头痛地国际分类第三版中文Word文档格式.docx
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头痛地国际分类第三版中文Word文档格式.docx
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一、原发性头痛(theprimaryheadaches)
1.偏头痛(Migraine)
1.1Migrainewithoutaura无先兆偏头痛
1.2Migrainewithaura有先兆偏头痛
1.2.1Migrainewithtypicalaura
先兆性偏头痛的诊断标准:
符合B-C特征,至少发作2次发作
完全可逆以下症状的1项或多项
✓视觉、感觉、语言障碍(典型先兆)
✓肢体无力症状(偏瘫型偏头痛)
✓脑干症状(基底型偏头痛)
视网膜症状(视网膜型偏头痛)
✓至少1个先兆逐渐发展的过程>
5min,和/或
不同先兆接连发生过程>
5min
✓每个先兆症状持续时间5-60min
✓至少一个先兆症状为单侧性
✓先兆发生同时或之后内60min出现符合偏头痛
肢体无力症状可以持续至72h,部分患者肢体无力感可持续数周;
若患者先兆持续1周以上,称为无梗死的持续先兆一般先兆症状多为双侧,可持续数月或数年
若先兆持续60min至1周以内,则称为propablemigrainewithaura
若出现影像学梗死灶,则称为偏头痛性脑梗死
(年轻女性,后循环比较常见)
1.2.1.1Typicalaurawithheadache
1.2.1.2Typicalaurawithoutheadache
1.2.2Migrainewithbrainstemaura
1.2.3Hemiplegicmigraine偏瘫型偏头痛
1.2.3.1Familialhemiplegicmigraine(FHM)—家族性
1.2.3.1.1Familialhemiplegicmigrainetype1(FHM1)
1.2.3.1.2Familialhemiplegicmigrainetype2(FHM2)
1.2.3.1.3Familialhemiplegicmigrainetype3(FHM3)
1.2.3.1.4Familialhemiplegicmigraine,otherloci
1.2.3.2Sporadichemiplegicmigraine—散发性
1.2.4Retinalmigraine
1.3Chronicmigraine慢性偏头痛
1.4Complicationsofmigraine偏头痛并发症
1.4.1Statusmigrainosus偏头痛持续状态
1.4.2Persistentaurawithoutinfarction
1.4.3Migrainousinfarction偏头痛脑梗死
1.4.4Migraineaura-triggeredseizure
1.5Probablemigraine很可能的偏头痛
1.5.1Probablemigrainewithoutaura
1.5.2Probablemigrainewithaura
1.6Episodicsyndromesthatmaybeassociatedwithmigraine可能与偏头痛有关的发作性综合征
慢性偏头痛:
偏头痛发作每月>
15天,连续3个月以上
偏头痛持续状态:
单次发作持续72小时以上
1.6.1Recurrentgastrointestinaldisturbance
1.6.1.1Cyclicalvomitingsyndrome周期性呕吐
1.6.1.2Abdominalmigraine腹型偏头痛
1.6.2Benignparoxysmalvertigo良性发作性眩晕
1.6.3Benignparoxysmaltorticollis良性发作性斜颈
2.紧张型头痛(Tension-typeheadache)每次发作持续30min-7d,慢性者可持续不缓解
2.1Infrequentepisodictension-typeheadache偶发性<
1d/月,至少10次以上(<
12d/年)
2.1.1Infrequentepisodictension-typeheadacheassociatedwithpericranialtenderness
2.1.2Infrequentepisodictension-typeheadachenotassociatedwithpericranialtenderness
2.2Frequentepisodictension-typeheadache频发性≥1d/月,但<
15d,至少发作10次以上(≥12d/年但<
180d)
2.2.1Frequentepisodictension-typeheadacheassociatedwithpericranialtenderness
2.2.2Frequentepisodictension-typeheadachenotassociatedwithpericranialtenderness
2.3Chronictension-typeheadache慢性紧张型头痛每月发作≥15d,3个月以上
2.3.1Chronictension-typeheadacheassociatedwithpericranialtenderness
2.3.2Chronictension-typeheadachenotassociatedwithpericranialtenderness
丛集性头痛的诊断标准:
至少符合B-D的5次以上的发作
单侧、眼眶、上眼眶及/或颞部重度或极重度疼痛,如不治疗持续15min-180min;
伴随至少以上一项症状
同侧结膜充血/流泪
同侧鼻腔充血/流鼻水
同侧眼皮水肿
同侧前额及脸部出汗
同侧瞳孔缩小/眼睑下垂
不安的症状或躁动
发作频率隔日1至8次/日
除外其他疾患
2.4Probabletension-typeheadache很可能的紧张型头痛
2.4.1Probableinfrequentepisodictension-typeheadache
2.4.2Probablefrequentepisodictension-typeheadache
2.4.3Probablechronictension-typeheadache
3.三叉自主神经性头痛(Trigeminalautonomiccephalalgias)
3.1Clusterheadache丛集性头痛
3.1.1Episodicclusterheadache发作性丛集性头痛
3.1.2Chronicclusterheadache慢性丛集性头痛
(复发作大于1年无缓解期,或缓解期<
1个月)
3.2Paroxysmalhemicrania
3.2.1Episodicparoxysmalhemicrania
