Kienbacher C, Wöber C, Zesch H E, Hafferl-Gattermayer A, Posch M, Karwautz A, Zormann A, Berger G, Zebenholzer K, Konrad A, Wöber-Bingöl C
Headache Unit, Department of Neuropsychiatry of Childhood and Adolescents, Medical University of Vienna, Vienna, Austria.
Cephalalgia. 2006 Jul;26(7):820-30. doi: 10.1111/j.1468-2982.2006.01108.x.
We performed a long-term follow-up examination in children and adolescents with migraine and tension-type headache (TTH) in order to investigate the evolution of clinical features and headache diagnoses, to compare International Classification of Headache Disorders (ICHD)-I and ICHD-II criteria and to identify prognostic factors. We re-examined 227 patients (52.4% female, age 17.6 +/- 3.1 years) 6.6 +/- 1.6 years after their first presentation to a headache centre using identical semistructured questionnaires. Of 140 patients initially diagnosed with migraine, 25.7% were headache free, 48.6% still had migraine and 25.7% had TTH at follow-up. Of 87 patients with TTH, 37.9% were headache free, 41.4% still had TTH and 20.7% had migraine. The number of subjects with definite migraine was higher in ICHD-II than in ICHD-I at baseline and at follow-up. The likelihood of a decrease in headache frequency decreased with a changing headache location at baseline (P < 0.0001), with the time between baseline and follow-up (P = 0.0019), and with an initial diagnosis of migraine (P = 0.014). Female gender and a longer time between headache onset and first examination tended to have an unfavourable impact. In conclusion, 30% of the children and adolescents presenting to a headache centre because of migraine or TTH become headache-free in the long-term. Another 20-25% shift from migraine to TTH or vice versa. ICHD-II criteria are superior to those of ICHD-I in identifying definite migraine in children and adolescents presenting to a headache centre. The prognosis is adversely affected by an initial diagnosis of migraine and by changing headache location, and it tends to be affected by an increasing time between headache onset and first presentation.
我们对偏头痛和紧张型头痛（TTH）的儿童及青少年进行了长期随访检查，以研究临床特征和头痛诊断的演变，比较《国际头痛疾病分类》（ICHD）-I和ICHD-II标准，并确定预后因素。我们使用相同的半结构化问卷，在首次就诊于头痛中心6.6±1.6年后，对227例患者（女性占52.4%，年龄17.6±3.1岁）进行了复查。在最初诊断为偏头痛的140例患者中，随访时25.7%无头痛，48.6%仍有偏头痛，25.7%有紧张型头痛。在87例紧张型头痛患者中，37.9%无头痛，41.4%仍有紧张型头痛，20.7%有偏头痛。在基线和随访时，ICHD-II中确诊偏头痛的受试者数量均高于ICHD-I。在基线时头痛部位改变（P<0.0001）、基线与随访之间的时间（P = 0.0019）以及初始诊断为偏头痛（P = 0.014）时，头痛频率降低的可能性减小。女性性别以及头痛发作与首次检查之间的时间较长往往产生不利影响。总之，因偏头痛或紧张型头痛就诊于头痛中心的儿童及青少年中，30%长期无头痛。另外20%-25%从偏头痛转变为紧张型头痛或反之。在识别就诊于头痛中心的儿童及青少年的确诊偏头痛方面，ICHD-II标准优于ICHD-I。预后受到偏头痛初始诊断、头痛部位改变的不利影响，且往往受到头痛发作与首次就诊之间时间增加的影响。
