Sandrini G, Friberg L, Jänig W, Jensen R, Russell D, Sanchez del Rìo M, Sand T, Schoenen J, Buchem M, van Dijk J G
University Centre for Adaptive Disorders and Headache, IRCCS C. Mondino Foundation, Pavia, Italy.
Eur J Neurol. 2004 Apr;11(4):217-24. doi: 10.1111/j.1468-1331.2003.00785.x.
The use of instrumental examinations in headache patients varies widely. In order to evaluate their usefulness, the most common instrumental procedures were evaluated, on the basis of evidence from the literature, by an EFNS Task Force (TF) on neurophysiological tests and imaging procedures in non-acute headache patients. The conclusions of the TF regarding each technique are expressed in the following guidelines for clinical use. 1 Interictal electroencephalography (EEG) is not routinely indicated in the diagnostic evaluation of headache patients. Interictal EEG is, however, indicated if the clinical history suggests a possible diagnosis of epilepsy (differential diagnosis). Ictal EEG could be useful in certain patients suffering from hemiplegic and basilar migraine. 2 Recording of evoked potentials is not recommended for the diagnosis of headache disorders. 3 There is no evidence to justify the recommendation of autonomic tests for the routine clinical examination of headache patients. 4 Manual palpation of pericranial muscles, with standardized palpation pressure, can be recommended for subdividing patient groups but not for diagnosis. Pressure algometry and electromyography (EMG) cannot be recommended as clinical diagnostic tests. 5 In adult and paediatric patients with migraine, with no recent change in attack pattern, no history of seizures, and no other focal neurological signs or symptoms, the routine use of neuroimaging is not warranted. In patients with atypical headache patterns, a history of seizures and/or focal neurological signs or symptoms, magnetic resonance imaging (MRI) may be indicated. 6 If attacks can be fully accounted for by the standard headache classification [International Headache Society (IHS)], a positron emission tomography (PET) or single-photon emission computerized tomography (SPECT) and scan will generally be of no further diagnostic value. 7 Nuclear medicine examinations of the cerebral circulation and metabolism can be carried out in subgroups of headache patients for diagnosis and evaluation of complications, when patients experience unusually severe attacks, or when the quality or severity of attacks has changed. 8 Transcranial Doppler examination is not helpful in headache diagnosis. Although many of the examinations described are of little or no value in the clinical setting, most of the tools have a vast potential for further exploring the pathophysiology of headaches and the effects of pharmacological treatment.
仪器检查在头痛患者中的应用差异很大。为了评估其效用，欧洲神经科学联合会（EFNS）一个关于非急性头痛患者神经生理学测试和成像程序的特别工作组（TF），根据文献证据，对最常见的仪器检查程序进行了评估。TF关于每种技术的结论在以下临床应用指南中阐述。1. 发作间期脑电图（EEG）在头痛患者的诊断评估中并非常规必需。然而，如果临床病史提示可能诊断为癫痫（鉴别诊断），则需要进行发作间期EEG检查。发作期EEG对某些偏瘫性和基底型偏头痛患者可能有用。2. 不推荐用诱发电位记录来诊断头痛疾病。3. 没有证据支持在头痛患者的常规临床检查中推荐自主神经测试。4. 以标准化触诊压力对手颅骨周围肌肉进行手动触诊，可用于对患者群体进行细分，但不能用于诊断。压力痛觉测定法和肌电图（EMG）不能作为临床诊断测试推荐。5. 在偏头痛的成年和儿科患者中，若发作模式近期无变化、无癫痫病史且无其他局灶性神经体征或症状，则无需常规进行神经影像学检查。对于具有非典型头痛模式、癫痫病史和/或局灶性神经体征或症状的患者，可能需要进行磁共振成像（MRI）检查。6. 如果发作可以完全用标准头痛分类法[国际头痛协会（IHS）]解释，正电子发射断层扫描（PET）或单光子发射计算机断层扫描（SPECT）通常没有进一步的诊断价值。7. 当患者经历异常严重的发作，或发作的性质或严重程度发生变化时，可对部分头痛患者进行脑循环和代谢的核医学检查，以用于诊断和评估并发症。8. 经颅多普勒检查对头痛诊断没有帮助。尽管上述许多检查在临床环境中价值不大或没有价值，但大多数工具在进一步探索头痛的病理生理学和药物治疗效果方面具有巨大潜力。
