持续性偏侧头痛12例临床分析

Hemicrania continua:clinical analysis of 12 cases

目的分析持续性偏侧头痛的临床特点,提高对持续性偏侧头痛的认识和治疗效果。方法按照国际头痛学会2004年制定的国际头痛疾患分类诊断标准收集病例。疼痛程度评分,采用视觉模拟尺度数字分级法（visual analog scale,VAS）。分析12例持续性偏侧头痛的临床表现及治疗结果 ,并结合文献进行总结。结果 12例病例中男7例,女5例,发病年龄20~73岁。在头痛基础期疼痛程度评分为（3.75±0.87）分,疼痛加剧期为（9.08±1.08）分;12个患者在疼痛恶化期均具有同侧下列部分或全部三叉自主神经症状：流泪、球结膜充血、流涕、鼻塞。全部病例均使用了吲哚美辛口服治疗,全部有效;5例使用维拉帕米预防治疗,3例有效,2例无效;3例使用了托吡酯预防治疗,2例有效,1例无效。治疗后9例头痛发作完全停止,3例恶化次数减少,疼痛程度明显减轻。结论应提高对持续性偏侧头痛的认识,首选吲哚美辛治疗,维拉帕米或托吡酯可作为预防治疗的选择,以提高长期治疗的耐受性和治疗效果。

Objective To clinically study the features of hemicrania continua.Methods Twelve patients with hemicrania continua were prospectively analyzed over the past more than 3 years in our hospitals.Results There were seven male and five female.The mean age was 46.17±18.54 years（24 to 75 years）.The mean age of onset was 43±9.78（20 to 73 years old.During exacerbation,three patients presented with lacrimation,nasal congestion;four presented with lacrimation,conjunctival injection;two presented with conjunctival injection;one with presented conjunctival injection,nasal congestion,one presented with lacrimation and one presented with lacrimation,conjunctival injection,nasal congestion and rhinorrhea.Pain intensity（scale 0 to 10）was 3.75±0.87 and 9.08±1.08 at the baseline and during the exacerbation,repectively.Twelve cases were treated with indomethacin.Nine of them had an immediate and complete response and three of them remitted partially.Five patients were treated with verapamil plus indomethacin and three of them had a complete response.Three patients were treated with torpimarate plus indomethacin and two of them had a complete response.One patient stopped taking indomethacin because of gastroenteric side effects.This patient received a partial relief after treatment with verapamil and prednisone.Conclusions Hemicrania continua is a rare benign disorder.The patients with hemicrania continua should receive indomethacin firstly.They may be treated with verapamil or torpiramate when they can not tolerate the adverse effects or when the effects of indomethacin fade.