紧张型头痛(tension type headache,TTH)在人群中极其常见,是神经内科门诊中最为常见的疾病,表现为慢性头部紧束样或压迫性疼痛,通常为双侧头痛[1],其中慢性紧张型头痛[2](chronic tension type headache,CTTH)较为常见且难治,根据是否...紧张型头痛(tension type headache,TTH)在人群中极其常见,是神经内科门诊中最为常见的疾病,表现为慢性头部紧束样或压迫性疼痛,通常为双侧头痛[1],其中慢性紧张型头痛[2](chronic tension type headache,CTTH)较为常见且难治,根据是否伴有颅周组织压痛,又可将其分为伴有颅周组织压痛及不伴有颅周组织压痛两个亚型[3]。在临床实践中发现,展开更多
Objectives. This study of premonitory symptoms in migraine was performed to document the frequency, duration, and types of symptoms in a large group of migr aine patients. Background. Prodrome importance continues to ...Objectives. This study of premonitory symptoms in migraine was performed to document the frequency, duration, and types of symptoms in a large group of migr aine patients. Background. Prodrome importance continues to be debated. Interv ention early in the migraine attack is assuming more importance and necessitates better knowledge of the prodrome. Methods. A total of 893 migraine patients ( IHS 1.1-1.7) were evaluated at first visit. Prodrome frequency, duration, and c haracteristics were analyzed in the total migraine population IHS 1.1-1.7 and I HS 1.1-1.6 migraine. Results. A total of 32.9%of IHS migraine 1.1 1.6 patie nts reported prodrome symptoms with an average of 9.42 hours. IHS 1.1-1.7 migra ine reported 29.7%and 6.8 hours, respectively. The most commonest symptoms were tiredness, mood change, and gastrointestinal symptoms; all three of these sympt oms were present together in 17%of the patients with prodrome. The duration of prodrome was less than 1 hour in 45.1%, 1-2 hours in 13.6%, 2-4 hours in 15. 0%, 4-12 hours in 13.1%, and greater than 12 hours in 13.2%. IHS 1.1-1.7 pa tients showed similar findings. IHS 1.1-1.6 patients with prodrome differed fro m patients without prodrome in having more triggers as a whole (P <..01), more i ndividual triggers including alcohol (P <..01), hormones (P <..01), light (P <.. 001), not eating (P <..05), perfume (P <..01), stress (P <..01), and weather cha nges (P <.05), a longer duration of aura (P <.05), longer time between aura and headache (P <.05), more aura with no headache (P <..05), longer time to peak of headache (P <..05), longer time to respond to triptan (P <.05), longer maximum d uration of headache (P <.05), and more headache associated nausea (P <..05), mor e headache associated running of the nose or tearing of (the eyes (P <.05), more postdrome syndrome (P <..05), and longer duration of postdrome syndrome (P <..0 01). Conclusions. This study provides a portrait of prodrome in a large cohort of patients. It highlights differences between patients with prodrome and patie nts not having prodrome, and it draws attention to the potential of preventing t he headache phase of the acute migraine attack.展开更多
Objectives. To describe a method for quantifying headache symptoms/features in family practice charts for patients diagnosed with headache NOS (not otherwis e specified, IGD 9: 784) and to determine the share of NOS h...Objectives. To describe a method for quantifying headache symptoms/features in family practice charts for patients diagnosed with headache NOS (not otherwis e specified, IGD 9: 784) and to determine the share of NOS headache diagnoses w ith clinical data strongly suggestive of migraine or probable migraine headache. Background. Headache is one of the most common pain symptoms that brings pati ents to a family physician. However, the majority of headache sufferers do not r eceive a specific headache diagnosis when they visit physicians. Methods. We e xamined the chart notes of 454 patients exclusively diagnosed with one or more I CD 9 coded headache NOS diagnoses from July 1, 1995 through December 31,1999 at a large suburban, university affiliated practice. We developed a template cont aining 20 headache items combining International Headache Society diagnostic cri teria and additional headache symptoms/features, and decision rules for coding s ymptom s/features and collected data from patient charts. We then developed dec ision rules and reclassified NOS headaches into categories strongly suggestive o f migraine, probable migraine headache, or other diagnosis. Our main outcome mea sure is the consistency in the application of decision rules and diagnostic crit eria. Results. With this method we estimate 3 in 10 (29%) headache NOS patien ts may have had migraine (8%) or probable migraine headache (21%). Reclassifi ed migraine visits averaged 6.5 migraine symptoms and reclassified probable migr aine headache visits 4.7 migraine symptoms. Logistic regression analysis support s the consistency of diagnostic criteria for classifying headache based on coded symptoms/features our model correctly predicted 96%of visits. Evidence of ph ysical examination was recorded at 75%of visits suggesting that physician atten tion is focused on elimination of secondary headache. Conclusions. We think th e use of our rigorous procedures reveals that a substantial amount of migraine a nd probable migraine headache may be missed in everyday practice. We hope our fi ndings will provide a basis for the development of diagnostic methods more close ly suited to the needs of nonspecialists, and contribute to a better standard of care for headache patients seen in primary care practice. Finally, we are hopef ul that other researchers will consider using our template and guideline procedu res in their efforts to identify diagnostic patterns and study headache and othe r health problems.展开更多
