Migraine-偏头痛(中英双语版)课件

migraine

偏头痛

ChongqingUniversityofMedicalScience

Migraineismanifestedbyheadachethatisarecurrence,usuallyunilateralandfrequently

pulsatile

inquality

搏动性;itisoftenassociatedwithnausea,vomiting,photophobia畏光,phonophobia惧声andlassitude乏力.Visualorotherneurologicauras神经学先兆

occurinabout10%ofpatients.

Theonsetisearlyinlifeapproximately25%beginningduringthefirstdecade,55%by20yearsofage,morethan90%beforeage40.

A.Causeandpathogenesis

Therealcausesandthe

pathogenesisandpathophysiologiccourse

ofmigraineisunknown.

1.Certainfoods:

tyramine酪胺-containingcheeses,meat,suchashotdogsorbacon,withnitrite亚硝酸preservatives,chocolatecontainingbutnotchocolatealone.Foodadditives:monosodiumglutamate谷氨酸一钠；

Fasting禁食;Emotion情绪;Menses月经;

Drugs:especiallyoralcontraceptiveagents;vasodilators(nitriglycerin硝酸甘油)Brightslightsmayalsotriggerorprecipitateattacks.

4.vasomotorandautonomic

血管运动和自律神经

Intracranialvasoconstrictionandextracranialvasodilatationhavelongbeenheldtobetherespectivecausesoftheauraandheadachephasesofmigraine.ButthestudyofCBF脑血流

can’tconfirm.5.spreadingdepression扩布性抑制

MorerecentstudiesofrCBF局部脑血流

duringmigraineattackshavedemonstratedareductioninregionalflow,whichbeginsintheoccipitalregionandthentowardswith1cm/svelocity

duringtheauraphase.

6.Neurotransmitter（神经递质）

Serotonin血清素

inplateletsdecreases

andurinaryserotoninincreasesduringtheacutephaseofamigraineattack.Depletionofserotoninbyreserpine利血平mayprecipitatemigraineanddecreasedbyserotoninantagonists(sumatriptan,英明格)B.Theclassificationofmigraine

1.classicmigraine

（典型偏头痛）

2.common

migraine

（普通型偏头痛）

3.specialtype:

a.ophthalmoplegicM.

（眼肌麻痹型偏头痛）

b.hemiplegicM.

（偏瘫型偏头痛）

c.

basilarartery

M.

（基底动脉型偏头痛)

d.

late-lifeM.（晚发性偏头痛）

e.migraineEquivalents

（偏头痛等值症）:

3)companysymptoms伴随症状:

Thenausea(恶心),vomiting(呕吐),photophobia(畏光),phonophobia(惧声),irritability(激惹),andlassitude

(倦怠)arecommon.Uncommonly,migraineareassociatedwithfrankneurologicdeficits明显神经学缺陷

thataccompanyorpersistbeyondresolutionofthepainphase.ThoseMayincludehemiparesis,hemisensoryloss偏身感觉丧失,speech

dysfunction语言功能障碍,or

visualdisturbance视觉紊乱.Samepatientshavevertigo眩晕,ataxia共济失调,oralteredconsciousness意识.

3.specialtype:

a.ophthalmoplegicM.

（眼肌麻痹型偏头痛）

Duringor

aftermigraineattackoccur

ocularnerveparalysis,ptosis,pupildilation,ets.andpersistshoursormonths.b.hemiplegicM.

