慢性緊張性頭痛和慢性偏頭痛的癥狀學(xué)臨床研究
發(fā)布時(shí)間：2018-08-20 12:29
【摘要】：[目的]比較慢性緊張性頭痛(chronic tension-type headache,CTTH)和慢性偏頭痛(chronic migraine,CM)的癥狀學(xué)特點(diǎn);明確慢性緊張性頭痛和慢性偏頭痛癥狀特點(diǎn)的臨床影響因素。[方法]收集2016年12月到2017年3月解放軍昆明總醫(yī)院神經(jīng)內(nèi)科門(mén)診以頭痛為主訴的連續(xù)就診患者的信息;采用自制頭痛資料采集問(wèn)卷,對(duì)頭痛患者的一般資料、臨床癥狀、輔助檢查、既往就診情況、既往服藥情況進(jìn)行詳細(xì)收集,然后由頭痛研究組成員依據(jù)國(guó)際頭痛分類標(biāo)準(zhǔn)第三版試用版(The International Classification of Headache Disorders,3rd edition(beta version),ICHD-3-beta)對(duì)慢性緊張性頭痛和慢性偏頭痛進(jìn)行診斷。對(duì)收集到的數(shù)據(jù)進(jìn)行錄入,計(jì)量資料符合正態(tài)分布采用均值±標(biāo)準(zhǔn)差來(lái)表示,組間比較采用t檢驗(yàn),偏態(tài)分布用中位數(shù)和四分位間距表述,組間比較采用秩和檢驗(yàn);計(jì)數(shù)資料用頻數(shù)(N)與百分比(%)表示,組間比較用卡方檢驗(yàn),比較CM和CTTH的癥狀學(xué)差異,P0.05表示差異有統(tǒng)計(jì)學(xué)意義。針對(duì)CM、CTTH和頭痛危險(xiǎn)因素的相關(guān)性進(jìn)行逐步向后法Logistics回歸分析,明確CM和CTTH的臨床影響因素。所有數(shù)據(jù)統(tǒng)計(jì)分析采用SPSS 20.0軟件進(jìn)行統(tǒng)計(jì)分析。[結(jié)果](1)本研究共收集門(mén)診病人6684例,其中以頭痛為主訴的患者584例,符合CTTH的患者124例,平均年齡為46.44±11.51歲,女性患者87(70.16%)例;符合CM的患者155例,平均年齡43.43±12.11歲,女性患者107(69.03%)例;CTTH組患者的平均就診年齡大于CM患者組(P0.05)。(2)CTTH的癥狀學(xué)特征有:CTTH患者頭痛發(fā)作時(shí)更多伴有頭昏(20.96%vs.10.96%,OR=2.15,95%CI,1.11-4.18),頭痛部位多見(jiàn)于全頭痛(24.19%vs.5.80%,OR=5.17,95%CI,2.35-11.39)、后枕部疼痛(21.77%vs.12.25%,OR=1.99,95%CI,1.05-3.78)、前額部疼痛(19.35%vs.7.09%,OR=3.14,95%CI,1.47-6.70)、頭頂部疼痛(15.32%vs.7.09%,OR=2.37,95%CI,1.08-5.18)為主;CTTH 的頭痛性質(zhì)以悶痛脹痛(66.12%vs.25.16%,OR=5.81。95%CI,3.45-9.76)、緊縮樣疼痛(15.32%vs.1.93%,OR=9.16,95%CI,2.64-31.77)更多見(jiàn);CTTH 患者的頭痛持續(xù)時(shí)間以72小時(shí)較CM更多見(jiàn)(19.35%vs.10.32%,R=2.08。95%CI,1.05-4.12),并且常常不能自行緩解(49.19%vs.35.48%,OR=0.56,95CI,0.35-0.92)。CM的癥狀學(xué)特征有:CM患者比CTTH患者頭痛發(fā)作時(shí)更多伴有聽(tīng)覺(jué)癥狀(25.16%vs.13.70%,OR=0.47,95%CI,0.25-0.88);頭痛部位以一側(cè)頭痛更多見(jiàn)(68.38%vs.14.51%,OR=0.078,95%CI,0.04-0.14);頭痛性質(zhì)以搏動(dòng)性跳痛更多見(jiàn)(74.83%vs.4.83%,OR=0.017,95%CI,0.007-0.042);發(fā)作形式更多以間斷性發(fā)作為主(93.54%vs.81.45%,OR=3.30,95%CI,1.51-7.24);并且CM患者更多伴有頭痛家族遺傳病史(21.29%vs.8.87%,OR=0.36,95%CI,0.17-0.74)。(3)多因素Logistics回歸分析結(jié)果顯示伴有頭暈、頭昏、輕度頭痛、中度頭痛是緊張性頭痛發(fā)展為CTTH的獨(dú)立預(yù)測(cè)因素。伴有頭暈的緊張性頭痛患者較伴有其他癥狀的緊張性頭痛患者發(fā)展為CTTH風(fēng)險(xiǎn)增加2.47倍(OR=2.47,95%CI,1.22-5.01);伴有頭昏癥狀的緊張性頭痛患者較伴有其他癥狀的緊張性頭痛患者發(fā)展為CTTH的風(fēng)險(xiǎn)增加2.37倍(OR=2.37,95%CI,1.19-4.73);輕度疼痛的緊張性頭痛患者發(fā)展為CTTH的風(fēng)險(xiǎn)增加2.43倍(OR=2.43,95%CI,1.05-5.60);中度疼痛的緊張性頭痛患者發(fā)展為CTTH的風(fēng)險(xiǎn)增加2.03倍(OR=2.03,95%CI,1.04-3.95)。頭痛能自行緩解、伴有聽(tīng)覺(jué)癥狀、家族史是偏頭痛發(fā)展為CM的獨(dú)立預(yù)測(cè)因素。頭痛能自行緩解的患者發(fā)展為慢性偏頭痛的風(fēng)險(xiǎn)增加2.34倍(OR=2.34,95%CI,1.37-3.98);伴有聽(tīng)覺(jué)癥狀(耳鳴)的患者較伴有其他癥狀的偏頭痛患者發(fā)展為CM的風(fēng)險(xiǎn)增加2.64倍(OR=2.64,95%CI,1.32-5.29);頭痛家族史的偏頭痛患者發(fā)展為CM的風(fēng)險(xiǎn)增加 2.82 倍(OR=2.82,95%CI,1.30-6.11)。[結(jié)論](1)慢性緊張性頭痛患者的平均年齡較慢性偏頭痛的平均年齡大。(2)慢性緊張性頭痛患者的頭痛部位主要以全頭痛、后枕部疼痛、前額部疼痛、頭頂痛為主;頭痛性質(zhì)主要以緊縮樣疼痛、悶脹痛為主;CTTH較CM更多伴隨頭昏;且持續(xù)大于72小時(shí)、不能自行緩解者較CM更多見(jiàn)。(3)慢性偏頭痛患者的頭痛部位主要以一側(cè)顳部多見(jiàn);頭痛性質(zhì)主要以搏動(dòng)性跳痛多見(jiàn);CM患者較CTTH患者更多伴隨聽(tīng)覺(jué)癥狀;頭痛多以間斷發(fā)作為主;且更多伴有頭痛家族遺傳病史。(4)伴有頭暈、頭昏,輕度、中度疼痛是緊張性頭痛發(fā)展為CTTH的獨(dú)立預(yù)測(cè)因素。(5)能自行緩解、伴有聽(tīng)覺(jué)癥狀、有頭痛家族史是偏頭痛發(fā)展為CM的獨(dú)立預(yù)測(cè)因素。
