多发性硬化患者原发性头痛的特征及发病情况

Characteristics and prevalence of primary headaches in patients w ith multiple sclerosis

目的探讨原发性头痛与多发性硬化(MS)间的关系。方法选择171例MS患者,其中头痛组51例,非头痛组120例,分析头痛组原发性头痛的特征及不同类型头痛的发病情况。对比头痛组和非头痛组的病程、发病类型、影像学及相关疾病的发病情况。结果 29.8%的MS患者伴有原发性头痛,2/3患者头痛早于MS症状,头痛以颞侧、枕部好发,搏动性、紧缩性痛常见,持续4 h以上,发作较频繁,多为中、重度疼痛。多有3处以上(90.2%)的发病部位,脑干、丘脑、胼胝体处的病灶明显多于非头痛组。偏头痛(47.1%)最常见,以年轻的复发缓解型多发性硬化(R-R MS)多见。继发进展型多发性硬化(SP MS)好发紧张型头痛,年龄较偏头痛患者更大(P<0.05)。头痛组患者较非头痛组患者更易合并脑梗死(P<0.05)。结论近1/3的MS患者伴有原发性头痛,年轻患者多见,病灶较多,脑干为主,疼痛较严重,偏头痛最常见。

Objective To investigate the association betw een primary headaches and multiple sclerosis（ M S）. Methods One hundred and seventy-one M S patients w ere enrolled and divided into tw o groups,headache group（ 51 cases） and non headache group（ 120 cases）. M S form,duration,radiology and occurrence of other related diseases in the tw o groups w ere retrospectively analyzed and compared. Features and incidence of subtypes of primary headaches in non headache group w ere also analyzed. Results 29. 8% M S patients w ere accompanied by primary headaches. Tw o-thirds of patients reported headaches before occurring of M S symptoms. Throbbing and tightening pain w ere common,mainly appeared in the bitemporal and occiput. Pain often lasted for more than 4 hours,attacked frequently and severely. M ost of the patients in headache group show ed more than 3 lesion locations（ 90. 2%）,w hich w ere more common in the brainstem,thalamus and corpus callosum than those of non headache group. Of primary headaches,migraine（ 47. 1%）w as the most common type,observed more often in young relapsing-remitting M S（ R-R M S） patients. While,secondary progressive M S（ SP M S） patients w as often accompanied by tension-type headache,w ho w ere older than migraine patients（ P〈0. 05）. The patients in headache group w ere more likely combined w ith cerebral infarction than those in non headache group（ P〈0. 05）. Conclusion Nearly one-third of M S patients are accompanied by primary headaches,of w hich migraine is the most common type. The headaches are often serious. These patients alw ays have more demyelinating lesions than those w ithout headaches,and the lesions mainly locate in the brain stem.