比较第2版头痛疾病国际分类和选择性诊断标准对青少年慢性每日头痛分类的差异

Objectives.- To compare the second edition of the International Classificati on of Headache Disorders (ICHD- 2) and the Silberstein- Lipton (S- L) criteri a in the classification of adolescents with chronic daily headache (CDH). Method s.- We reviewed the clinical records and the headache diaries of 170 adolescent s (13 to 17 years) seen between 1998 and 2003 at a headache center. Relevant inf ormation was transferred to a standardized form that included operational criter ia for the ICHD- 2. CDH subtypes were classified according the criteria propose d by S- L into transformed migraine (TM) with (TM+ ) and without medication ov eruse (TM- ), chronic tension- type headache (C- TTH), new daily persistent h eadache (NDPH), and he micrania continua (HC). Results.- From the 69 patients with TM- according t he S- L criteria, most (71% ) could be classified as chronic migraine (CM), wh ile a minority of patients required a combination of diagnosis, mainly migraine and CTTH (14.4% ). Of the patients with TM+ , just 39.6% met the criteria fo r probable CM (PCM) with probable medication overuse (PMO). If instead of 15 mig raine days per month, we considered 15 or more days of migraine or probable migr aine, 84% of the subjects with TM- and 68.7% of those with TM+ could be classified. Of the 27 subjects classified as NDPH without medication overuse acc ording to the S- L system, the majority (51.2% ) were also classified as NDPH according the ICHD- 2. Interestingly, three (11.1% of the subjects with NDPH without medication overuse) were classified as CM in the ICHD- 2 because these patients had an abrupt onset of 15 or more days of migraine per month. All patie nts with NDPH with medication overuse according to the S- L criteria required a combination of diagnoses in the ICHD- 2. All subjects with CTTH received a sin gle diagnosis in both classification systems. Conclusions.- (i) Among adolescen ts with TM, the majority (58.1% ) could be classified as CM, according to the I CHD- 2. These results were driven by TM without medication overuse, (ii) If the ICHD- 2 criteria for CM are revised to require 15 days of migraine or probable migraine, the proportion of patients with TM- who meet the criteria for CM inc reases from 71% to 84% ; for TM+ , the proportion with probable chronic migr aine and PMO increases from 30% to 68% . (iii) About half of the patients wit h NDPH according to the S- L criteria have too many migraine features to meet I CHD- 2 criteria for NDPH.

慢性偏头痛现场测试可供选择的标准

The criteria for chronic migraine (CM), as proposed by the Second Edition of the International Classification of Headache Disorders (ICHD-2) is very restrictive, excluding most patients that evolve from episodic migraine. In this study we empirically tested three recent proposals for revised criteria for CM. We included individuals with transformed migraine (TM) with or without medication overuse, according to the criteria proposed by Silberstein and Lipton. All individuals had headache calendars for at least three consecutive months. We assessed the proportion of subjects that fulfilled ICHD-2 criteria for CM or probable chronic migraine with probable medication overuse (CM+). We also tested three proposals for making the CM criteria more inclusive. In proposal 1, CM/CM +would require at least 15 days of migraine or probable migraine per month. Proposal 2 suggests that CM/CM +would be classified in those with ≥15 days of headache per month, where at least 50%of these days are migraine or probable migraine. Proposal 3 suggests that CM/CM +would be classified in those with chronic daily headache and at least 8 days of migraine or probable migraine per month. Among TM sufferers, 399 (62.5%) had TM with medication overuse, and just 10.2%were classified as CM+158 (37.5%) had TM without medication overuse; just nine (5.6%) met current ICHD-2 criteria for CM. Using the alternative criteria, proposal 1 included 48.7%of patients with TM without medication overuse; proposal 2 captured 88%, and proposal 3 classified 94.9%of these patients. For TM with medication overuse, the proportions for proposals 1-3 were, respectively, 37%, 81%and 91%. The differences were statistically significant, favouring proposal 3. Consistently, criteria for CM and CM+should be revised to require at least 8 days of migraine or probable migraine per month, in individuals with 15 or more days of headache per month.