[Abstract]:[Objective] To compare the symptomatic characteristics of chronic tension-type headache (CTTH) and chronic migraine (CM), and to identify the clinical influencing factors of the symptoms of chronic tension headache and chronic migraine. The headache data collection questionnaire was used to collect the general information, clinical symptoms, auxiliary examinations, previous visits and medications of the patients with headache, and then the headache team members were asked to use the third edition of the International Classification of Headache. Chronic tension headache and migraine were diagnosed by on-of-Headache Disorders, 3rd Edition (beta version), ICHD-3-beta. The collected data were entered and the measurements were expressed by mean (+) standard deviation, t-test, median and quartile spacing, and inter-group ratio. Compared with rank sum test, counting data were expressed by frequency (N) and percentage (%). Chi-square test was used to compare the symptomatic differences between CM and CTTH, and P 0.05 was statistically significant. [Results] A total of 6 684 outpatients were collected in this study, including 584 patients with headache as the main complaint, 124 patients with CTTH, with an average age of 46.44 [11.51], 87 (70.16%) women, 155 patients with CM, with an average age of 43.43 [12.11], and 107 (67 (66.16%) women. The average age of CTTH patients was older than that of CM patients (P 0.05). (2) The symptoms of CTTH patients were characterized by dizziness (20.96% vs. 10.96%, OR = 2.15, 95% CI, 1.11-4.18) and headache (24.19% vs. 5.80%, OR = 5.17, 95% CI, 2.35-11.39), occipital pain (21.77% vs. 12.25%, OR = 1.99, 95% C.99). I, 1.05-3.78, I, 1.05-3.78, prefrontal pain (19.35% vs. 7.09%, OR = 3.14, 95% CI, 1.14, 95% CI, 1.47-6.70), headache (15.32% vs. 7.09%, OR = 2.09%, OR = 2.37, 95% CI, 95% CI, 1.08-5.18) was predominant; CTTHheadachewas characterized by stuffpain (66.12% vs. 25.16%, OR = 5.25.16%, OR = 5.81.95% CI, 3.45-95% CI, 3.45-9.76), constrict-like pain (15.32% vs. 1.32%, vs. 1.1.93%, OR = 1.93%, OR = 1.93%, OR 31.77) More common; headache in CTTH patients The duration of 72 hours was more common than that of CM (19.35% vs. 10.32%, R = 2.08.95% CI, 1.05-4.12), and it was often unable to relieve itself (49.19% vs. 35.48%, OR = 0.56, 95 CI, 0.35-0.92). The symptoms of CM were more accompanied by hearing symptoms (25.16% vs. 13.70%, OR = 0.47, 95% CI, 0.25-0.88) than that of CTTH. More frequent (68.38% vs. 14.51%, OR = 0.078, 95% CI, 0.04-0.14); more frequent headache was pulsatile bouncing pain (74.83% vs. 4.83%, OR = 0.017, 95% CI, 0.007-0.042); more frequent episodes were intermittent attacks (93.54% vs. 81.45%, OR = 3.30, 95% CI, 1.51-7.24); and CM patients had more family history of headache (21.29% vs. 0.87%, OR = 95% CI, 0.36% CI, 1.51-7.24). (3) Multivariate logistic regression analysis showed that dizziness, dizziness, mild headache and moderate headache were independent predictors of the development of tension headache into CTTH. Patients with tension headache with dizziness had a 2.37-fold increased risk of developing CTTH (OR = 2.37, 95% CI, 1.19-4.73); patients with tension headache with mild pain had a 2.43-fold increased risk of developing CTTH (OR = 2.43, 95% CI, 1.05-5.60); and patients with moderate pain had a 2.37-fold increased risk of developing CTTH (OR = 2.43, 95% CI, 1.05-5.60). Headache relief, with auditory symptoms, and family history were independent predictors of migraine progression to CM. Patients with headache relief had a 2.34-fold increased risk of