3.2.2Chronicparoxysmalhemicrania
3.3Short-lastingunilateralneuralgiformheadacheattacks
3.3.1Short-lastingunilateralneuralgiformheadacheattackswithconjunctivalinjectionandtearing(SUNCT)
3.3.1.1EpisodicSUNCT
3.3.1.2ChronicSUNCT
3.3.2Short-lastingunilateralneuralgiformheadacheattackswithcranialautonomicsymptoms(SUNA)
3.3.2.1EpisodicSUNA
3.3.2.2ChronicSUNA
3.4Hemicraniacontinua
3.5Probabletrigeminalautonomiccephalalgia
3.5.1Probableclusterheadache
3.5.2Probableparoxysmalhemicrania
3.5.3Probableshort-lastingunilateralneuralgiformheadacheattacks
3.5.4Probablehemicraniacontinua
4.其它的原发性头痛Otherprimaryheadachedisorders)
4.1Primarycoughheadache原发性咳嗽头痛
4.1.1Probableprimarycoughheadache
4.2Primaryexerciseheadache原发性运动性头痛
4.2.1Probableprimaryexerciseheadache
4.3Primaryheadacheassociatedwithsexualactivity原发性性活动伴随的头痛
4.3.1Probableprimaryheadacheassociatedwithsexualactivity
4.4Primarythunderclapheadache原发性霹雳头痛
4.5Cold-stimulusheadache冷刺激性头痛
4.5.1Headacheattributedtoexternalapplicationofacoldstimulus
4.5.2Headacheattributedtoingestionorinhalationofacoldstimulus
4.5.3Probablecold-stimulusheadache
4.5.3.1Headacheprobablyattributedtoexternalapplicationofacoldstimulus
4.5.3.2Headacheprobablyattributedtoingestionorinhalationofacoldstimulus
NDPH诊断标准:
持续性头痛,符合B-C的标准
Distinctandclearlyrememberedonset,withpainbecomingcontinuousandunremittingwithin24hours
Presentfor>
3months
慢性头痛,起病急,可清晰回忆发病时间为哪一天
疼痛缺乏特点,可以为偏头痛,可以为紧张性,亦可两者混合
若患者符合慢性偏头痛或慢性紧张型头痛的标准,则不诊断NDPH
若患者为药物过度使用性头痛,且符合NDPH的标准,
则可两者均可作为诊断
4.6External-pressureheadache
4.6.1External-compressionheadache
4.6.2External-tractionheadache
4.6.3Probableexternal-pressureheadache
4.6.3.1Probableexternal-compressionheadache
4.6.3.2Probableexternal-tractionheadache
4.7Primarystabbingheadache
4.7.1Probableprimarystabbingheadache
4.8Nummularheadache
4.8.1Probablenummularheadache
4.9Hypnicheadache
4.9.1Probablehypnicheadache
4.10Newdailypersistentheadache(NDPH)新症每日持续性头痛
4.10.1Probablenewdailypersistentheadach
二、继发性头痛(thesecondaryheadaches)
5.缘于头、颈部外伤的头痛(Headacheattributedtotraumaorinjurytotheheadand/orneck)
5.1Acuteheadacheattributedtotraumaticinjurytothehead
5.1.1Acuteheadacheattributedtomoderateorseveretraumaticinjurytothehead
5.1.2Acuteheadacheattributedtomildtraumaticinjurytothehead
5.2Persistentheadacheattributedtotraumaticinjurytothehead
5.2.1Persistentheadacheattributedtomoderateorseveretraumaticinjurytothehead
5.2.2Persistentheadacheattributedtomildtraumaticinjurytothehead
5.3Acuteheadacheattributedtowhiplash
5.4Persistentheadacheattributedtowhiplash
5.5Acuteheadacheattributedtocraniotomy
5.6Persistentheadacheattributedtocraniotomy
6.缘于头颈部血管疾病的头痛(Headacheattributedtocranialorcervicalvasculardisorder)
6.1Headacheattributedtoischaemicstrokeortransientischaemicattack
6.1.1Headacheattributedtoischaemicstroke(cerebralinfarction)
6.1.2Headacheattributedtotransientischaemicattack(TIA)
6.2Headacheattributedtonon-traumaticintracranialhaemorrhage
