Takeshima Takao, Kikui Shoji
Headache Center, Department of Neurology, Tominaga Hospital.
Brain Nerve. 2013 Sep;65(9):1043-55.
Primary headache disorders such as migraine, tension-type headache, and cluster headache are prevalent and disabling neurological disorders. Although most headache disorders are largely treatable, they are under-recognized, under-diagnosed, and under-treated. Many headache sufferers in Japan do not receive appropriate and effective health care; hence, the illness, which should be relieved, persists and acts as an individual and societal burden. One of the barriers most responsible for this is poor awareness of the disorders. For lifting the burden, health care must be improved. Education is an essential way to resolve these issues at multiple levels. We have a Japanese version of the international headache classification and diagnostic criteria II (ICHD-II) and guidelines for the management of chronic headaches. Utilization of these resources is key for the improvement of headache management in our country. Not only neurologists, but also neurosurgeons and other medical specialists are participating in headache care in Japan. The Japanese Headache Society and the Japanese Society for Neurology should play major roles in health care service, education programs, as well as clinical and basic research for headache disorders. The road map for realizing our aim on headache treatment is as follows: (1) increase the number of units concerning headache in lectures for medical students, implement training programs for residents and neurologists, and offer continuous medical educations for physicians and neurologists; (2) secure more funding for headache research; (3) propagate medical care for headache in primary care settings and regional fundamental hospitals; (4) reform the health care system for headache and incentivize appropriate compensation for headache care in public health insurance; and (5) spread appropriate information on medical and socio-ethical issues related to headache for the sufferers and citizens. The authors expect that many neurologists have an interest in headache and understanding headaches, and better health care for headache disorders will bring great benefits for the sufferers.
偏头痛、紧张型头痛和丛集性头痛等原发性头痛疾病是常见且使人致残的神经系统疾病。尽管大多数头痛疾病在很大程度上是可治疗的，但它们未得到充分认识、诊断和治疗。日本许多头痛患者未得到适当有效的医疗保健；因此，本应缓解的疾病持续存在，并成为个人和社会的负担。造成这种情况的最主要障碍之一是对这些疾病的认识不足。为了减轻负担，必须改善医疗保健。教育是在多个层面解决这些问题的重要途径。我们有国际头痛分类和诊断标准第二版（ICHD-II）的日文版以及慢性头痛管理指南。利用这些资源是改善我国头痛管理的关键。在日本，不仅神经科医生，神经外科医生和其他医学专家也参与头痛护理。日本头痛协会和日本神经学会应在头痛疾病的医疗服务、教育项目以及临床和基础研究中发挥主要作用。实现我们头痛治疗目标的路线图如下：（1）增加医学生讲座中有关头痛的课程数量，为住院医师和神经科医生实施培训项目，并为医生和神经科医生提供继续医学教育；（2）为头痛研究争取更多资金；（3）在基层医疗单位和地区基础医院推广头痛医疗服务；（4）改革头痛医疗保健系统，并鼓励在公共医疗保险中对头痛护理给予适当补偿；（5）向患者和公众传播有关头痛的医学和社会伦理问题的适当信息。作者期望许多神经科医生对头痛感兴趣并了解头痛，更好的头痛疾病医疗保健将为患者带来巨大益处。
