丛集性头痛误诊为慢性鼻窦炎15例临床分析
摘要
目的分析丛集性头痛(cluster headache, CH)误诊为慢性鼻窦炎的临床资料,提高临床医生对该病的认识水平,降低误诊率。方法回顾性分析2009年1月—2017年12月解放军第988医院收治的15例误诊为慢性鼻窦炎的CH患者临床资料。结果本组以头痛为主诉就诊,头痛时间15～180 min,发作频率每日1～7次,伴有鼻塞和(或)流涕,头颅影像学检查提示鼻窦异常11例,均被误诊为慢性鼻窦炎,给予药物和手术治疗,症状均无明显缓解。入我院后根据患者临床症状,疼痛发作特点及发作时体征,并结合医技检查结果,明确诊断为CH,误诊时间1～17年,确诊后给予止痛剂、糖皮质激素、中药、高流量吸氧等治疗,头痛明显缓解。结论 CH因症状、影像学表现与慢性鼻窦炎相似,易被误诊;加强临床医生对头痛分类的学习,仔细询问病史,认真体格检查,综合分析鉴别,有利于避免临床误诊误治。
引文
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[2] 张文波,王宇卉.丛集性头痛及其药物治疗进展[J].世界临床药物,2013,34(7):394-397.
[3] 曾令全,刘艳,何佳,等.全麻诱发丛集性头痛1例报告[J].临床误诊误治,2010,23(5):458-459.
[4] Palacios-Cena D, Talavera B, Lopez-Ruiz P, et al. Living With Cluster Headache: A Qualitative Study of Patients' Perspectives[J].Headache, 2016,56(7):1171-1182.
[5] 王泽琳,许盈盈.丛集性头痛96例临床分析[J].临床荟萃,1996,11(11):520.
[6] Ljubisavljevic S, Zidverc Trajkovic J. Cluster headache: pathophysiology, diagnosis and treatment[J].J Neurol, 2018. doi.org/10.1007/s00415-018-9007-4.
[7] Jurno M E ,Pereira B S R ,Fonseca F A S, et al. Epidemiologic study of cluster headache prevalence in a medium-size city in Brazil[J].Arq Neuropsiquiatr, 2018,76(7):467-472.
[8] 范志亮,于生元.丛集性头痛基因遗传学研究进展[J].中国疼痛医学杂志,2018,24(3):207-209.
[9] May A, Schwedt T J, Magis D, et al. Cluster headache[J].Nat Rev Dis Primers, 2018,4:18006.
[10] Lee Y J, Chen Y T, Ou S M, et al. Temperature variation and the incidence of cluster headache periods: A nationwide population study[J].Cephalalgia, 2014,34(9):656-663.
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[12] Rozen T D. Cluster Headache Clinical Phenotypes: Tobacco Nonexposed (Never Smoker and No Parental Secondary Smoke Exposure as a Child) versus Tobacco-Exposed: Results from the United States Cluster Headache Survey[J].Headache, 2018,58(5):688-699.
[13] Sohn J H, Chu M K, Park K Y, et al. Vitamin D deficiency in patients with cluster headache: a preliminary study[J].J Headache Pain, 2018,19(1):54.
[14] Zidverc-Trajkovic J, Markovic K, Radojicic A, et al. Cluster headache: Is age of onset important for clinical presentation?[J].Cephalalgia, 2014,34(9):664-670.
[15] Katsarou M S, Papasavva M, Latsi R, et al. Population-Based Analysis of Cluster Headache-Associated Genetic Polymorphisms[J].J Mol Neurosci, 2018,65(3):367-376.
[16] Hoffmann J, May A. Diagnosis, pathophysiology, and management of cluster headache[J].Lancet Neurol, 2018,17(1):75-83.
[17] 朱莎莎,王晓辉,王晓琳,等.丛集性头痛患者炎症细胞因子分析[J].中国神经精神疾病杂志,2017,43(5):274-278.
[18] 范志亮,于生元.丛集性头痛基因遗传学研究进展[J].中国疼痛医学杂志,2018,24(3):207-214.
[19] Sanchez Del Rio M, Leira R, Pozo-Rosich P, et al. Errors in recognition and management are still frequent in patients with cluster headache[J].Eur Neurol, 2014,72(3-4):209-212.
[20] Lund N, Barloese M, Petersen A, et al. Chronobiology differs between men and women with cluster headache, clinical phenotype does not[J].Neurology, 2017,88(11):1069-1076.
[21] Voiticovschi-Iosob C, Allena M, De Cillis I, et al. Diagnostic and therapeutic errors in cluster headache: a hospital-based study[J].J Headache Pain, 2014,15:56.
[22] Barloese M C J. The pathophysiology of the trigeminal autonomic cephalalgias, with clinical implications[J].Clin Auton Res, 2018,28(3),315-324.
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[24] Cashman E C, Smyth D. Primary headache syndromes and sinus headache: An approach to diagnosis and management[J].Auris Nasus Larynx, 2012,39(3):257-260.
[25] 薛战尤,赵元,王安海,等.丛集性头痛高流量氧疗治疗的可行性分析[J].包头医学院学报,2018,34(4):88,99.
