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1、-The international Classification of Headache disorders, 3rd Editon无先兆偏头痛的诊断标准：A：符合B-D特征，至少发作5次发作B：头痛（未经治疗）发作持续4-72小时C：至少有以下特征中的2项 单侧性、搏动性、中重度痛、日常活动会加重D：至少以下一项伴随症状： 恶心和/或呕吐、畏光和畏声E：不能归因于其他头痛分类的国际标准(ICHD-III)概述：头痛分为三大组：原发性头痛；继发性头痛；脑神经痛、中枢和原发性颜面痛及其他头痛。每一种原发性头痛均视为一种独立的疾病；继发性头痛一般只是某种疾病的一种症状，该头痛称为“缘于”此种疾病
2、的头痛。三大组头痛共分为14类：一、原发性头痛（the primary headaches）1.偏头痛（Migraine）1.1 Migraine without aura无先兆偏头痛1.2 Migraine with aura有先兆偏头痛1.2.1 Migraine with typical aura先兆性偏头痛的诊断标准：A：符合B-C特征，至少发作2次发作B：完全可逆以下症状的1项或多项 视觉、感觉、语言障碍（典型先兆） 肢体无力症状（偏瘫型偏头痛） 脑干症状（基底型偏头痛） 视网膜症状（视网膜型偏头痛）C：至少有以下特征中的2项 至少1个先兆逐渐发展的过程5min，和/或不同先兆接连发
3、生过程5min 每个先兆症状持续时间5-60min 至少一个先兆症状为单侧性 先兆发生同时或之后内60min出现符合偏头痛D：不能归因于其他l 肢体无力症状可以持续至72h，部分患者肢体无力感可持续数周；l 若患者先兆持续1周以上，称为无梗死的持续先兆一般先兆症状多为双侧，可持续数月或数年l 若先兆持续60min至1周以内，则称为propable migraine with aural 若出现影像学梗死灶，则称为偏头痛性脑梗死 （年轻女性，后循环比较常见）1.2.1.1 Typical aura with headache1.2.1.2 Typical aura without headach
4、e1.2.2 Migraine with brainstem aura1.2.3 Hemiplegic migraine偏瘫型偏头痛1.2.3.1 Familial hemiplegic migraine (FHM)家族性1.2.3.1.1 Familial hemiplegic migraine type 1 (FHM1)1.2.3.1.2 Familial hemiplegic migraine type 2 (FHM2)1.2.3.1.3 Familial hemiplegic migraine type 3 (FHM3)1.2.3.1.4 Familial hemiplegic mig
5、raine, other loci1.2.3.2 Sporadic hemiplegic migraine散发性1.2.4 Retinal migraine1.3 Chronic migraine慢性偏头痛1.4 Complications of migraine偏头痛并发症1.4.1 Status migrainosus偏头痛持续状态1.4.2 Persistent aura without infarction1.4.3 Migrainous infarction偏头痛脑梗死1.4.4 Migraine aura-triggered seizure1.5 Probable migraine
6、很可能的偏头痛1.5.1 Probable migraine without aura1.5.2 Probable migraine with aura1.6 Episodic syndromes that may be associated with migraine可能与偏头痛有关的发作性综合征慢性偏头痛：偏头痛发作每月15天，连续3个月以上偏头痛持续状态：单次发作持续72小时以上1.6.1 Recurrent gastrointestinal disturbance1.6.1.1Cyclical vomiting syndrome周期性呕吐1.6.1.2 Abdominal migrai
7、ne腹型偏头痛1.6.2 Benign paroxysmal vertigo良性发作性眩晕1.6.3 Benign paroxysmal torticollis良性发作性斜颈2.紧张型头痛（Tension-type headache）每次发作持续30min-7d，慢性者可持续不缓解2.1 Infrequent episodic tension-type headache偶发性 1d/月，至少10次以上（12d/年）2.1.1 Infrequent episodic tension-type headache associated with pericranial tenderness2.1.2
8、 Infrequent episodic tension-type headache not associated with pericranial tenderness2.2 Frequent episodic tension-type headache频发性1d/月，但15d，至少发作10次以上（12d/年但180d）2.2.1 Frequent episodic tension-type headache associated with pericranial tenderness2.2.2 Frequent episodic tension-type headache not asso
9、ciated with pericranial tenderness2.3 Chronic tension-type headache慢性紧张型头痛 每月发作15d，3个月以上2.3.1 Chronic tension-type headache associated with pericranial tenderness2.3.2 Chronic tension-type headache not associated with pericranial tenderness丛集性头痛的诊断标准：A：至少符合B-D的5次以上的发作B：单侧、眼眶、上眼眶及/或颞部重度或极重度疼痛，如不治疗持续1
10、5min-180min；C：伴随至少以上一项症状同侧结膜充血/流泪同侧鼻腔充血/流鼻水同侧眼皮水肿同侧前额及脸部出汗同侧瞳孔缩小/眼睑下垂不安的症状或躁动D：发作频率隔日1至8次/日E：除外其他疾患2.4 Probable tension-type headache很可能的紧张型头痛2.4.1 Probable infrequent episodic tension-type headache2.4.2 Probable frequent episodic tension-type headache2.4.3 Probable chronic tension-type headache3.三叉
11、自主神经性头痛（Trigeminal autonomic cephalalgias）3.1 Cluster headache丛集性头痛3.1.1 Episodic cluster headache发作性丛集性头痛3.1.2 Chronic cluster headache慢性丛集性头痛（复发作大于1年无缓解期，或缓解期3 months D：除外其他疾患l 慢性头痛，起病急，可清晰回忆发病时间为哪一天l 疼痛缺乏特点，可以为偏头痛，可以为紧张性，亦可两者混合l 若患者符合慢性偏头痛或慢性紧张型头痛的标准，则不诊断NDPHl 若患者为药物过度使用性头痛，且符合NDPH的标准，则可两者均可作为诊断4
