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A:A:符合B-D特征,至少發作5次發作B:頭痛(未經治療)發作持續4-72小時C:至少有以下特征中的2項單側性、搏動性、中重度痛、日常活動會加重D:至少以下一項伴隨癥狀:惡心和/或嘔吐、畏光和畏聲先兆性偏頭痛的診斷標準:E:不能歸因于其他A:符合B-C特征,至少發作2次發作B:完全可逆以下癥狀的1項或多項視覺、感覺、語言障礙(典型先兆)肢體無力癥狀(偏癱型偏頭痛)腦干癥狀(基底型偏頭痛)視網膜癥狀(視網膜型偏頭痛)C:至少有以下特征中的2項至少1個先兆逐漸發展的過程>5min,和/或不同先兆接連發生過程>5minTheinternationalClassificationofHeadachedisorders,3rdEditon頭痛分類的國際標準(ICHD-III)概述:頭痛分為三大組:原發性頭痛;繼發性頭痛;腦神經痛、中樞和原發性顏面痛及其他頭痛。每一種原發性頭痛均視為一種獨立的疾病;繼發性頭痛一般只是某種疾病的一種癥狀,該頭痛稱為“緣于”此種疾病的頭痛,無先兆偏頭痛的診斷標準:三大組頭痛共分為14類:一、原發性頭痛(theprimaryheadaches).偏頭痛(Migraine)Migrainewithoutaura無先兆偏頭痛Migrainewithaura有先兆偏頭痛MigrainewithtypicalauraTypicalaurawithheadacheTypicalaurawithoutheadacheMigrainewithbrainstemauraHemiplegicmigraine偏癱型偏頭痛Familialhemiplegicmigraine(FHM)—家族性Familialhemiplegicmigrainetype1(FHM1)Familialhemiplegicmigrainetype2(FHM2)Familialhemiplegicmigrainetype3(FHM3)Familialhemiplegicmigraine,otherlociSporadichemiplegicmigraine—散發性RetinalmigraineChronicmigraine慢性偏頭痛Complicationsofmigraine偏頭痛并發癥Statusmigrainosus偏頭痛持續狀態Persistentaurawithoutinfarction
Migrainousinfarction偏頭痛腦梗死Migraineaura-triggeredseizureProbablemigraine很可能的偏頭痛ProbablemigrainewithoutauraProbablemigrainewithauraEpisodicsyndromesthatmaybeassociatedwithmigraine可能與偏頭痛有關的發作性綜合征慢性偏頭痛:偏頭痛發作每月>15慢性偏頭痛:偏頭痛發作每月>15天,連續3個月以上偏頭痛持續狀態:單次發作持續72小時以上vomitingsyndrome周期性嘔吐Abdominalmigraine腹型偏頭痛Benignparoxysmalvertigo良性發作性眩暈Benignparoxysmaltorticollis良性發作性斜頸.緊張型頭痛(Tension-typeheadache)每次發作持續30min-7d,慢性者可持續不緩解Infrequentepisodictension-typeheadache偶發性<1d/月,至少10次以上(<12d/年)Infrequentepisodictension-typeheadacheassociatedwithpericranialtendernessInfrequentepisodictension-typeheadachenotassociatedwithpericranialtendernessFrequentepisodictension-typeheadache頻發性三1d/月,但<15d,至少發作10次以上(三12d/年但<180d)Frequentepisodictension-typeheadacheassociatedwithpericranialtendernessFrequentepisodictension-typeheadachenotassociatedwithpericranialtendernessChronictension-typeheadache慢性緊張型頭痛每月發作三15d,3個月以上Chronictension-typeheadacheassociatedwithpericranialtendernessChronictension-typeheadachenotassociatedwithpericranialtendernessProbabletension-typeheadache很可能的緊張型頭痛叢集性頭痛的診斷標準:A:A:至少符合B-D的5次以上的發作Probablefrequentepisodictension-typeheadacheProbablechronictension-typeheadacheB:單側、眼眶、上眼眶及/或顳部重度或極重度疼痛,Probablechronictension-typeheadache如不治療持續15min-180min;
