头痛的临床特征与管理：来自印度东部一家三级医疗中心的真实前瞻性观察研究。

Clinical Characteristics and Management of Headache: A Real-Life Prospective, Observational Study From a Tertiary Care Center in Eastern India.

作者信息

Nayak Soumyadarshan, Parida Muktikanta, Das Shanti Bhusan, Padhi Prabhat Kumar, Behera Manoranjan, Patil Anant, Khurana Amandeep, Kumar Swain Santosh

机构信息

Neurology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND.

Internal Medicine, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, IND.

出版信息

Cureus. 2020 Dec 31;12(12):e12409. doi: 10.7759/cureus.12409.

DOI:10.7759/cureus.12409

PMID:33409110

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7779133/

Abstract

OBJECTIVE

To describe clinical profile and management pattern of headache in patients presenting to a tertiary care center. Methods: In this observational study, demographics, radiological investigations, triggers, and treatment pattern in patients aged ≥ 14 years presenting with headache were recorded. Disability and severity of headache were assessed with Migraine Disability Assessment (MIDAS) score, Visual Analogue Scale (VAS), and Headache Impact Test (HIT-6) in case of migraineurs and VAS and HIT-6 for all other headache disorders. Patients were evaluated at baseline and after three and six months post-treatment.

RESULTS

Out of 400 patients (60.25% females and 39.75% males), 277 (69.25%) had primary headache among whom 119 (42.96%) had migraine without aura. Stress, menstruation, fasting, and inadequate sleep were common triggers for migraine. Nausea, vomiting, photo-phonophobia and neck pain were the most common accompanying symptoms in patients with headache. Out of 106 (38.3%) patients with tension-type headache, 68.9% were episodic. In the migraine subset, 81% presented with moderate to severe disability at baseline, which changed to minimal to mild disability at three and six months post-treatment (p < 0.001). For abortive treatment, 130 (79.7%) patients were prescribed naproxen, domperidone, and sumatriptan. In 69 (42.3%) patients, valproic acid/divalproex was used for prophylaxis. Most common causes of secondary headaches (30.75%) were intracranial bleeds and cerebral venous sinus thrombosis. Most common abnormalities on computerized tomography were intracerebral hemorrhage, subarachnoid hemorrhage, sinusitis, and space-occupying lesions (SOLs).

CONCLUSION

In our study, migraine was the most common etiology of headache. Headache was more common in females than males, and primary headache was more common than secondary headache. Sodium valproate was the commonly used prophylaxis in migraine.

摘要

目的

描述在一家三级医疗中心就诊的头痛患者的临床特征及治疗模式。方法：在这项观察性研究中，记录了年龄≥14岁的头痛患者的人口统计学信息、影像学检查、诱发因素及治疗模式。对于偏头痛患者，使用偏头痛残疾评估（MIDAS）评分、视觉模拟量表（VAS）和头痛影响测试（HIT - 6）评估头痛的残疾程度和严重程度；对于所有其他头痛疾病，则使用VAS和HIT - 6进行评估。在基线以及治疗后3个月和6个月对患者进行评估。

结果

在400名患者中（女性占60.25%，男性占39.75%），277名（69.25%）患有原发性头痛，其中119名（42.96%）为无先兆偏头痛。压力、月经、禁食和睡眠不足是偏头痛的常见诱发因素。恶心、呕吐、畏光畏声和颈部疼痛是头痛患者最常见的伴随症状。在紧张型头痛患者中，106名（38.3%）患者中68.9%为发作性。在偏头痛亚组中，81%的患者在基线时表现为中度至重度残疾，在治疗后3个月和6个月变为轻度至极轻度残疾（p < 0.001）。对于发作期治疗，130名（79.7%）患者被开具了萘普生、多潘立酮和舒马曲坦。在69名（42.3%）患者中，使用丙戊酸/丙戊酸二钠进行预防。继发性头痛最常见的原因（30.75%）是颅内出血和脑静脉窦血栓形成。计算机断层扫描最常见的异常是脑出血、蛛网膜下腔出血、鼻窦炎和占位性病变（SOLs）。