颈部疼痛与偏头痛关系的观察性研究
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摘要
目的:探讨颈部疼痛与偏头痛的关系。方法:连续选择因头痛首次就诊于龙岩市第一医院神经内科的病人,先进行颈部疼痛的问卷调查,而后由头痛专家进行诊断。结果:在310例头痛病人中,195例(63%)头痛同时有颈部疼痛发作,根据《国际头痛疾病分类第3版(试行版)》标准,其中诊断偏头痛的高达77%,大部分病人因颈部疼痛进行了不必要的检查和治疗,45%病人进行了颈部放射影像学检查。多元分析显示,低教育水平、无偏头痛先兆、头痛累及头后部是偏头痛合并颈部疼痛发作的独立预测因素。结论:大部分合并颈部疼痛发作的头痛病人为偏头痛病人,误诊将增加病人不必要的经济负担并降低病人的生活质量,在临床工作中应重视此类病人。
Objective: To analyze the relationship between cervical pain and migraine. Methods: Patients who visited the department of neurology in Longyan First Hospital for headache at the ?rst time were included, and they completed a questionnaire about cervical pain and were subsequently examined by an experienced headache clinician. Results: Of all 310 patients with headache, 195(63%) patients believed that they suffered from cervical pain with headache. According to the International Classi?cation of Headache Disorders 3 rd edition(Beta version)(ICHD-Ⅲ β) criteria, 77% of cases of these patients were diagnosed as migraine. The majority of patients who believed that they suffered from cervical pain underwent unnecessary medical exams(including cervical radiological examination in 45% of cases) and received inadequate treatments for their real diagnosis.Multivariate analysis disclosed that lower educational level, absence of migraine aura, and pain involving the back of the head were independent predictors of migraine combined with cervical pain. Conclusion: The majority of headache patients with cervical pain attacks suffer from migraine. The misdiagnosis produces an economic burden and leads to impaired quality of life of patients. We should pay attention to such patients in clinical work.
Objective: To analyze the relationship between cervical pain and migraine. Methods: Patients who visited the department of neurology in Longyan First Hospital for headache at the ?rst time were included, and they completed a questionnaire about cervical pain and were subsequently examined by an experienced headache clinician. Results: Of all 310 patients with headache, 195(63%) patients believed that they suffered from cervical pain with headache. According to the International Classi?cation of Headache Disorders 3 rd edition(Beta version)(ICHD-Ⅲ β) criteria, 77% of cases of these patients were diagnosed as migraine. The majority of patients who believed that they suffered from cervical pain underwent unnecessary medical exams(including cervical radiological examination in 45% of cases) and received inadequate treatments for their real diagnosis.Multivariate analysis disclosed that lower educational level, absence of migraine aura, and pain involving the back of the head were independent predictors of migraine combined with cervical pain. Conclusion: The majority of headache patients with cervical pain attacks suffer from migraine. The misdiagnosis produces an economic burden and leads to impaired quality of life of patients. We should pay attention to such patients in clinical work.
引文
[1]中华医学会疼痛学分会头面痛学组,中国医师协会神经内科医师分会疼痛和感觉障碍专委会.中国偏头痛防治指南[J].中国疼痛医学杂志, 2016, 22(10):721-727.
[2]Al-Hashel JY, Ahmed SF, Alroughani R, et al. Migrainemisdiagnosis as a sinusitis, a delay that can last for ma-ny years[J]. J Headache Pain, 2013,14:97.
[3]Miller S, Matharu MS. Migraine is underdiagnosed andundertreated[J]. Practitioner, 2014, 258(1774):19-24, 2-3.
[4]Landgraf MN, von KR, Heinen F, et al. Self-reported neckand shoulder pain in adolescents is associated with episodicand chronic migraine[J]. Cephalalgia, 2016, 36(8):807-811.
[5]Florencio LL, Oliveira AS, Lemos TW, et al. Patientswith chronic, but not episodic, migraine display alteredactivityoftheirneckextensormuscles[J].JElectro-myogr Kinesiol, 2016, 30:66-72.
[6]The International Classi?cation of Headache Disorders,3rd edition(beta version)[J]. Cephalalgia, 2013, 33(9):629-808.
[7]Viana M, Sances G, Terrazzino S, et al.When cervicalpain is actually migraine:An observational study in 207patients[J]. Cephalalgia, 2018, 38(2):383-388.
[8]Ruiz MR, Munoz AM, de Torres LP, et al. Biopsycho-socialfeaturesofpatientswithwidespreadchronicmusculoskeletal pain in family medicine clinics[J]. FamPract, 1997, 14(3):242-248.
[9]中国后循环缺血专家共识组.中国后循环缺血的专家共识[J].中华内科杂志, 2006, 45(9):786-787.
[10]MancusoCA,StalM,DuculanR, et al.Physicalandpsychologicalcomorbidityindependentlyassociatedwith spine-related disability[J]. Spine(Phila Pa 1976),2014, 39(23):1969-1974.
[11]VianaM.GoingtotheUSA-aUSheadachecenterfrom an Italian perspective[J]. Nat Rev Neurol, 2011,7(12):710-712.
[2]Al-Hashel JY, Ahmed SF, Alroughani R, et al. Migrainemisdiagnosis as a sinusitis, a delay that can last for ma-ny years[J]. J Headache Pain, 2013,14:97.
[3]Miller S, Matharu MS. Migraine is underdiagnosed andundertreated[J]. Practitioner, 2014, 258(1774):19-24, 2-3.
[4]Landgraf MN, von KR, Heinen F, et al. Self-reported neckand shoulder pain in adolescents is associated with episodicand chronic migraine[J]. Cephalalgia, 2016, 36(8):807-811.
[5]Florencio LL, Oliveira AS, Lemos TW, et al. Patientswith chronic, but not episodic, migraine display alteredactivityoftheirneckextensormuscles[J].JElectro-myogr Kinesiol, 2016, 30:66-72.
[6]The International Classi?cation of Headache Disorders,3rd edition(beta version)[J]. Cephalalgia, 2013, 33(9):629-808.
[7]Viana M, Sances G, Terrazzino S, et al.When cervicalpain is actually migraine:An observational study in 207patients[J]. Cephalalgia, 2018, 38(2):383-388.
[8]Ruiz MR, Munoz AM, de Torres LP, et al. Biopsycho-socialfeaturesofpatientswithwidespreadchronicmusculoskeletal pain in family medicine clinics[J]. FamPract, 1997, 14(3):242-248.
[9]中国后循环缺血专家共识组.中国后循环缺血的专家共识[J].中华内科杂志, 2006, 45(9):786-787.
[10]MancusoCA,StalM,DuculanR, et al.Physicalandpsychologicalcomorbidityindependentlyassociatedwith spine-related disability[J]. Spine(Phila Pa 1976),2014, 39(23):1969-1974.
[11]VianaM.GoingtotheUSA-aUSheadachecenterfrom an Italian perspective[J]. Nat Rev Neurol, 2011,7(12):710-712.