21例圆形头痛临床表现与治疗效果

Nummular headache： 21 new cases and therapeutic results

目的分析圆形头痛的临床特点，提高对圆形头痛的认识和治疗效果。方法分析总结广东三九脑科医院等2006年2月至2008年2月诊治的21例NH的临床特点及治疗效果。结果21例病例中男9例，女12例，年龄18～63（37±12）岁，病史7d至30年，疼痛部位：顶部7例，颞部6例，枕部8例，颞顶交界1例；头痛在头部左侧10例、右侧9例、枕部中央1例、顶部中央1例，1例患者同时在左枕部和颞顶交界处两处疼痛。13例患者头痛区域为直径0．6～5cm的圆形，8例患者头痛区域为直径（1～2）cm×（1．5～3）cm的椭圆形。疼痛性质为针刺样痛6例、锐痛3例、搏动性痛3例、挤压性痛1例、胀痛5例、隐痛3例；3例采用利多卡因加地塞米松进行神经阻滞治疗，1例获得30h缓解，2例无效，1例在用阿米替林和帕罗西汀治疗无效后用针灸治疗获得缓解，1例用卡马西平和阿米替林连续治疗3个月疼痛逐渐减轻直至最后消失，8例用阿米替林和吲哚美辛或布罗芬治疗疼痛消失，1例用沙格雷酯和阿米替林治疗后疼痛消失，2例用阿米替林和吲哚美辛治疗无效，1例服用尼莫地平头痛消失，4例未治疗，3例失访。结论NH并不是十分少见的头痛类型；阿米替林与吲哚美辛、布罗芬或卡马西平合用和针灸治疗可能对部分NH患者有效。

Objective To evaluate the clinical feature of nummular headache and the efficiency of treatment in China. Method The data of 21 NH patients treated from February 2006 to February 2008, were aralyzed. Results They were 9 men, 12 women, aged 37 ±12 （ 18-63 ） years. Headache history ranged from 7 days to 30 years. 13 patients reported head pain confined to a circular area of 0. 6 to 5 centimeter, and the other 8 patients had pain in an elliptical area of 1 -2 centimeter x 1.5 -3 centimeter. The symptomatic area was located in the parietal （ n = 7 ）, occipital （ n = 8 ）, temporal （ n = 6 ）, or border regions between temporal and parietal（ n = 1 ）. The right side was affected in 10 patients and the left side in the 9 patients, the middle of occipital and parietal areas were affected in 1 patient, respectively. Seven patients had mild pain, 8 patients had moderate pain and 6 patients had severe pain. The characteristics of headache included stabbing pain （ n = 6 ）, sharp pain （ n = 3 ）, pulsating apin （ n = 3 ）, grinding pain （ n = 1 ）, exploding pain（ n = 5 ）, included light -dull apin （n = 3 ）. Three patients were treated by local nerve block with lidocaine plus dexamethasone phosphate/acetate and one of them got some 30 hours of prominent pain relief, no relief was obtained for other two patients. One patient obtained pain remission by acupuncture after amitriptyline, paroxetine had been tried ineffectively. One patient, woman, 38 years old, was treated by carbamazepine （tegretol） and amitriptyline for 3 months and pain relief was obtained gradually and the head pain disappeared finally. 8 patients were treated effectively by amitripline combining indomethacium , ibuprofen or carbamazepine. One patient was treated effectively by nimodipime. 2 patients were treated ineffectively by amitripline combining indomethacium. 4 patients were not treated. 3 patients were lost to follow-up. Conclusion NH is not very rare and some of NH patients may be treated effectively by acupuncture or amitripline combining indomethacium, ibuprofen or carbamazepine.