Sergeev A V
Sechenov First Moscow State Medical University, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2018;118(1):96-102. doi: 10.17116/jnevro20181181196-102.
Differential diagnosis of migraine, can be difficult, especially of migraine with aura. On the one hand, some diseases can produce symptoms similar to migraine (cerebral aneurysm before rupture, reversible cerebral vasoconstriction syndrome). On the other hand, migraine with aura and some other disorders are conditions that have common pathophysiological mechanisms (e.g., CADASIL and MELAS syndrome, antiphospholipid syndrome). Thirdly, clinical presentations of migraine are often difficult to distinguish from features of other headache conditions (migraine with aura - transient ischemic attack, migraine with visual aura - occipital epilepsy). The author discusses the differential diagnosis of acute headache, especially thunderclap headache, and main strategies of effective treatment of migraine attacks.
偏头痛的鉴别诊断可能很困难，尤其是有先兆的偏头痛。一方面，一些疾病可产生与偏头痛相似的症状（未破裂的脑动脉瘤、可逆性脑血管收缩综合征）。另一方面，有先兆的偏头痛与其他一些疾病具有共同的病理生理机制（例如，伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病、线粒体脑肌病伴乳酸血症和卒中样发作综合征、抗磷脂综合征）。第三，偏头痛的临床表现往往难以与其他头痛疾病的特征相区分（有先兆的偏头痛——短暂性脑缺血发作、有视觉先兆的偏头痛——枕叶癫痫）。作者讨论了急性头痛尤其是霹雳样头痛的鉴别诊断，以及偏头痛发作的有效治疗主要策略。
