Lipton R B, Cady R K, Stewart W F, Wilks K, Hall C
IMR, Stamford, Connecticut, USA.
Neurology. 2002 May 14;58(9 Suppl 6):S27-31. doi: 10.1212/wnl.58.9_suppl_6.s27.
Article abstract Migraine is a heterogeneous condition that causes symptoms that vary both among individuals and within individuals from attack to attack. We examined and reviewed several important lessons on the diagnosis of migraine learned from the distribution of headache types and patterns of treatment response in the Spectrum Study, including recruitment and diagnostic issues. The accuracy of an initial diagnosis, assigned by a clinician in the context of a clinical trial, was compared with the results of a final diagnosis, assigned by a neurologist, reviewing the initial evaluation as well as headache diaries for up to 10 attacks. Several lessons can be learned from the Spectrum Study. Recruitment difficulties teach us that disabling tension-type headache is difficult to find, suggesting that it is rare. Examination of the final diagnosis given after diary evaluations suggests that a diagnosis of migraine can usually be confirmed for patients with disabling headache. After reclassification of the final sample of 432 subjects, 24/75 (32%) patients initially clinically classified as having disabling episodic tension-type headache proved to have migraine or migrainous headache after a diary review. Among study participants, 90% of subjects with disabling headache (HIMQ score >250) had a migraine-related disorder. Treatment response suggests that, in migraineurs, tension-type headaches may have a pathophysiology similar to that of migraine. The diary data show that mild headaches in patients with disabling migraine often evolve into full-blown migraine. The Spectrum Study supports the view that, for patients with disabling episodic headache, migraine is often the correct diagnosis. In clinical practice, the suspicion of migraine should be high for patients experiencing episodic disabling headache. Assessment of headache-related disability may assist practitioners in making a diagnosis of migraine.
偏头痛是一种异质性疾病，其症状在个体之间以及个体每次发作时都有所不同。我们研究并回顾了从频谱研究中头痛类型分布和治疗反应模式中学到的关于偏头痛诊断的几个重要经验教训，包括招募和诊断问题。将临床医生在临床试验背景下做出的初始诊断准确性与神经科医生做出的最终诊断结果进行比较，神经科医生会回顾初始评估以及长达10次发作的头痛日记。从频谱研究中可以学到几个经验教训。招募困难告诉我们，致残性紧张型头痛很难找到，这表明它很罕见。对日记评估后给出的最终诊断进行检查表明，对于患有致残性头痛的患者，通常可以确诊为偏头痛。在对432名受试者的最终样本进行重新分类后，最初临床分类为患有致残性发作性紧张型头痛的24/75（32%）患者在日记回顾后被证明患有偏头痛或偏头痛样头痛。在研究参与者中，90%患有致残性头痛（HIMQ评分>250）的受试者患有与偏头痛相关的疾病。治疗反应表明，在偏头痛患者中，紧张型头痛可能具有与偏头痛相似的病理生理学。日记数据显示，患有致残性偏头痛的患者中的轻度头痛往往会演变成全面发作的偏头痛。频谱研究支持这样一种观点，即对于患有致残性发作性头痛的患者，偏头痛往往是正确的诊断。在临床实践中，对于经历发作性致残性头痛的患者，应高度怀疑偏头痛。对头痛相关残疾的评估可能有助于医生做出偏头痛的诊断。