Objective: Pregnancy-induced hypertension with proteinuria (preeclampsia- PE) is linked to increased vascular reactivity, increased vasoconstrictors, endothelial damage and platelet hyperaggregation, which are also ty...Objective: Pregnancy-induced hypertension with proteinuria (preeclampsia- PE) is linked to increased vascular reactivity, increased vasoconstrictors, endothelial damage and platelet hyperaggregation, which are also typical features of migraine patients. Thus, we investigated the association between headache and PE. Methods: In a case-control study, we evaluated the occurrence of primary headache forms in 75 women with a recent history of PE. Seventy-five controls were selected from women having uneventful pregnancy at term. Both groups were matched for age and parity. Subjects’ headache history was evaluated by using an ad hoc structured questionnaire. The International Headache Society criteria for primary headaches were applied to diagnose the specific form of headache. Results: In PE cases, gestational age at parturition was 34.2 ± 3.8 weeks and birthweight was 1820 ± 746 g, whereas in controls they were 39.3± 1.5 weeks and 3365 ± 437 g, respectively (P < 0.01). Sixty-six (44% ) subjects suffered from headache. Headache was significantly more frequent in PE (47/75) than in controls (19/75), OR 4.95 (95% CI, 2.47- 9.92). Migraine without aura was more frequently present in cases than in controls while episodic tension-type headache was equally distributed among groups. Fifty-two patients met the criteria of severe PE. The number of patients suffering from headache was significantly higher in severe patients (39 cases, 75% ) than in those with moderate PE (8 cases, 34.8% ), OR = 5.63 (95% CI, 1.97- 16.03). With respect to controls, PE patients reported a more frequent onset at menarche, more menstrually related attacks and an increased rate of improvement during pregnancy. Conclusion: This study shows that there is a strong association between migraine history and PE development, namely with the severe form of PE.展开更多
文摘紧张型头痛(tension type headache,TTH)在人群中极其常见,是神经内科门诊中最为常见的疾病,表现为慢性头部紧束样或压迫性疼痛,通常为双侧头痛[1],其中慢性紧张型头痛[2](chronic tension type headache,CTTH)较为常见且难治,根据是否伴有颅周组织压痛,又可将其分为伴有颅周组织压痛及不伴有颅周组织压痛两个亚型[3]。在临床实践中发现,
文摘Objectives. This study of premonitory symptoms in migraine was performed to document the frequency, duration, and types of symptoms in a large group of migr aine patients. Background. Prodrome importance continues to be debated. Interv ention early in the migraine attack is assuming more importance and necessitates better knowledge of the prodrome. Methods. A total of 893 migraine patients ( IHS 1.1-1.7) were evaluated at first visit. Prodrome frequency, duration, and c haracteristics were analyzed in the total migraine population IHS 1.1-1.7 and I HS 1.1-1.6 migraine. Results. A total of 32.9%of IHS migraine 1.1 1.6 patie nts reported prodrome symptoms with an average of 9.42 hours. IHS 1.1-1.7 migra ine reported 29.7%and 6.8 hours, respectively. The most commonest symptoms were tiredness, mood change, and gastrointestinal symptoms; all three of these sympt oms were present together in 17%of the patients with prodrome. The duration of prodrome was less than 1 hour in 45.1%, 1-2 hours in 13.6%, 2-4 hours in 15. 0%, 4-12 hours in 13.1%, and greater than 12 hours in 13.2%. IHS 1.1-1.7 pa tients showed similar findings. IHS 1.1-1.6 patients with prodrome differed fro m patients without prodrome in having more triggers as a whole (P <..01), more i ndividual triggers including alcohol (P <..01), hormones (P <..01), light (P <.. 001), not eating (P <..05), perfume (P <..01), stress (P <..01), and weather cha nges (P <.05), a longer duration of aura (P <.05), longer time between aura and headache (P <.05), more aura with no headache (P <..05), longer time to peak of headache (P <..05), longer time to respond to triptan (P <.05), longer maximum d uration of headache (P <.05), and more headache associated nausea (P <..05), mor e headache associated running of the nose or tearing of (the eyes (P <.05), more postdrome syndrome (P <..05), and longer duration of postdrome syndrome (P <..0 01). Conclusions. This study provides a portrait of prodrome in a large cohort of patients. It highlights differences between patients with prodrome and patie nts not having prodrome, and it draws attention to the potential of preventing t he headache phase of the acute migraine attack.