.三叉自主神經性頭痛(Trigeminalautonomiccephalalgias)Clusterheadache叢集性頭痛Episodicclusterheadache發作性叢集性頭痛Chronicclusterheadache慢性叢集性頭痛(復發作大于1年無緩解期,或緩解期<1個月)ParoxysmalhemicraniaEpisodicparoxysmalhemicraniaChronicparoxysmalhemicraniaShort-lastingunilateralneuralgiformheadacheattacksShort-lastingunilateralneuralgiformheadacheattackswithconjunctivalinjectionandtearing(SUNCT)EpisodicSUNCTChronicSUNCTShort-lastingunilateralneuralgiformheadacheattackswithcranialautonomicsymptoms(SUNA)EpisodicSUNAChronicSUNAHemicraniacontinuaProbabletrigeminalautonomiccephalalgiaProbableclusterheadacheProbableparoxysmalhemicraniaProbableshort-lastingunilateralneuralgiformheadacheattacksProbablehemicraniacontinua.其它的原發性頭痛Otherprimaryheadachedisorders)Primarycoughheadache原發性咳嗽頭痛ProbableprimarycoughheadachePrimaryexerciseheadache原發性運動性頭痛
ProbableprimaryexerciseheadachePrimaryheadacheassociatedwithsexualactivity原發性性活動伴隨的頭痛ProbableprimaryheadacheassociatedwithsexualactivityPrimarythunderclapheadache原發性霹靂頭痛Cold-stimulusheadache冷刺激性頭痛HeadacheattributedtoexternalapplicationofacoldstimulusHeadacheattributedtoingestionorinhalationofacoldstimulusProbablecold-stimulusheadacheHeadacheprobablyattributedtoexternalapplicationofacoldstimulusHeadacheprobablyattributedtoingestionorinhalationofacoldstimulusNDPH診斷標準:NDPH診斷標準:A:持續性頭痛,符合B-C的標準B:Distinctandclearlyrememberedonset,withpainbecomingcontinuousandunremittingwithin24hoursC:Presentfor>3monthsD:除外其他疾患External-compressionheadacheExternal-tractionheadacheProbableexternal-pressureheadacheProbableexternal-compressionheadacheProbableexternal-tractionheadachePrimarystabbingheadacheProbableprimarystabbingheadacheNummularheadacheProbablenummularheadacheHypnicheadacheProbablehypnicheadacheNewdailypersistentheadache(NDPH)新癥每日持續性頭痛Probablenewdailypersistentheadach二、繼發性頭痛(thesecondaryheadaches)
.緣于頭、頸部外傷的頭痛(Headacheattributedtotraumaorinjurytotheheadand/orneck)AcuteheadacheattributedtotraumaticinjurytotheheadAcuteheadacheattributedtomoderateorseveretraumaticinjurytotheheadAcuteheadacheattributedtomildtraumaticinjurytotheheadPersistentheadacheattributedtotraumaticinjurytotheheadPersistentheadacheattributedtomoderateorseveretraumaticinjurytotheheadPersistentheadacheattributedtomildtraumaticinjurytotheheadAcuteheadacheattributedtowhiplashPersistentheadacheattributedtowhiplashAcuteheadacheattributedtocraniotomyPersistentheadacheattributedtocraniotomy.緣于頭頸部血管疾病的頭痛(Headacheattributedtocranialorcervicalvasculardisorder)HeadacheattributedtoischaemicstrokeortransientischaemicattackHeadacheattributedtoischaemicstroke(cerebralinfarction)Headacheattributedtotransientischaemicattack(TIA)Headacheattributedtonon-traumaticintracranialhaemorrhageHeadacheattributedtonon-traumaticintracerebralhaemorrhage非夕卜傷性腦出血Headacheattributedtonon-traumaticsubarachnoidhaemorrhage(SAH)Headacheattributedtonon-traumaticacutesubduralhaemorrhage供5口用急性硬膜下血腫Headacheattributedtounrupturedvascularmalformation未破裂的血管畸形Headacheattributedtounrupturedsaccularaneurysm囊性動脈瘤Headacheattributedtoarteriovenousmalformation(AVM)動靜脈畸形Headacheattributedtoduralarteriovenousfistula(DAVF)硬膜動靜脈屢Headacheattributedtocavernousangioma海綿竇血管瘤Headacheattributedtoencephalotrigeminalorleptomeningealangiomatosis(SturgeWebersyndrome)
