Zhu Kai-yun, Huang Yan, Zhong Shui-sheng, Bao Ze-yan, Tian Xin-liang
Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou 510510, China.
Zhonghua Yi Xue Za Zhi. 2008 Nov 11;88(41):2935-7.
To evaluate the clinical feature of nummular headache and the efficiency of treatment in China.
The data of 21 NH patients treated from February 2006 to February 2008, were analyzed.
They were 9 men, 12 women, aged 37 +/- 12 (18 - 63) years. Headache history ranged from 7 days to 30 years. 13 patients reported head pain confined to a circular area of 0.6 to 5 centimeter, and the other 8 patients had pain in an elliptical area of 1 - 2 centimeter x 1.5 - 3 centimeter. The symptomatic area was located in the parietal (n = 7), occipital(n = 8), temporal (n = 6), or border regions between temporal and parietal (n = 1). The right side was affected in 10 patients and the left side in the 9 patients, the middle of occipital and parietal areas were affected in 1 patient, respectively. Seven patients had mild pain, 8 patients had moderate pain and 6 patients had severe pain. The characteristics of headache included stabbing pain (n = 6), sharp pain (n = 3), pulsating apin (n = 3), grinding pain (n = 1), exploding pain (n = 5), included light-dull apin (n = 3). Three patients were treated by local nerve block with lidocaine plus dexamethasone phosphate/acetate and one of them got some 30 hours of prominent pain relief, no relief was obtained for other two patients. One patient obtained pain remission by acupuncture after amitriptyline, paroxetine had been tried ineffectively. One patient, woman, 38 years old, was treated by carbamazepine (tegretol) and amitriptyline for 3 months and pain relief was obtained gradually and the head pain disappeared finally. 8 patients were treated effectively by amitriptyline combining indomethacium, ibuprofen or carbamazepine. One patient was treated effectively by nimodipine. 2 patients were treated ineffectively by amitriptyline combining indomethacium. 4 patients were not treated. 3 patients were lost to follow-up.
NH is not very rare and some of NH patients may be treated effectively by acupuncture or amitriptyline combining indomethacium, ibuprofen or carbamazepine.
评估钱币状头痛的临床特征及在中国的治疗效果。
分析2006年2月至2008年2月间治疗的21例钱币状头痛患者的数据。
男性9例，女性12例，年龄37±12（18 - 63）岁。头痛病史从7天至30年不等。13例患者报告头痛局限于直径0.6至5厘米的圆形区域，另外8例患者的疼痛位于1 - 2厘米×1.5 - 3厘米的椭圆形区域。症状区域位于顶叶（n = 7）、枕叶（n = 8）、颞叶（n = 6）或颞叶与顶叶之间的边界区域（n = 1）。右侧受累10例患者，左侧受累9例患者，枕叶和顶叶中部各有1例患者受累。7例患者为轻度疼痛，8例患者为中度疼痛，6例患者为重度疼痛。头痛的特征包括刺痛（n = 6）、锐痛（n = 3）、搏动性疼痛（n = 3）、研磨痛（n = 1）、炸裂样疼痛（n = 5）、轻钝痛（n = 3）。3例患者接受利多卡因加磷酸地塞米松/醋酸地塞米松局部神经阻滞治疗，其中1例患者疼痛明显缓解30小时，另外2例患者未缓解。1例患者在尝试阿米替林、帕罗西汀无效后通过针灸获得疼痛缓解。1例38岁女性患者接受卡马西平（痛痉宁）和阿米替林治疗3个月，疼痛逐渐缓解，最终头痛消失。8例患者通过阿米替林联合吲哚美辛、布洛芬或卡马西平治疗有效。1例患者通过尼莫地平治疗有效。2例患者通过阿米替林联合吲哚美辛治疗无效。4例患者未接受治疗。3例患者失访。
钱币状头痛并非十分罕见，部分钱币状头痛患者可通过针灸或阿米替林联合吲哚美辛、布洛芬或卡马西平得到有效治疗。
