Trainor Arleigh, Miner James
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
Am J Emerg Med. 2008 Nov;26(9):1029-34. doi: 10.1016/j.ajem.2007.12.008.
The aim of this study is to determine if emergency physicians treat headache subtypes differently and if this difference affects pain relief.
This was a prospective observational, institutional review board-approved study of adults undergoing treatment for a primary headache. Before the treatment and 60 minutes after, patients completed a 100-mm Visual Analog Scale (VAS) describing their pain. Patients also completed a headache diagnosis worksheet that differentiated headache type based on International Headache Society criteria. Treatments were recorded. Data were analyzed using descriptive statistics, 95% confidence intervals, analysis of variance, and chi(2) tests as appropriate.
A total of 184 patients were enrolled: 83 (45.1%) with migraine, 61 (33.2%) with migrainous, and 40 (21.7%) with tension-type headaches. There was no difference in the presenting VAS score or treatments of the 3 headache subtypes. The migraine group was most likely to receive any pain medication (78.31%), and the tension group the least likely to receive any pain medication (62.50%). A 50% decrease in VAS was achieved by only 32.5% of the patients. Sumatriptan, followed by droperidol, provided the greatest decrease in VAS scores. Oral and parenteral narcotics provided equivalent pain relief, with nonsteroidal anti-inflammatory drugs (NSAIDs) providing the least pain relief.
There was no difference in the treatments used or pain relief achieved between migraine, migrainous, and tension-type headaches. The differentiation of primary headache subtypes does not appear to be important to their treatment in the acute setting of the emergency department.
本研究旨在确定急诊医生对不同类型头痛的治疗方式是否存在差异，以及这种差异是否会影响疼痛缓解情况。
这是一项经机构审查委员会批准的前瞻性观察性研究，研究对象为接受原发性头痛治疗的成年人。在治疗前和治疗后60分钟，患者完成一份100毫米视觉模拟量表（VAS），描述其疼痛程度。患者还完成一份头痛诊断工作表，根据国际头痛协会标准区分头痛类型。记录治疗情况。数据采用描述性统计、95%置信区间、方差分析和适当的卡方检验进行分析。
共纳入184例患者：83例（45.1%）为偏头痛，61例（33.2%）为类偏头痛，40例（21.7%）为紧张型头痛。三种头痛亚型的初始VAS评分或治疗方式无差异。偏头痛组最有可能接受任何止痛药物治疗（78.31%），紧张型头痛组最不可能接受任何止痛药物治疗（62.50%）。仅32.5%的患者VAS评分降低了50%。舒马曲坦，其次是氟哌利多，使VAS评分降低幅度最大。口服和注射用麻醉剂提供的疼痛缓解效果相当，非甾体抗炎药（NSAIDs）提供的疼痛缓解效果最差。
偏头痛、类偏头痛和紧张型头痛在治疗方式或疼痛缓解方面无差异。在急诊科急性情况下，原发性头痛亚型的区分对其治疗似乎并不重要。
