慢性偏头痛临床特征分析与国际诊断标准测试

Clinical features of chronic migraine and clinical test of international diagnostic criteria

摘要:

目的：研究慢性偏头痛（chronic migraine，CM）的临床特征，并对国际头痛疾病分类第3版试行版（International Classifi－cation of Headache Disorders，3rd Edition，beta version，ICHD-Ⅲ beta）及专家共识版（Expert Opinion criteria，EOc）CM的诊断标准进行临床实践测试。方法：回顾性分析重庆医科大学附属第一医院神经内科头痛门诊2014年6月至2016年6月CM患者的人口学特征及临床特征，并对ICHD-Ⅲ beta及EOc版CM诊断标准进行临床实践测试分析。结果：共纳入236例CM患者，165例（69.9%）患者合并药物过度使用，仅2例（0.8%）患者使用曲普坦类，无患者使用麦角胺类。CM患者的偏头痛亚型中最常见的是无先兆偏头痛（migraine without aura，MO；70.3%），其次为可能性偏头痛（probable migraine，PM；26.3%）和先兆偏头痛（mi－graine with aura，MA；3.4%）。236例患者均满足EOc版标准，仅167例（70.8%）满足ICHD-Ⅲ beta版CM标准。69例不符合ICHD-Ⅲ beta标准的患者中，62例为不典型偏头痛发作，符合PM，7例为有典型偏头痛发作但既往发作少于5次。结论：CM患者常合并药物过度使用，但偏头痛特异性止痛药曲普坦及麦角胺类使用较少。EOc版CM诊断标准更符合中国CM患者的实际情况，可能更利于在临床中应用。

Abstract:

Objective：To explore clinical features of chronic migraine（CM） and to test the International Classification of Headache Disorders-Ⅲ，beta version（ICHD-Ⅲ beta） and Expert Opinion criteria（EOc） in practice. Methods：Demographic characteristics and clinic features of CM patients in neurology outpatient department of the First Affiliated Hospital of Chongqing Medical University from June 2014 to June 2016 were retrospectively analyzed. CM diagnostic criteria according to ICHD-Ⅲ beta and EOc were evaluated. Results：A total of 236 CM patients were included：165 patients（69.9%） were concurrent with medication overuse，just 2 patients （0.8%） used triptans and none used ergotamines. The most common migraine subtype was migraine without aura（MO，70.3%），followed by probable migraine（PM，26.3%） and migraine with aura（MA，3.4%）. All 236 patients met the EOc criteria and only 167 patients（70.8%） met ICHD-Ⅲ beta for CM. For the 69 patients who met EOc but not met ICHD-Ⅲ beta，62 had atypical migraine attacks，which was consistent with PM，and another 7 had typical migraine attacks but less than a total history of 5 attacks. Conclusion：CM patients are often in combination with medication overuse，however，migraine-specific medications including triptans and ergo－tamines，are used infrequently. According to the situation of Chinese CM patients，the EOc is more suitable and may be more appro－priate in the clinical work.