Rammohan K, Shyma M M, Das Soumitra, Shaji C Velayudhan
Department of Neurology, T D MCH, Alappuzha, Kerala, India.
Department of Neurology, PVS Memorial Hospital, Kochi, Kerala, India.
J Neurosci Rural Pract. 2018 Jan-Mar;9(1):143-148. doi: 10.4103/jnrp.jnrp_304_17.
Epicrania fugax (EF) is a rare newly described primary headache characterized by paroxysms of unilateral pain radiating across one hemicranium.
We aimed to describe 10 new cases of EF and assess the psychiatric comorbidity.
Cases of EF were identified from patients attending the neurology outpatient department of a tertiary level referral and teaching hospital by the first author during a period extending from January 1, 2015 to April 31, 2017. Case ascertainment was done as per ICHD 3 beta criteria from among patients presenting with complaints of headache after detailed history and clinical examination. Clinical and demographic features were noted and patients were subjected to Mini Neuropsychiatric Interview to screen for psychiatric comorbidity followed by Becks Anxiety/Depression Inventory.
A total of 10 subjects were obtained during the study period, 4 males, and 6 females. Mean age of subjects was 45.3 years (standard deviation-10). Seventy percent had anteroposterior, and 30% had posteroanterior radiation of pain. The most common character of pain was stabbing (50%) followed by electrical (40%) and pressing (10%). None of the subjects had autonomic symptoms or focal symptoms in the scalp while 30% subjects had hyperesthesia in the affected area of the scalp. Six subjects (60%) patients had episodic course while 40% had chronic course. Sixty percent had comorbid anxiety while one (10%) had comorbid depression. A significant relation was obtained between duration of disease and occurrence of anxiety as well as Becks Anxiety Inventory scores while there was no correlation with attack duration. There was also a nonsignificant correlation between visual analog score and occurrence of anxiety symptoms.
Our study conclusively proves the existence of EF as a rare, distinct primary headache syndrome in our study population. It has a significant psychiatric comorbidity consisting of 60% of generalized anxiety disorder, 10% of panic attacks, and 10% of depression.
偏头痛性神经痛（EF）是一种罕见的新描述的原发性头痛，其特征为单侧疼痛阵发性发作，放射至一侧半侧颅骨。
我们旨在描述10例新的EF病例并评估其精神共病情况。
第一作者在2015年1月1日至2017年4月31日期间，从一家三级转诊和教学医院的神经内科门诊患者中识别出EF病例。根据国际头痛疾病分类第三版（ICHD-3β）标准，在详细询问病史和进行临床检查后，从主诉头痛的患者中确定病例。记录临床和人口统计学特征，并让患者接受简易神经精神访谈以筛查精神共病，随后进行贝克焦虑/抑郁量表评估。
研究期间共获得10名受试者，4名男性和6名女性。受试者的平均年龄为45.3岁（标准差为10）。70%的患者疼痛呈前后放射，30%呈后前放射。最常见的疼痛性质是刺痛（50%），其次是电击样（40%）和压迫样（10%）。所有受试者在头皮均无自主神经症状或局灶性症状，而30%的受试者在头皮受累区域有感觉过敏。6名受试者（60%）病程为发作性，40%为慢性病程。60%的患者有共病焦虑，1名（10%）有共病抑郁。疾病持续时间与焦虑的发生以及贝克焦虑量表得分之间存在显著相关性，而与发作持续时间无关。视觉模拟评分与焦虑症状的发生之间也存在非显著相关性。
我们的研究确凿地证明了EF作为一种罕见的、独特的原发性头痛综合征在我们的研究人群中存在。它有显著的精神共病，包括60%的广泛性焦虑障碍、10%的惊恐发作和10%的抑郁症。