[26] 李娇,周冀英.丛集性头痛高流量氧疗的研究进展[J].重庆医学,2015,44(20):2857-2859.
[27] 陈朱莹,卜志刚,白银,等.丛集性头痛的内科治疗进展[J].武警医学院学报,2005,14(2):145-146.
[28] Tepper S J, Duplin J, Nye B, et al. Prescribing Oxygen for Cluster Headache: A Guide for the Provider[J].Headache, 2017,57(9):1428-1430.
[2] 张文波,王宇卉.丛集性头痛及其药物治疗进展[J].世界临床药物,2013,34(7):394-397.
[3] 曾令全,刘艳,何佳,等.全麻诱发丛集性头痛1例报告[J].临床误诊误治,2010,23(5):458-459.
[4] Palacios-Cena D, Talavera B, Lopez-Ruiz P, et al. Living With Cluster Headache: A Qualitative Study of Patients' Perspectives[J].Headache, 2016,56(7):1171-1182.
[5] 王泽琳,许盈盈.丛集性头痛96例临床分析[J].临床荟萃,1996,11(11):520.
[6] Ljubisavljevic S, Zidverc Trajkovic J. Cluster headache: pathophysiology, diagnosis and treatment[J].J Neurol, 2018. doi.org/10.1007/s00415-018-9007-4.
[7] Jurno M E ,Pereira B S R ,Fonseca F A S, et al. Epidemiologic study of cluster headache prevalence in a medium-size city in Brazil[J].Arq Neuropsiquiatr, 2018,76(7):467-472.
[8] 范志亮,于生元.丛集性头痛基因遗传学研究进展[J].中国疼痛医学杂志,2018,24(3):207-209.
[9] May A, Schwedt T J, Magis D, et al. Cluster headache[J].Nat Rev Dis Primers, 2018,4:18006.
[10] Lee Y J, Chen Y T, Ou S M, et al. Temperature variation and the incidence of cluster headache periods: A nationwide population study[J].Cephalalgia, 2014,34(9):656-663.
[11] Russell M B. Epidemiology and genetics of cluster headache[J].Lancet Neurol, 2004,3(5):279-283.
[12] Rozen T D. Cluster Headache Clinical Phenotypes: Tobacco Nonexposed (Never Smoker and No Parental Secondary Smoke Exposure as a Child) versus Tobacco-Exposed: Results from the United States Cluster Headache Survey[J].Headache, 2018,58(5):688-699.
[13] Sohn J H, Chu M K, Park K Y, et al. Vitamin D deficiency in patients with cluster headache: a preliminary study[J].J Headache Pain, 2018,19(1):54.
[14] Zidverc-Trajkovic J, Markovic K, Radojicic A, et al. Cluster headache: Is age of onset important for clinical presentation?[J].Cephalalgia, 2014,34(9):664-670.
[15] Katsarou M S, Papasavva M, Latsi R, et al. Population-Based Analysis of Cluster Headache-Associated Genetic Polymorphisms[J].J Mol Neurosci, 2018,65(3):367-376.
[16] Hoffmann J, May A. Diagnosis, pathophysiology, and management of cluster headache[J].Lancet Neurol, 2018,17(1):75-83.
[17] 朱莎莎,王晓辉,王晓琳,等.丛集性头痛患者炎症细胞因子分析[J].中国神经精神疾病杂志,2017,43(5):274-278.
[18] 范志亮,于生元.丛集性头痛基因遗传学研究进展[J].中国疼痛医学杂志,2018,24(3):207-214.
[19] Sanchez Del Rio M, Leira R, Pozo-Rosich P, et al. Errors in recognition and management are still frequent in patients with cluster headache[J].Eur Neurol, 2014,72(3-4):209-212.
[20] Lund N, Barloese M, Petersen A, et al. Chronobiology differs between men and women with cluster headache, clinical phenotype does not[J].Neurology, 2017,88(11):1069-1076.
[21] Voiticovschi-Iosob C, Allena M, De Cillis I, et al. Diagnostic and therapeutic errors in cluster headache: a hospital-based study[J].J Headache Pain, 2014,15:56.
[22] Barloese M C J. The pathophysiology of the trigeminal autonomic cephalalgias, with clinical implications[J].Clin Auton Res, 2018,28(3),315-324.
[23] 陈丹,陈璐,Beule A G,等.慢性鼻-鼻窦炎临床诊治进展[J].重庆医学,2015,44(23):3286-3288.
[24] Cashman E C, Smyth D. Primary headache syndromes and sinus headache: An approach to diagnosis and management[J].Auris Nasus Larynx, 2012,39(3):257-260.
[25] 薛战尤,赵元,王安海,等.丛集性头痛高流量氧疗治疗的可行性分析[J].包头医学院学报,2018,34(4):88,99.
[26] 李娇,周冀英.丛集性头痛高流量氧疗的研究进展[J].重庆医学,2015,44(20):2857-2859.
[27] 陈朱莹,卜志刚,白银,等.丛集性头痛的内科治疗进展[J].武警医学院学报,2005,14(2):145-146.
[28] Tepper S J, Duplin J, Nye B, et al. Prescribing Oxygen for Cluster Headache: A Guide for the Provider[J].Headache, 2017,57(9):1428-1430.