assessments were performed on patients who had headaches that had attracted their attention at least once in the past year. Headache assessment data were collected using a self-made headache scale. The ICHD-II standard and its 2006 revised edition were used to diagnose headache. The headache degree was assessed by (VAS). Results: a total of 529 patients were assessed, 134 (25.3%) of whom reported having at least one headache in the past year. Among all the headache patients, 26 (19.5%) were diagnosed as migraine and 64 (48%) as tension headache and 49 (34.6%) as other types of headache. Clinical features of headache: 73.1% migraine and 84.7% tension headache were bilateral headache. The most common pain of migraine and other types of headache was pulsatile pain (61.57.8%), the most common pain of tension headache was flatulence (52.4%). 62.5% of migraine patients had photophobia during headache attack, and 23.1% of them were accompanied with nausea and vomiting. Sixteen per cent of patients with tension headache were accompanied by fear of sound, while other types of headache accompanied by symptoms were less common. The most severe pain was migraine, followed by other types of headache (p0.05). The frequency of migraine attack was significantly less than that of tension headache and other types of headache (p0.05). 77.0% migraine patients 57.2% tension headache patients and 51.0% other headache patients have been treated with headache in the past year, of which 23.1% migraine patients or 6.5% tension headache patients or 16.2% other types of headache patients have been accurately diagnosed. In the past year, 61.9% of all headache patients had used drugs, compound painkillers, Chinese patent medicines and non-steroidal drugs were the most commonly used three kinds of drugs, only 8.2% of the patients were prescribed by doctors. Conclusion: the prevalence of headache is about 25% in 65 years old people in geriatrics. Tension headache is the most common type of headache, followed by migraine. Headache and migraine are mainly bilateral, moderate, pulsatile headache, photophobia and fear of sound are common accompanying symptoms in the elderly, nausea and vomiting are rare. The clinical features of tension headache are bilateral, mild to moderate, non-pulsatile headache, accompanied by rare symptoms. More than 2/3 headache patients have had a headache visit, and only a small number of these patients have had a definite diagnosis. About 60% of headache patients have used acute pain relievers, and less than 10% have taken medications under the guidance of doctors. Compound analgesics, non-steroidal anti-inflammatory drugs, Chinese patent medicine is the most commonly used three types of painkillers.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R747.2

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