文摘Objectives. To describe a method for quantifying headache symptoms/features in family practice charts for patients diagnosed with headache NOS (not otherwis e specified, IGD 9: 784) and to determine the share of NOS headache diagnoses w ith clinical data strongly suggestive of migraine or probable migraine headache. Background. Headache is one of the most common pain symptoms that brings pati ents to a family physician. However, the majority of headache sufferers do not r eceive a specific headache diagnosis when they visit physicians. Methods. We e xamined the chart notes of 454 patients exclusively diagnosed with one or more I CD 9 coded headache NOS diagnoses from July 1, 1995 through December 31,1999 at a large suburban, university affiliated practice. We developed a template cont aining 20 headache items combining International Headache Society diagnostic cri teria and additional headache symptoms/features, and decision rules for coding s ymptom s/features and collected data from patient charts. We then developed dec ision rules and reclassified NOS headaches into categories strongly suggestive o f migraine, probable migraine headache, or other diagnosis. Our main outcome mea sure is the consistency in the application of decision rules and diagnostic crit eria. Results. With this method we estimate 3 in 10 (29%) headache NOS patien ts may have had migraine (8%) or probable migraine headache (21%). Reclassifi ed migraine visits averaged 6.5 migraine symptoms and reclassified probable migr aine headache visits 4.7 migraine symptoms. Logistic regression analysis support s the consistency of diagnostic criteria for classifying headache based on coded symptoms/features our model correctly predicted 96%of visits. Evidence of ph ysical examination was recorded at 75%of visits suggesting that physician atten tion is focused on elimination of secondary headache. Conclusions. We think th e use of our rigorous procedures reveals that a substantial amount of migraine a nd probable migraine headache may be missed in everyday practice. We hope our fi ndings will provide a basis for the development of diagnostic methods more close ly suited to the needs of nonspecialists, and contribute to a better standard of care for headache patients seen in primary care practice. Finally, we are hopef ul that other researchers will consider using our template and guideline procedu res in their efforts to identify diagnostic patterns and study headache and othe r health problems.
文摘Objective: Pregnancy-induced hypertension with proteinuria (preeclampsia- PE) is linked to increased vascular reactivity, increased vasoconstrictors, endothelial damage and platelet hyperaggregation, which are also typical features of migraine patients. Thus, we investigated the association between headache and PE. Methods: In a case-control study, we evaluated the occurrence of primary headache forms in 75 women with a recent history of PE. Seventy-five controls were selected from women having uneventful pregnancy at term. Both groups were matched for age and parity. Subjects’ headache history was evaluated by using an ad hoc structured questionnaire. The International Headache Society criteria for primary headaches were applied to diagnose the specific form of headache. Results: In PE cases, gestational age at parturition was 34.2 ± 3.8 weeks and birthweight was 1820 ± 746 g, whereas in controls they were 39.3± 1.5 weeks and 3365 ± 437 g, respectively (P < 0.01). Sixty-six (44% ) subjects suffered from headache. Headache was significantly more frequent in PE (47/75) than in controls (19/75), OR 4.95 (95% CI, 2.47- 9.92). Migraine without aura was more frequently present in cases than in controls while episodic tension-type headache was equally distributed among groups. Fifty-two patients met the criteria of severe PE. The number of patients suffering from headache was significantly higher in severe patients (39 cases, 75% ) than in those with moderate PE (8 cases, 34.8% ), OR = 5.63 (95% CI, 1.97- 16.03). With respect to controls, PE patients reported a more frequent onset at menarche, more menstrually related attacks and an increased rate of improvement during pregnancy. Conclusion: This study shows that there is a strong association between migraine history and PE development, namely with the severe form of PE.