（偏瘫型偏头痛）

withhemiplegia;last10m.~days~wk.;children,lessinadult.

c.basilararterymigraine(基底动脉型偏头痛）

mostcommoninchildrenandyouthfulwomen;visualalteration:fielddefects

andscotomas,

ataxia,vertigo,tinnitus耳鸣，diplopia复视，nystagmus眼震，dysarthria构音障碍，bilaterallimbsnumbandweak,impairmentofrecognizeandconsciousness,andnausea,vomiting,ets.D.Diagnosisofmigraine

AccordingtotheInternationalassociateofheadacherecomm-endedaprogrammein1988,thediagnosisofmigrainewillbeinkeepingwithbelowcriterion.

a.Migrainewithaura1.Have2subjectsofbelow,breakout2atleast;2.Havebelowcharacteristicatleast3subjects:

1)Morethan1timeauraoffunctionaldisturbanceinfocalcortexorbrainstem2)Anauraatleastgradualdevelopmentandpersistmorethan4min.,orhave2auras；

3）Theaurapersistslessthan60min.;4)Thereisnotanintervaltimebetweentheauraandheadache;

3.

Haveoneofbelowatleast：

1)Noevidenceoforganicdiseasesbyhistoryandexamination；

2）Apossibleoforganicdiseasesbyhistoryandexamination,butwasdenybytest；

3）Althoughhavesomeorganicdiseases,butthe1stmigraineattackhavenotrelationwithit.

典型（有先兆）偏头痛诊断标准

1.符合以下2项,发作至少两次；

2.有以下特征至少3项:1)有局限性脑皮质或/和脑干功能障碍的大于1次以上的先兆；

2）至少有一个先兆症状逐渐发展、持续4分钟以上，或先后有两个以上的先兆；

3）先兆症状持续的时间小于60分钟；

4）先兆症状与头痛间无间歇期。

3.

至少有下列之一：

1)病史和体检不提示有器质性疾病证据；

2）病史和体检提示有某种器质性疾病可能，但经检查被否定；

3）虽有某种器质性疾病，但首次偏头痛发作与该疾病无密切关系。

b.Migrainewithoutaura

1.Have2-4subjectsofbelow,breakoutmorethan

5timesatleast

;2.

Ifnottreat,itcontinues4-72h.aseizure,;3.Havebelowcharacteristicatleast2subjects:1)unilateral;2)pulsatile(throbbing)

；

3)middle-seriousdegree,dailylifelimited;4)Headacheseriousafteract

；

4.Haveoneofbelow:1)nausea&vomiting;2)photophobia,phonophobia；

5.Withoutotherknownsimilardiseases,andexcludeotherdiseasesofthebody.

普通型（无先兆）偏头痛诊断标准

1.符合下述2-4项,发作至少5次以上;2.如果不治疗,每次发作持续4-72小时;3.有以下特征至少两项:1)单侧型;2)搏动型；3)中-重度头痛,日常活动受限;4)活动后头痛加重；

4.发作期间有下列之一:1)恶心和呕吐;2)畏光和惧声；

5.无其他已知的类似疾病:病史和躯体的其他方面正常。

1)Clusterheadache

(丛集性头痛）

men>women;(4～5：1）

20-50yr.;recurrent;severalormanytimesdailyforseveraldaysorweekes;Prodromes先兆

areuncommon,Ictal发作

andstopsuddenly;periorbitalstrongpainwithcongestionoftheconjunctivae,lacrimation流泪,occasionalptosis上睑下垂

oftheeyelidsandsweating;Seriouslyill(inseverecaseswithvomiting,nauseafrequently)subcutaneous,nosal,intravenousorintramuscularisusedfordrugs.Dihydroergotaminemesylate(酒石酸二氢麦角胺):

0.25-1.0mg,im.oriv.

Ergotamine（麦角胺):0.6-1.0mg，takeorally

or

2mgsublingualorbyrectaSumatriptam(英明格):25-50mg,takeorally(the5-HTagonist)

or

6mgsubcutaneousinjectionPethidine(哌替啶):50-150mg,im.Chlorpromazine(氯丙嗪):10mg,intravenousinjectionCodeine(可待因):

15-60mg,PO

Whengivingthedrugsyouhavetotelltheclinicalsideeffectsforpatient.2.

Prophylactictreatment

预防性治疗

PTisindicatedforpatientswhohavefrequentattacks