腦三叉神經或軟腦膜血管瘤病HeadacheattributedtoarteritisHeadacheattributedtogiantcellarteritis(GCA)顳動脈炎Headacheattributedtoprimaryangiitisofthecentralnervoussystem(PACNS)Headacheattributedtosecondaryangiitisofthecentralnervoussystem(SACNS)顆動脈炎診斷標準:美國風濕學會1990年.50歲以上發病:50歲以上發現癥狀.新發的頭痛:出現新發的局限性頭痛.顆動脈異常:顆動脈壓痛或者與頸動脈的動脈硬化無關的搏動減弱.血沉值升高:50mm/h以上 Headacheattributedtocervicalcarotidorvertebralarterydisorder頸動脈或錐動脈疼痛Headacheorfacialorneckpainattributedtocervicalcarotidorvertebralarterydissection動脈夾層Post-endarterectomyheadache內膜剝脫術后頭痛Headacheattributedtocarotidorvertebralangioplasty頸動脈血管成型術頭痛Headacheattributedtocerebralvenousthrombosis(CVT)腦靜脈血栓形成HeadacheattributedtootheracuteintracranialarterialdisorderHeadacheattributedtoanintracranialendovascularprocedureAngiographyheadacheHeadacheattributedtoreversiblecerebralvasoconstrictionsyndrome(RCVS)Headacheprobablyattributedtoreversiblecerebralvasoconstrictionsyndrome(RCVS)Headacheattributedtointracranialarterialdissection顱內動脈夾層HeadacheattributedtogeneticvasculopathyCerebralAutosomalDominantArteriopathywithSubcorticalInfarctsandLeukoencephalopathy(CADASIL)
MitochondrialEncephalopathy,LacticAcidosisandStroke-likeepisodes(MELAS)HeadacheattributedtoanothergeneticvasculopathyHeadacheattributedtopituitaryapoplexy垂體卒中.緣于非血管性顱內疾病的頭痛(Headacheattributedtonon-vascularintracranialdisorder)Headacheattributedtoincreasedcerebrospinalfluidpressure顱內壓增高Headacheattributedtoidiopathicintracranialhypertension(IIH)Headacheattributedtointracranialhypertensionsecondarytometabolic,toxicorhormonalcausesHeadacheattributedtointracranialhypertensionsecondarytohydrocephalusHeadacheattributedtolowcerebrospinalfluidpressure顱內壓低下Post-duralpunctureheadache腰穿后CSFfistulaheadache腦脊液漏Headacheattributedtospontaneousintracranialhypotension自發性低顱壓Headacheattributedtonon-infectiousinflammatorydisease非感染性炎性疾病HeadacheattributedtoneurosarcoidosisHeadacheattributedtoaseptic(non-infectious)meningitisHeadacheattributedtoothernon-infectiousinflammatorydiseaseHeadacheattributedtolymphocytichypophysitisSyndromeoftransientHeadacheandNeurologicalDeficitswithcerebrospinalfluidLymphocytosis(HaNDL)Headacheattributedtointracranialneoplasia顱內新生物HeadacheattributedtointracranialneoplasmHeadacheattributedtocolloidcystofthethirdventricleHeadacheattributedtocarcinomatousmeningitis癌性腦膜炎Headacheattributedtohypothalamicorpituitaryhyper-orhyposecretionHeadacheattributedtointrathecalinjection鞘內注射Headacheattributedtoepilepticseizure