developing chronic migraine (OR = 2.34, 95% CI, 1.37-3.98); those with auditory symptoms (tinnitus) were more likely to develop migraines with other symptoms than those with other symptoms (OR = 2.34, 95% CI, 1.37-3.98). Patients with headache had a 2.64-fold increased risk of developing CM (OR = 2.64, 95% CI, 1.32-5.29); migraine patients with family history of headache had a 2.82-fold increased risk of developing CM (OR = 2.82, 95% CI, 1.30-6.11). [Conclusion] (1) The average age of patients with chronic tension headache was older than that of patients with chronic migraine. (2) Patients with chronic tension headache had a headache. Headache is mainly characterized by constrictive pain and stuffy pain; CTTH is more often accompanied by dizziness than CM; and persists for more than 72 hours, more often than CM. 3) The headache of chronic migraine patients is mainly located in one side of the temple; headache is mainly characterized by headache. Pulsatile bouncing pain was more common in CM patients than in CTTH patients; headaches were more frequent with auditory symptoms; headaches were predominantly intermittent; and more frequent with family history of headache. (4) Dizziness, dizziness, mild, moderate pain was an independent predictor of the development of tension headache into CTTH. (5) Self-relief, auditory symptoms, family history of headache was migraine. Pain development is an independent predictor of CM.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R741;R747.2
本文編號(hào)：2193611
[Abstract]:[Objective] To compare the symptomatic characteristics of chronic tension-type headache (CTTH) and chronic migraine (CM), and to identify the clinical influencing factors of the symptoms of chronic tension headache and chronic migraine. The headache data collection questionnaire was used to collect the general information, clinical symptoms, auxiliary examinations, previous visits and medications of the patients with headache, and then the headache team members were asked to use the third edition of the International Classification of Headache. Chronic tension headache and migraine were diagnosed by on-of-Headache Disorders, 3rd Edition (beta version), ICHD-3-beta. The collected data were entered and the measurements were expressed by mean (+) standard deviation, t-test, median and quartile spacing, and inter-group ratio. Compared with rank sum test, counting data were expressed by frequency (N) and percentage (%). Chi-square test was used to compare the symptomatic differences between CM and CTTH, and P 0.05 was statistically significant. [Results] A total of 6 684 outpatients were collected in this study, including 584 patients with headache as the main complaint, 124 patients with CTTH, with an average age of 46.44 [11.51], 87 (70.16%) women, 155 patients with CM, with an average age of 43.43 [12.11], and 107 (67 (66.16%) women. The average age of CTTH patients was older than that of CM patients (P 0.05). (2) The symptoms of CTTH patients were characterized by dizziness (20.96% vs. 10.96%, OR = 2.15, 95% CI, 1.11-4.18) and headache (24.19% vs. 5.80%, OR = 5.17, 95% CI, 2.35-11.39), occipital pain (21.77% vs. 12.25%, OR = 1.99, 95% C.99). I, 1.05-3.78, I, 1.05-3.78, prefrontal pain (19.35% vs. 7.09%, OR = 3.14, 95% CI, 1.14, 95% CI, 1.47-6.70), headache (15.32% vs. 