Nash Justin M, Lipchik Gay L, Holroyd Kenneth A, McCool Heidi, Stensland Michael
Centers for Behavioral and Preventive Medicine, Brown Medical School and The Miriam Hospital, Providence, RI, USA.
Headache. 2003 Jan;43(1):2-13. doi: 10.1046/j.1526-4610.2003.03002.x.
We assessed the views of physicians interested in headache as to the diagnosis of the most commonly occurring and currently controversial headaches.
The International Headache Society (IHS) classification system has received wide professional endorsement and considerable empirical support, but in the United States, their adoption by clinicians may be proceeding more slowly. Questions remain, including what diagnostic criteria for migraine and tension-type headache clinicians may continue to favor over those outlined by the IHS, to what extent is the "transformed migraine" diagnosis used in clinical practice, and how is analgesic rebound headache diagnosed with regard to the various quantitative measures of analgesic use.
Members of the American Headache Society rated the importance of IHS and non-IHS diagnostic criteria for migraine and tension-type headache and for analgesic rebound headache. Respondents also described their use of the proposed transformed migraine diagnosis.
Two-thirds (67.3%) of the respondents reported use of the IHS criteria or the IHS criteria in conjunction with clinical judgment. For migraine and tension-type headache, IHS criteria were rated with high importance, but some respondents reported using additional non-IHS diagnostic criteria and de-emphasizing certain IHS criteria. For chronic headache, almost two-thirds (63%) of respondents reported using the transformed migraine diagnosis. For analgesic rebound headache, respondents preferred to make the diagnosis based on medication consumption that is lower than amounts stipulated in the IHS classification system.
There remains a number of physicians interested in headache who do not use the IHS classification system, who modify the IHS criteria in practice, and who use the "transformed migraine" diagnosis for patients with chronic daily headache.
我们评估了对头痛感兴趣的医生对于最常见且当前存在争议的头痛诊断的看法。
国际头痛协会（IHS）的分类系统已获得广泛的专业认可和大量实证支持，但在美国，临床医生对其采用可能进展较为缓慢。问题依然存在，包括临床医生可能继续青睐的偏头痛和紧张型头痛的诊断标准相较于IHS所概述的标准是什么，“转化型偏头痛”诊断在临床实践中的使用程度如何，以及关于各种镇痛药使用的定量测量，镇痛药反弹性头痛是如何诊断的。
美国头痛协会的成员对IHS和非IHS偏头痛、紧张型头痛以及镇痛药反弹性头痛的诊断标准的重要性进行了评分。受访者还描述了他们对提议的转化型偏头痛诊断的使用情况。
三分之二（67.3%）的受访者报告使用IHS标准或IHS标准结合临床判断。对于偏头痛和紧张型头痛，IHS标准被评为高度重要，但一些受访者报告使用了额外的非IHS诊断标准并淡化了某些IHS标准。对于慢性头痛，近三分之二（63%）的受访者报告使用了转化型偏头痛诊断。对于镇痛药反弹性头痛，受访者更倾向于根据低于IHS分类系统规定量的药物消耗量来进行诊断。
仍有许多对头痛感兴趣的医生不使用IHS分类系统，在实践中修改IHS标准，并且对慢性每日头痛患者使用“转化型偏头痛”诊断。