12、.6 External-pressure headache4.6.1 External-compression headache4.6.2 External-traction headache4.6.3 Probable external-pressure headache4.6.3.1 Probable external-compression headache4.6.3.2 Probable external-traction headache4.7 Primary stabbing headache4.7.1 Probable primary stabbing headache4.8 N
13、ummular headache4.8.1 Probable nummular headache4.9 Hypnic headache4.9.1 Probable hypnic headache4.10 New daily persistent headache (NDPH) 新症每日持续性头痛4.10.1 Probable new daily persistent headach二、继发性头痛（the secondary headaches）5.缘于头、颈部外伤的头痛（Headache attributed to trauma or injury to the head and/or nec
14、k）5.1 Acute headache attributed to traumatic injury to the head5.1.1 Acute headache attributed to moderate or severe traumatic injury to the head5.1.2 Acute headache attributed to mild traumatic injury to the head5.2 Persistent headache attributed to traumatic injury to the head5.2.1 Persistent head
15、ache attributed to moderate or severe traumatic injury to the head5.2.2 Persistent headache attributed to mild traumatic injury to the head5.3 Acute headache attributed to whiplash5.4 Persistent headache attributed to whiplash5.5 Acute headache attributed to craniotomy5.6 Persistent headache attribu
16、ted to craniotomy6.缘于头颈部血管疾病的头痛（Headache attributed to cranial or cervical vascular disorder ）6.1 Headache attributed to ischaemic stroke or transient ischaemic attack6.1.1 Headache attributed to ischaemic stroke (cerebral infarction)6.1.2 Headache attributed to transient ischaemic attack (TIA)6.2 H
17、eadache attributed to non-traumatic intracranial haemorrhage6.2.1 Headache attributed to non-traumatic intracerebral haemorrhage非外伤性脑出血6.2.2 Headache attributed to non-traumatic subarachnoid haemorrhage (SAH)6.2.3 Headache attributed to non-traumatic acute subdural haemorrhage (ASDH)急性硬膜下血肿6.3 Heada
18、che attributed to unruptured vascular malformation未破裂的血管畸形6.3.1 Headache attributed to unruptured saccular aneurysm囊性动脉瘤6.3.2 Headache attributed to arteriovenous malformation (AVM) 动静脉畸形6.3.3 Headache attributed to dural arteriovenous fistula (DAVF) 硬膜动静脉瘘6.3.4 Headache attributed to cavernous angi
19、oma 海绵窦血管瘤 6.3.5 Headache attributed to encephalotrigeminal or leptomeningeal angiomatosis (Sturge Weber syndrome) 脑三叉神经或软脑膜血管瘤病 6.4 Headache attributed to arteritis6.4.1 Headache attributed to giant cell arteritis (GCA) 颞动脉炎6.4.2 Headache attributed to primary angiitis of the central nervous system
20、 (PACNS)6.4.3 Headache attributed to secondary angiitis of the central nervous system (SACNS)颞动脉炎诊断标准：美国风湿学会1990年1. 50岁以上发病：50岁以上发现症状2新发的头痛：出现新发的局限性头痛3颞动脉异常：颞动脉压痛或者与颈动脉的动脉硬化无关的搏动减弱4血沉值升高：50mm/h以上5动脉活检异常：单核细胞为主的细胞浸润或者伴多核巨细胞的肉芽肿出现为特征的血管炎证据l 5项中如满足3项以上，敏感度935。特异性912可能分类为颞动脉炎。6.5 Headache attributed to
21、cervical carotid or vertebral artery disorder颈动脉或锥动脉疼痛6.5.1 Headache or facial or neck pain attributed to cervical carotid or vertebral artery dissection动脉夹层6.5.2 Post-endarterectomy headache内膜剥脱术后头痛6.5.3 Headache attributed to carotid or vertebral angioplasty颈动脉血管成型术头痛6.6 Headache attributed to cer
