Bigal Marcelo E, Lipton Richard B
Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Rousso Bldg, Room 330, Bronx, NY 10461, USA.
J Headache Pain. 2007 Oct;8(5):263-72. doi: 10.1007/s10194-007-0418-3. Epub 2007 Oct 23.
Chronic daily headaches (CDHs) refers to primary headaches that happen on at least 15 days per month, for 4 or more hours per day, for at least three consecutive months. The differential diagnosis of CDHs is challenging and should proceed in an orderly fashion. The approach begins with a search for "red flags" that suggest the possibility of a secondary headache. If secondary headaches that mimic CDHs are excluded, either on clinical grounds or through investigation, the next step is to classify the headaches based on the duration of attacks. If the attacks last less than 4 hours per day, a trigeminal autonomic cephalalgia (TAC) is likely. TACs include episodic and chronic cluster headache, episodic and chronic paroxysmal hemicrania, SUNCT, and hypnic headache. If the duration is > or =4 h, a CDH is likely and the differential diagnosis encompasses chronic migraine, chronic tension-type headache, new daily persistent headache and hemicrania continua. The clinical approach to diagnosing CDH is the scope of this review.
慢性每日头痛（CDHs）是指每月至少有15天、每天持续4小时以上、且至少连续三个月发作的原发性头痛。CDHs的鉴别诊断具有挑战性，应按部就班地进行。诊断方法首先要寻找提示继发性头痛可能性的“红旗”症状。如果基于临床依据或通过检查排除了疑似CDHs的继发性头痛，下一步则根据发作持续时间对头痛进行分类。如果发作时间每天少于4小时，则可能是三叉自主神经性头痛（TAC）。TAC包括发作性和慢性丛集性头痛、发作性和慢性阵发性偏侧头痛、短时间单侧神经痛性头痛发作并伴有结膜充血及流泪综合征（SUNCT）和睡眠性头痛。如果持续时间≥4小时，则可能是CDH，鉴别诊断包括慢性偏头痛、慢性紧张型头痛、新发性每日持续性头痛和持续性偏侧头痛。本综述的范围是CDH的临床诊断方法。
