头颈动脉夹层首发头痛的特点

Characteristics of primary headache caused by cervicocerebral artery dissection

目的 分析以头痛为首发症状的头颈动脉夹层患者的头痛特点。 方法 连续收集并前瞻性登记2010—2017年于郑州大学第一附属医院神经内科和神经介入科诊治的非蛛网膜下腔出血的头颈动脉夹层患者146例,对其中以头痛为首发症状的患者通过调查问卷面对面收集其临床表现,分析其首发头痛的特点。将146例头颈动脉夹层患者按是否以头痛为首发症状分为首发头痛组(20例,占13.7%)和非首发头痛组(126例,占86.3%)。 结果 首发头痛组有6例(30.0%)患者合并脑缺血事件,非首发头痛组有97例(77.0%)合并脑缺血事件,两组比较差异有统计学意义(χ^2=18.338,P<0.01);首发头痛组有17例(85.0%)患者夹层位于后循环,非首发头痛组有70例(55.6%)患者夹层位于后循环,两组比较差异有统计学意义(χ^2=6.214,P=0.013)。在仅以头痛为首发症状的20例患者中,40.0%(8/20)的患者头痛为持续性,60.0%(12/20)的患者为间断性;70.0%(14/20)的患者为重度头痛,25.0%(5/20)的患者为中度头痛,5.0%(1/20)的患者为轻度头痛;60.0%(12/20)的患者头痛性质为搏动性和胀痛;11/17的后循环夹层患者头痛累及枕部。 结论 以头痛为首发症状的头颈动脉夹层患者的头痛往往是突发的、与以往经历的头痛不同的重度疼痛,头痛的性质常表现为偏头痛样,可呈持续性或间断性。相比前循环动脉夹层,后循环动脉夹层患者较多以头痛为首发症状。

Objective To analyze the characteristics of the primary headache due to cervicocerebral artery dissection (CAD). Methods A total of 146 consecutive patients with CAD in the First Affiliated Hospital of Zhengzhou University from 2010 to 2017 were observed. There were 20 cases who complained of primary headache, of which the characteristics of pain were analyzed according to their clinical features that were collected face to face through questionnaire. According to whether complicated by primary headache, the 146 patients were classified into two groups: 20 cases (13.7%) in the primary headache group, and 126 cases (86.3%) in the non-primary headache group. Results Patients in the primary headache group had a lower prevalence of transient ischemic attack or cerebral infarction compared with the non-primary headache group (30.0% (6/20) vs 77.0% (97/126), χ^2=18.338, P<0.01). CAD patients in the primary headache group were more likely involved in posterior circulation compared with the non-primary headache group (85.0% (7/20) vs 55.6% (70/126), χ^2=6.214, P=0.013). Of the 20 patients with primary headache, 40.0% (8/20) had continuous headache and 60.0% (12/20) had intermittent headache;70.0% (14/20) presented with severe headache, 25.0% (5/20) with moderate headache and 5.0% (1/20) with mild headache;For the nature of pain, 60.0% (12/20) was similar to migraine;11/17 of patients with posterior circulation dissection showed occipital pain. Conclusions The primary headache caused by CAD is a severe pain occurring suddenly, and different from those of previous experiences. The nature of headache is often similar to migraine, which can be continuous or intermittent. In addition, compared with anterior circulation, patients with posterior circulation dissection often have headache as the initial symptom.