曲普坦类药物相关副作用的评估:方法对结果的影响

Background. - A recent study conducted in triptan- na ve migraine patients showed that tolerability was the second most important attribute of an acute treatment. However, the proportion of patients reporting side effects after any acute treatment may vary with regard to the method of assessment. Objectives. - To contrast two methods of assessing adverse events (prompted and unprompted) in those with headache using triptans. Methods. - This study was conducted in two sites, a headache center in the United States, and a neurology office focusing on headache in Italy. We prospectively surveyed 415 adults with headache, who had been using the same triptan for at least 3 months. Participants were asked about their headache and treatment history. Subjects then completed a standardized questionnaire, assessing adverse events in two different ways. First, subjects were asked if they had any adverse events when using the triptan. After returning the first part of the questionnaire, subjects received a second form, where 49 possible adverse events were listed. We contrasted and correlated both sets of answers. Results. - Most patients (U.S. = 74.9% , Italy = 65.5% ) reported no side effects in the unprompted questionnaire. However, most of them (U.S. = 62.9% , Italy = 54.1% ) reported at least one side effect in the prompted questionnaire. Most patients that reported side effects in the unprompted questionnaire said they had just one adverse event, while most reported two or more side effects in the prompted questionnaire. Both in the unprompted and in the prompted questionnaires, most side effects were rated as mild or moderate. Interestingly, 31 (7.5% ) subjects (pooling data from both sites together) graded their adverse events as severe in the prompted questionnaire, but had not self- reported them. Conclusions. - (1) When assessing adverse events, the method of data collection may dramatically influence the results. (2)- From those subjects who did not self- report adverse events after using a triptan, most of them will report positively if presented with a list of side effects.

以头痛为主诉的患者偏头痛的流行病学调查与诊断

Context. Headache experts have suggested that to improve the recognition of migraine, patients with a stable pattern of episodic, disabling headache and a n ormal physical exam should be considered to have migraine in the absence off con tradictory evidence. The premise upon which this approach is based that is, that episodic, recurrent primary headache in the clinic is usually migraine has not been evaluated in prospective clinical studies. Objectives. To (1) evaluate t he diagnoses of patients consulting their physician with primary episodic headac he and (2) compare clinic diagnoses and patient self diagnoses with Internation al Headache Society (IHS) headache diagnoses assigned on the basis of longitudin al data from patient diaries. Design. Prospective, open label study. During t he screening visit, patients self reported a headache diagnosis and then were a ssigned a headache diagnosis by their physician following his or her customary p ractice. Patients with a new physician diagnosis of migraine or nonmigraine prim ary headache were given diaries to record headache symptoms for up to 3 months o r 6 attacks. Members of an expert panel, unaware of the clinic diagnosis, used d iary data to assign a headache diagnosis to each attack and to each patient. Set ting. One hundred twenty eight (128) practices in 15 countries including the United States. Patients. A total of 1203 male and female patients between 18 a nd 65 years of age who consulted their physician with headache as a primary or s econdary complaint. Results. Overall, 94%of patients with a physician diagnos is of nonmigraine primary headache or a new clinic diagnosis of migraine had IHS defined migraine (76%) or probable migraine (migrainous) (1 8%) headache on the basis of longitudinal diary data. A new clinic diagnosis of migraine was almost always correct: 98%of patients with a clinic diagnosis of migraine had IHS defined migraine (87%of patients) or probable migraine (11%o f patients) headache on the basis of longitudinal diary data. On the other hand, review of diaries of patients with a clinic diagnosis of nonmigraine revealed t hat 82%of these patients had IHS defined migraine (48%) or probable migraine (34%) headache. Altogether, one in four patients (25%) with IHS defined migra ine according to longitudinal diary data did not receive a clinic diagnosis of m igraine. Conclusions. These findings support the diagnostic approach of consid ering episodic, disabling primary headaches with an otherwise normal physical ex am to be migraine in the absence of contradictory evidence. If in doubt of diagn osis or when assigning a nonmigraine diagnosis, strong consideration should be g iven to the use of a diary to confirm primary headache diagnosis.