22、ebral venous thrombosis (CVT) 脑静脉血栓形成6.7 Headache attributed to other acute intracranial arterial disorder6.7.1 Headache attributed to an intracranial endovascular procedure6.7.2 Angiography headache6.7.3 Headache attributed to reversible cerebral vasoconstriction syndrome (RCVS)6.7.3.1 Headache pro
23、bably attributed to reversible cerebral vasoconstrictionsyndrome (RCVS)6.7.4 Headache attributed to intracranial arterial dissection颅内动脉夹层6.8 Headache attributed to genetic vasculopathy6.8.1 Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL)6.8.2 Mit
24、ochondrial Encephalopathy, Lactic Acidosis and Stroke-like episodes (MELAS)6.8.3 Headache attributed to another genetic vasculopathy6.9 Headache attributed to pituitary apoplexy垂体卒中7.缘于非血管性颅内疾病的头痛（Headache attributed to non-vascular intracranial disorder ）7.1 Headache attributed to increased cerebro
25、spinal fluid pressure颅内压增高7.1.1 Headache attributed to idiopathic intracranial hypertension (IIH)7.1.2 Headache attributed to intracranial hypertension secondary to metabolic, toxic or hormonal causes7.1.3 Headache attributed to intracranial hypertension secondary to hydrocephalus7.2 Headache attrib
26、uted to low cerebrospinal fluid pressure颅内压低下7.2.1 Post-dural puncture headache腰穿后7.2.2 CSF fistula headache脑脊液漏7.2.3 Headache attributed to spontaneous intracranial hypotension自发性低颅压7.3 Headache attributed to non-infectious inflammatory disease非感染性炎性疾病7.3.1 Headache attributed to neurosarcoidosis7.
27、3.2 Headache attributed to aseptic (non-infectious) meningitis7.3.3 Headache attributed to other non-infectious inflammatory disease7.3.4 Headache attributed to lymphocytic hypophysitis7.3.5 Syndrome of transient Headache and Neurological Deficits with cerebrospinal fluid Lymphocytosis (HaNDL)7.4 He
28、adache attributed to intracranial neoplasia颅内新生物7.4.1 Headache attributed to intracranial neoplasm7.4.1.1 Headache attributed to colloid cyst of the third ventricle7.4.2 Headache attributed to carcinomatous meningitis癌性脑膜炎7.4.3 Headache attributed to hypothalamic or pituitary hyper- or hyposecretion
29、7.5 Headache attributed to intrathecal injection鞘内注射7.6 Headache attributed to epileptic seizure7.6.1 Hemicrania epileptica癫痫半颅痛7.6.2 Post-ictal headache癫痫发作后头痛7.7 Headache attributed to Chiari malformation type I (CM1)7.8 Headache attributed to other non-vascular intracranial disorder8.缘于物质或物质戒断的头痛
30、（Headache attributed to a substance or its withdrawal）8.1 Headache attributed to use of or exposure to a substance or its withdrawal缘于某种物质的应用或戒断8.1.1 Nitric oxide (NO) donor-induced headache一化氮诱发8.1.1.1 Immediate NO donor-induced headache8.1.1.2 Delayed NO donor-induced headache8.1.2 Phosphodiestera
31、se (PDE) inhibitor-induced headache磷酸二酯酶抑制剂8.1.3 Carbon monoxide (CO)-induced headache一氧化碳诱发8.1.4 Alcohol-induced headache酒精诱发8.1.4.1 Immediate alcohol-induced headache8.1.4.2 Delayed alcohol-induced headache8.1.5 Headache induced by food and/or additive由于食物成分/添加剂诱发8.1.5.1 Monosodium glutamate (MSG)
32、-induced headache谷氨酸单钠盐（味精）8.1.6 Cocaine-induced headache可卡因诱发8.1.7 Histamine-induced headache组织胺诱发8.1.7.1 Immediate histamine-induced headache8.1.7.2 Delayed histamine-induced headache8.1.8 Calcitonin gene-related peptide (CGRP)-induced headache降钙素基因相关多肽诱发8.1.8.1 Immediate CGRP-induced headache8.1.
