Rains J C, Penzien D B, Lipchik G L, Ramadan N M
Center for Sleep Evaluation, Elliot Hospital, Manchester, NH 03103, USA.
Cephalalgia. 2001 Jun;21(5):584-95. doi: 10.1046/j.1468-2982.2001.00210.x.
The International Headache Society (IHS) diagnostic criteria for headache improved the accuracy of primary headache diagnoses, including migraine. However, many migraineurs receive an 'atypical migraine' diagnosis according to the IHS nosology (IHS 1.7), indicating that they approximate but do not fully meet all IHS criteria. This study characterized and sub-classified patients with atypical migraine. Within a clinical sample of 382 headache sufferers, 83 patients met IHS criteria for 'atypical migraine'. Patients receiving the IHS 1.7 designation did not converge to form a homogeneous group. Rather, distinct and clinically relevant subgroups were empirically derived (e.g. migraine with atypical pain parameters, brief migraine, chronic migraine). The results call for revisions of the IHS diagnostic criteria for migraine that would minimize the number of patients receiving an atypical diagnosis. Revisions would include decreasing the minimum headache duration criteria from 4 h to 2 h, and developing a classification for 'chronic migraine' for migraine greater than 15 days per month. The proposed revision provides a means of diagnosing the daily and near-daily headache commonly observed in clinical populations.
国际头痛协会（IHS）的头痛诊断标准提高了原发性头痛诊断的准确性，包括偏头痛。然而，许多偏头痛患者根据IHS疾病分类法（IHS 1.7）被诊断为“非典型偏头痛”，这表明他们接近但未完全符合所有IHS标准。本研究对非典型偏头痛患者进行了特征描述和亚分类。在382名头痛患者的临床样本中，83名患者符合IHS“非典型偏头痛”标准。被指定为IHS 1.7的患者并未聚合成一个同质群体。相反，通过实证得出了不同的且具有临床相关性的亚组（例如，具有非典型疼痛参数的偏头痛、短暂性偏头痛、慢性偏头痛）。研究结果呼吁修订IHS偏头痛诊断标准，以尽量减少被诊断为非典型偏头痛的患者数量。修订内容将包括将最短头痛持续时间标准从4小时降至2小时，并为每月发作超过15天的偏头痛制定“慢性偏头痛”分类。提议的修订提供了一种诊断临床人群中常见的每日和近乎每日头痛的方法。