6.2.1Headacheattributedtonon-traumaticintracerebralhaemorrhage非外伤性脑出血
6.2.2Headacheattributedtonon-traumaticsubarachnoidhaemorrhage(SAH)
6.2.3Headacheattributedtonon-traumaticacutesubduralhaemorrhage(ASDH)急性硬膜下血肿
6.3Headacheattributedtounrupturedvascularmalformation未破裂的血管畸形
6.3.1Headacheattributedtounrupturedsaccularaneurysm囊性动脉瘤
6.3.2Headacheattributedtoarteriovenousmalformation(AVM)动静脉畸形
6.3.3Headacheattributedtoduralarteriovenousfistula(DAVF)硬膜动静脉瘘
6.3.4Headacheattributedtocavernousangioma海绵窦血管瘤
6.3.5Headacheattributedtoencephalotrigeminalorleptomeningealangiomatosis(SturgeWebersyndrome)
脑三叉神经或软脑膜血管瘤病
6.4Headacheattributedtoarteritis
6.4.1Headacheattributedtogiantcellarteritis(GCA)颞动脉炎
6.4.2Headacheattributedtoprimaryangiitisofthecentralnervoussystem(PACNS)
6.4.3Headacheattributedtosecondaryangiitisofthecentralnervoussystem(SACNS)
颞动脉炎诊断标准:
美国风湿学会1990年
1.50岁以上发病:
50岁以上发现症状
2.新发的头痛:
出现新发的局限性头痛
3.颞动脉异常:
颞动脉压痛或者与颈动脉的动脉硬化无关的搏动减弱
4.血沉值升高:
50mm/h以上
5.动脉活检异常:
单核细胞为主的细胞浸润或者伴多核巨细胞的肉芽肿出现为特征的血管炎证据
5项中如满足3项以上,敏感度93.5%。
特异性91.2%可能分类为颞动脉炎。
6.5Headacheattributedtocervicalcarotidorvertebralarterydisorder颈动脉或锥动脉疼痛
6.5.1Headacheorfacialorneckpainattributedtocervicalcarotidorvertebralarterydissection动脉夹层
6.5.2Post-endarterectomyheadache内膜剥脱术后头痛
6.5.3Headacheattributedtocarotidorvertebralangioplasty颈动脉血管成型术头痛
6.6Headacheattributedtocerebralvenousthrombosis(CVT)脑静脉血栓形成
6.7Headacheattributedtootheracuteintracranialarterialdisorder
6.7.1Headacheattributedtoanintracranialendovascularprocedure
6.7.2Angiographyheadache
6.7.3Headacheattributedtoreversiblecerebralvasoconstrictionsyndrome(RCVS)
6.7.3.1Headacheprobablyattributedtoreversiblecerebralvasoconstrictionsyndrome(RCVS)
6.7.4Headacheattributedtointracranialarterialdissection颅内动脉夹层
6.8Headacheattributedtogeneticvasculopathy
6.8.1CerebralAutosomalDominantArteriopathywithSubcorticalInfarctsandLeukoencephalopathy(CADASIL)
6.8.2MitochondrialEncephalopathy,LacticAcidosisandStroke-likeepisodes(MELAS)
6.8.3Headacheattributedtoanothergeneticvasculopathy
6.9Headacheattributedtopituitaryapoplexy垂体卒中
7.缘于非血管性颅内疾病的头痛(Headacheattributedtonon-vascularintracranialdisorder)
7.1Headacheattributedtoincreasedcerebrospinalfluidpressure颅内压增高
7.1.1Headacheattributedtoidiopathicintracranialhypertension(IIH)
7.1.2Headacheattributedtointracranialhypertensionsecondarytometabolic,toxicorhormonalcauses
7.1.3Headacheattributedtointracranialhypertensionsecondarytohydrocephalus
7.2Headacheattributedtolowcerebrospinalfluidpressure颅内压低下
7.2.1Post-duralpunctureheadache腰穿后
7.2.2CSFfistulaheadache脑脊液漏
7.2.3Headacheattributedtospontaneousintracranialhypotension自发性低颅压
7.3Headacheattributedtonon-infectiousinflammatorydisease非感染性炎性疾病
7.3.1Headacheattributedtoneurosarcoidosis
7.3.2Headacheattributedtoaseptic(non-infectious)meningitis
7.3.3Headacheattributedtoothernon-infectiousinflammatorydisease
7.3.4Headacheattributedto
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