新的每日持续性头痛的临床特征：328 例回顾性图表分析。

Clinical features of new daily persistent headache: A retrospective chart review of 328 cases.

机构信息

Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.

Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

出版信息

Headache. 2021 Nov;61(10):1529-1538. doi: 10.1111/head.14207. Epub 2021 Oct 28.

DOI:10.1111/head.14207

PMID:34710236

Abstract

OBJECTIVE

To describe the clinical features of new daily persistent headache (NDPH) at an outpatient neurology clinic with a subspecialty interest in headache in Houston, Texas.

METHODS

A retrospective chart review was performed by a neurologist subspecialty certified in headache medicine of all patients seen from September 1, 2011 through February 28, 2020 (8.5 years) with a provisional diagnosis of NDPH and abstracted charts meeting criteria for primary NDPH.

RESULTS

A total of 328 patients met the International Classification of Headache Disorders, 3rd edition criteria including 215 (65.5%) female patients. The mean age of onset was 40.3 years (range 12-87 years) with a mean age at first consultation in the study clinic of 42.6 years (range 12-87 years). The median [25th, 75th] duration of NDPH at initial consultation was 0.7 [0.3, 2.0] years, and at last visit, it was 1.9 [0.7, 4.8] years. The headaches were side-locked unilateral in 28/328 (8.5%). 12/328 cases (3.6%) with a thunderclap onset are reported. There was no obvious seasonal or other cyclical variation. The pain was usually moderate to severe and more often severe for the migraine phenotype (MP; 260/328 [79.3%] of cases) than for the tension-type phenotype (TTP). Precipitating factors were the following: stressful life events, 67/328 (20.4%); upper respiratory infection or flu-like illness, 33/328 (10.1%); and extracranial surgery, 5/328 (1.5%). Exacerbating or aggravating factors similar to migraine triggers were more often reported with the MP than with the TTP in this sample. For the MP, vertigo or dizziness was reported by 19/260 (7.3%) and a visual aura by 21/260 (8.1%) with descriptions provided. The prognostic types were the following for all patients: persisting (refractory), 305/328 (93.0%); relapsing-remitting, 9/328 (2.7%); and remitting (self-limited), 14/328 (4.3%).

CONCLUSION

NDPH is typically of moderate to severe intensity often with migraine features without obvious seasonal or other cyclical variation. Most cases are refractory. 3.6% have a thunderclap onset often with a good response to treatment.

摘要

目的

描述德克萨斯州休斯顿一家头痛专科门诊的新每日持续性头痛（NDPH）的临床特征。

方法

一位头痛医学专业认证的神经科医生对 2011 年 9 月 1 日至 2020 年 2 月 28 日（8.5 年）期间所有符合 NDPH 临时诊断标准且符合原发性 NDPH 标准的患者进行了回顾性图表审查。

结果

共有 328 名患者符合国际头痛疾病分类，第三版标准，其中 215 名（65.5%）为女性患者。发病年龄平均为 40.3 岁（范围 12-87 岁），首次在研究诊所就诊的平均年龄为 42.6 岁（范围 12-87 岁）。初始就诊时 NDPH 的中位数[25 分位，75 分位]持续时间为 0.7[0.3，2.0]年，末次就诊时为 1.9[0.7，4.8]年。328 例患者中 28 例（8.5%）头痛局限于单侧。报告了 12/328（3.6%）例霹雳样发作。无明显季节性或其他周期性变化。疼痛通常为中重度，偏头痛表型（MP；328 例中的 260/328 [79.3%]）比紧张型表型（TTP）更常为重度。促发因素如下：生活压力事件，67/328（20.4%）；上呼吸道感染或流感样疾病，33/328（10.1%）；以及颅外手术，5/328（1.5%）。在这个样本中，与 TTP 相比，MP 患者更常报告有压力生活事件、上呼吸道感染或流感样疾病等诱发因素，以及偏头痛的类似加重因素。对于 MP，260 例中的 19 例（7.3%）报告眩晕或头晕，21 例（8.1%）报告视觉先兆，并提供了描述。所有患者的预后类型如下：持续存在（难治性），305/328（93.0%）；复发缓解型，9/328（2.7%）；缓解（自限性），14/328（4.3%）。