7.09%, OR = 2.09%, OR = 2.37, 95% CI, 95% CI, 1.08-5.18) was predominant; CTTHheadachewas characterized by stuffpain (66.12% vs. 25.16%, OR = 5.25.16%, OR = 5.81.95% CI, 3.45-95% CI, 3.45-9.76), constrict-like pain (15.32% vs. 1.32%, vs. 1.1.93%, OR = 1.93%, OR = 1.93%, OR 31.77) More common; headache in CTTH patients The duration of 72 hours was more common than that of CM (19.35% vs. 10.32%, R = 2.08.95% CI, 1.05-4.12), and it was often unable to relieve itself (49.19% vs. 35.48%, OR = 0.56, 95 CI, 0.35-0.92). The symptoms of CM were more accompanied by hearing symptoms (25.16% vs. 13.70%, OR = 0.47, 95% CI, 0.25-0.88) than that of CTTH. More frequent (68.38% vs. 14.51%, OR = 0.078, 95% CI, 0.04-0.14); more frequent headache was pulsatile bouncing pain (74.83% vs. 4.83%, OR = 0.017, 95% CI, 0.007-0.042); more frequent episodes were intermittent attacks (93.54% vs. 81.45%, OR = 3.30, 95% CI, 1.51-7.24); and CM patients had more family history of headache (21.29% vs. 0.87%, OR = 95% CI, 0.36% CI, 1.51-7.24). (3) Multivariate logistic regression analysis showed that dizziness, dizziness, mild headache and moderate headache were independent predictors of the development of tension headache into CTTH. Patients with tension headache with dizziness had a 2.37-fold increased risk of developing CTTH (OR = 2.37, 95% CI, 1.19-4.73); patients with tension headache with mild pain had a 2.43-fold increased risk of developing CTTH (OR = 2.43, 95% CI, 1.05-5.60); and patients with moderate pain had a 2.37-fold increased risk of developing CTTH (OR = 2.43, 95% CI, 1.05-5.60). Headache relief, with auditory symptoms, and family history were independent predictors of migraine progression to CM. Patients with headache relief had a 2.34-fold increased risk of developing chronic migraine (OR = 2.34, 95% CI, 1.37-3.98); those with auditory symptoms (tinnitus) were more likely to develop migraines with other symptoms than those with other symptoms (OR = 2.34, 95% CI, 1.37-3.98). Patients with headache had a 2.64-fold increased risk of developing CM (OR = 2.64, 95% CI, 1.32-5.29); migraine patients with family history of headache had a 2.82-fold increased risk of developing CM (OR = 2.82, 95% CI, 1.30-6.11). [Conclusion] (1) The average age of patients with chronic tension headache was older than that of patients with chronic migraine. (2) Patients with chronic tension headache had a headache. Headache is mainly characterized by constrictive pain and stuffy pain; CTTH is more often accompanied by dizziness than CM; and persists for more than 72 hours, more often than CM. 3) The headache of chronic migraine patients is mainly located in one side of the temple; headache is mainly characterized by headache. Pulsatile bouncing pain was more common in CM patients than in CTTH patients; headaches were more frequent with auditory symptoms; headaches were predominantly intermittent; and more frequent with family history of headache. (4) Dizziness, dizziness, mild, moderate pain was an independent predictor of the development of tension headache into CTTH. (5) Self-relief, auditory symptoms, family history of headache was migraine. Pain development is an independent predictor of CM.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R741;R747.2
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