Hemicraniaepileptica癲癇半顱痛Post-ictalheadache癲癇發作后頭痛HeadacheattributedtoChiarimalformationtypeI(CM1)Headacheattributedtoothernon-vascularintracranialdisorder.緣于物質或物質戒斷的頭痛(Headacheattributedtoasubstanceoritswithdrawal)Headacheattributedtouseoforexposuretoasubstanceoritswithdrawal緣于某種物質的應用或戒斷Nitricoxide(NO)donor-inducedheadache一化氮誘發ImmediateNOdonor-inducedheadacheDelayedNOdonor-inducedheadachePhosphodiesterase(PDE)inhibitor-inducedheadache磷酸二酯酶抑制劑Carbonmonoxide(CO)-inducedheadache一氧化碳誘發Alcohol-inducedheadache酒精誘發Immediatealcohol-inducedheadacheDelayedalcohol-inducedheadacheHeadacheinducedbyfoodand/oradditive由于食物成分/添加劑誘發Monosodiumglutamate(MSG)-inducedheadache谷氨酸單鈉鹽(味精)Cocaine-inducedheadache可卡因誘發Histamine-inducedheadache組織胺誘發Immediatehistamine-inducedheadacheDelayedhistamine-inducedheadacheCalcitoningene-relatedpeptide(CGRP)-inducedheadache降鈣素基因相關多肽誘發ImmediateCGRP-inducedheadacheDelayedCGRP-inducedheadacheHeadacheattributedtoexogenousacutepressoragentHeadacheattributedtooccasionaluseofnon-headachemedication
Headacheattributedtolong-termuseofnon-headachemedicationHeadacheattributedtoexogenoushormoneHeadacheattributedtouseoforexposuretoothersubstanceMedication-overuseheadache(MOH)藥物過度使用性頭痛MOH診斷標準.符合3-4項的頭痛表現三15天.規律使用1種或多種用于頭痛急性期的止痛藥超過3個月.在藥物過度使用期間,頭痛進展或明顯加重4,停用所用過度使用藥物之后的2個月內,頭痛必需改善(緩解或重歸于之前的頭痛模式 Ergotamine-overuseheadache麥角胺類Triptan-overuseheadache曲普坦類Simpleanalgesic-overuseheadache單純止痛藥類Paracetamol(acetaminophen)-overuseheadache對乙酰氨基酚Acetylsalicylicacid-overuseheadache乙酰水楊酸/阿司匹林Othernon-steroidalanti-inflammatorydrug(NSAID)-overuseheadacheOpioid-overuseheadache鴉片類Combination-analgesic-overuseheadache復合制劑過度應用Medication-overuseheadacheattributedtomultipledrugclassesnotindividuallyoverused聯合用藥所致Medication-overuseheadacheattributedtounverifiedoveruseofmultipledrugclassesMedication-overuseheadacheattributedtoothermedicationHeadacheattributedtosubstancewithdrawal物質戒斷Caffeine-withdrawalheadache咖啡因Opioid-withdrawalheadache鴉片類Oestrogen-withdrawalheadache雌激素
Headacheattributedtowithdrawalfromchronicuseofothersubstance.緣于感染的頭痛(Headacheattributedtoinfection)Headacheattributedtointracranialinfection顱內感染Headacheattributedtobacterialmeningitisormeningoencephalitis細菌性腦膜炎/腦膜腦炎AcuteheadacheattributedtobacterialmeningitisormeningoencephalitisChronicheadacheattributedtobacterialmeningitisormeningoencephalitisPersistentheadacheattributedtopastbacterialmeningitisormeningoencephalitisHeadacheattributedtoviralmeningitisorencephalitis病毒性腦膜炎或腦炎HeadacheattributedtoviralmeningitisHeadacheattributedtoviralencephalitisHeadacheattributedtointracranialfungalorotherparasiticinfection真菌或寄生蟲感染AcuteheadacheattributedtointracranialfungalorotherparasiticinfectionChronicheadacheattributedtointracranialfungalorotherparasiticinfectionHeadacheattributedtobrainabscess月囪膿月中Headacheattributedtosubduralempyema硬膜下積膿Headacheattributedtosystemicinfection系統感染Headacheattributedtosystemicbacterialinfection系統細菌感染AcuteheadacheattributedtosystemicbacterialinfectionChronicheadacheattributedtosystemicbacterialinfectionHeadacheattributedtosystemicviralinfection系統病毒感染AcuteheadacheattributedtosystemicviralinfectionChronicheadacheattributedtosystemicviralinfectionHeadacheattributedtoothersystemicinfection其他系統感染AcuteheadacheattributedtoothersystemicinfectionChronicheadacheattributedtoothersystemicinfection
.緣于內環境紊亂的頭痛(Headacheattributedtodisorderofhomoeostasis)Headacheattributedtohypoxiaand/orhypercapnia缺氧和/或高碳酸血癥High-altitudeheadache高海拔頭痛Headacheattributedtoaeroplanetravel飛行頭痛Divingheadache潛水頭痛Sleepapnoeaheadache睡眠呼吸暫停性頭痛DialysisheadacheHeadacheattributedtoarterialhypertension高血壓性頭痛Headacheattributedtophaeochromocytoma嗜絡細胞瘤Headacheattributedtohypertensivecrisiswithouthypertensiveencephaffip高血壓腦病的高血壓危象Headacheattributedtohypertensiveencephalopathy高血壓腦病Headacheattributedtopre-eclampsiaoreclampsia先兆子癇Headacheattributedtoautonomicdysreflexia自主反射障礙Headacheattributedtohypothyroidism甲狀腺低下Headacheattributedtofasting禁食Cardiaccephalalgia心源性頭痛Headacheattributedtootherdisorderofhomoeostasis其他內環境穩定失調疾患.緣于頭、頸、眼、耳、鼻、鼻竇、牙、口或其他頭面部結構病變的頭面痛(Headacheorfacialpainattributedtodisorderofthecranium,neck,eyes,ears,nose,sinuses,teeth,mouthorotherfacialorcervicalstructure)Headacheattributedtodisorderofcranialbone顱骨Headacheattributedtodisorderoftheneck頸部CervicogenicheadacheHeadacheattributedtoretropharyngealtendonitisHeadacheattributedtocraniocervicaldystoniaHeadacheattributedtodisorderoftheeyes眼睛
Headacheattributedtoacuteglaucoma急性青光眼Headacheattributedtorefractiveerror屈光不正Headacheattributedtoheterophoriaorheterotropia(latentorpersistentsquint斜視HeadacheattributedtoocularinflammatorydisorderHeadacheattributedtotrochleitisHeadacheattributedtodisorderoftheears耳朵Headacheattributedtodisorderofthenoseorparanasalsinuses鼻子或鼻竇Headacheattributedtoacuterhinosinusitis急性鼻竇炎HeadacheattributedtochronicorrecurringrhinosinusitisHeadacheattributedtodisorderoftheteethorjawHeadacheattributedtotemporomandibulardisorder(TMD)HeadorfacialpainattributedtoinflammationofthestylohyoidligamentHeadacheorfacialpainattributedtootherdisorderofcranium,neck,eyes,ears,nose,sinuses,teeth,mouthorotherfacialorcervicalstructure.緣于精神疾病的頭痛(Headacheattributedtopsychiatricdisorder)Headacheattributedtosomatizationdisorder軀體化障礙Headacheattributedtopsychoticdisorder精神疾病三、腦神經痛、中樞和原發性顏面痛及其他頭痛(painfulcranialneuropathies,otherfacialpainsandotherheadaches).腦神經痛和中樞性顏面痛(Painfulcranialneuropathiesandotherfacialpain
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