33、8.2 Delayed CGRP-induced headache8.1.9 Headache attributed to exogenous acute pressor agent8.1.10 Headache attributed to occasional use of non-headache medication8.1.11 Headache attributed to long-term use of non-headache medication8.1.12 Headache attributed to exogenous hormone8.1.13 Headache attri
34、buted to use of or exposure to other substance8.2 Medication-overuse headache (MOH) 药物过度使用性头痛MOH诊断标准1 符合3-4项的头痛表现15天2 规律使用1种或多种用于头痛急性期的止痛药超过3个月3 在药物过度使用期间，头痛进展或明显加重4 停用所用过度使用药物之后的2个月内，头痛必需改善（缓解或重归于之前的头痛模式l MOH头痛表现多样，常有特征转换的独特模式l 过度是指规律且频繁，即每周2天或以上l 最常见的药物：对乙酰氨基酚曲坦类巴比妥类阿片类，此外阿司匹林、麦角类、镇痛药及复方制剂均可引起MOH8
35、.2.1 Ergotamine-overuse headache麦角胺类8.2.2 Triptan-overuse headache曲普坦类8.2.3 Simple analgesic-overuse headache单纯止痛药类8.2.3.1 Paracetamol (acetaminophen)-overuse headache对乙酰氨基酚8.2.3.2 Acetylsalicylic acid-overuse headache乙酰水杨酸/阿司匹林8.2.3.3 Other non-steroidal anti-inflammatory drug (NSAID)-overuse heada
36、che8.2.4 Opioid-overuse headache鸦片类8.2.5 Combination-analgesic-overuse headache复合制剂过度应用8.2.6 Medication-overuse headache attributed to multiple drug classes not individually over used联合用药所致8.2.7 Medication-overuse headache attributed to unverified overuse of multiple drug classes8.2.8 Medication-ove
37、ruse headache attributed to other medication8.3 Headache attributed to substance withdrawal物质戒断8.3.1 Caffeine-withdrawal headache咖啡因8.3.2 Opioid-withdrawal headache鸦片类8.3.3 Oestrogen-withdrawal headache雌激素8.3.4 Headache attributed to withdrawal from chronic use of other substance9.缘于感染的头痛（Headache a
38、ttributed to infection）9.1 Headache attributed to intracranial infection颅内感染9.1.1 Headache attributed to bacterial meningitis or meningoencephalitis细菌性脑膜炎/脑膜脑炎9.1.1.1 Acute headache attributed to bacterial meningitis or meningoencephalitis9.1.1.2 Chronic headache attributed to bacterial meningitis o
39、r meningoencephalitis9.1.1.3 Persistent headache attributed to past bacterial meningitis or meningoencephalitis9.1.2 Headache attributed to viral meningitis or encephalitis病毒性脑膜炎或脑炎9.1.2.1 Headache attributed to viral meningitis9.1.2.2 Headache attributed to viral encephalitis9.1.3 Headache attribut
40、ed to intracranial fungal or other parasitic infection真菌或寄生虫感染9.1.3.1 Acute headache attributed to intracranial fungal or other parasitic infection9.1.3.2 Chronic headache attributed to intracranial fungal or other parasitic infection9.1.4 Headache attributed to brain abscess脑脓肿9.1.5 Headache attrib
41、uted to subdural empyema硬膜下积脓9.2 Headache attributed to systemic infection系统感染9.2.1 Headache attributed to systemic bacterial infection系统细菌感染9.2.1.1 Acute headache attributed to systemic bacterial infection9.2.1.2 Chronic headache attributed to systemic bacterial infection9.2.2 Headache attributed t
42、o systemic viral infection系统病毒感染9.2.2.1 Acute headache attributed to systemic viral infection9.2.2.2 Chronic headache attributed to systemic viral infection9.2.3 Headache attributed to other systemic infection其他系统感染9.2.3.1 Acute headache attributed to other systemic infection9.2.3.2 Chronic headache attributed to other systemic infection10.缘于内环境紊乱的头痛（Headache attributed to disorder of