慢性每日头痛128例临床分析

Features of chronic daily headache： a clinical analysis of 128 cases

目的 探讨慢性每日头痛（CDH）患者的临床特征.方法 回顾性分析2011年8月至2012年3月头痛门诊诊治的128例CDH患者的临床资料,比较分析不伴药物过量的原发性慢性每日头痛（PCDH）与药物过量性头痛（MOH）临床特征的差异.结果 128例CDH患者中,女性102例（79.7％）,平均年龄45.2岁,其中MOH 88例.95.3％ （122/128）的患者头痛程度为中、重度,头痛时伴随恶心（68/128）、畏光（75/128）、畏声（102/128）及情绪抑郁（77/128）、烦躁（93/128）的发生率均在50％以上;73.4％ （94/128）伴发睡眠障碍,58.6％ （75/128）伴发头晕,45.3％ （58/128）平时伴发情绪烦躁改变,16.4％ （21/128）伴发情绪低落改变;偏头痛残疾程度评估问卷、头痛影响测试-6评分显示,分别有62.2％ （51/82）及73.2％ （82/112）的患者,头痛致残程度为严重影响生活.伴MOH患者较不伴药物过量患者年龄大,总头痛病程长,头痛程度重,原发性头痛类型慢性偏头痛的比例更高（t值分别为2.59、2.48、5.58和11.95,P值分别为0.011、0.015、0.018和0.001）.结论 CDH好发于中年女性,头痛程度以中、重度为主,较易伴发情绪烦躁、低落及睡眠障碍等症状,同时极易过量服用药物,致残性很高.

Objective To review the clinical features of chronic daily headache （CDH）.Methods The clinical data of 128 patients with chronic daily headache,including general condition,characteristics of headache,concomitant symptom and disability were analyzed retrospectively.The features of primary chronic daily headache （PCDH） and medication over-dose headache （MOH） were compared.Results Among 128 cases females accounted for 79.7％ with an average age of 45.2 years and 88 patients were associated with drug overdose.The symptoms included nausea （68/128）,photophobia （75/128）,phonophobia （102/ 128）,depression （77/128） and irritability （93/128）,sleep disorders （94/128）,dizziness （75/128）,emotional irritability（58/128） and depression（21/128）.The migraine disability assessment questionnaire and headache impact test-6 scores showed that disability was resulted from the severe degree of headache in 62.2％ （51/82） and 73.2％ （82/112） of CDH patients respectively.Compared with PCDH patients,the MOH patients had older age （t =2.59,P =0.011）,longer duration （t =2.48,P =0.015） and severer degree of headache（t =5.58,P =0.018）,and chronic migraine （t =11.95.P =0.001） was the most common primary headache type.Conclusions Most CDH patients are middle-aged women,with moderate to severe pain,usually complicated with depression,dysphoria and asomnia.Chronic daily headache patients are commonly associated with drug overdose.