Departamento de Neurologia, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
CEDOC - Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.
Headache. 2022 Sep;62(8):1053-1058. doi: 10.1111/head.14377. Epub 2022 Aug 26.
This retrospective case series study aimed to investigate the demographic and clinical patterns of primary stabbing headache (PSH). In addition, we tried to identify subgroups of treatment responses in a neurology outpatient consultation at a Portuguese tertiary hospital.
Clinical records were retrospectively reviewed and patients meeting the International Classification of Headache Disorders, 3rd edition, criteria for PSH were identified from January 2014 to December 2020. We collected data regarding demographic characteristics, clinical features of the headache, primary headache comorbidities, and information about treatment-related do PSH.
Of 1857 patients, 32 (1.7%; mean [SD] age of onset 56 [3.5] years) had the final diagnosis of PSH. Regarding headache characteristics, 20 patients (62.5%) reported episodes of stabbing in fixed locations and 12 (37.5%) in multiple areas; the duration of each attack was between ≤5 s (seven [21.9%]), 5-60 s (20 [62.5%]), and ≥60 s (five [15.6%]). In all, 18 patients (56.3%) had an episodic course (vs. six of 32 [18.8%] an acute course and eight of 32 [25%] a chronic course). In all, 17 patients started medical treatment (53.1%), with total or partial improvement in 10 (58.8%) of them. It was found that patients with pain in fixed locations had a better response to treatment when compared to patients with multiple locations, in a statistically significant way (eight of 11 vs. two of six, p = 0.023).
In our sample, the mean age of onset of PSH was >50 years and there was a wide range of PSH duration. The duration of each attack (>5 s), the pain in fixed locations, non-daily episodes of the pain in each attack, and the intermittent course of headache were the most prevalent clinical features. Finally, patients with stabbing in localized areas had a better response to treatment.
本回顾性病例系列研究旨在调查原发性刺痛性头痛（PSH）的人口统计学和临床模式。此外，我们试图在葡萄牙一家三级医院的神经科门诊中确定治疗反应的亚组。
回顾性审查临床记录，从 2014 年 1 月至 2020 年 12 月，根据国际头痛疾病分类，第 3 版标准，确定符合 PSH 标准的患者。我们收集了人口统计学特征、头痛的临床特征、原发性头痛合并症以及与 PSH 相关的治疗信息。
在 1857 名患者中，有 32 名（1.7%；发病年龄的平均值为 56 [3.5] 岁）最终诊断为 PSH。关于头痛特征，20 名患者（62.5%）报告了固定部位的刺痛发作，12 名患者（37.5%）报告了多个部位的刺痛发作；每次发作的持续时间为≤5 s（7 例 [21.9%]）、5-60 s（20 例 [62.5%]）和≥60 s（5 例 [15.6%]）。共有 18 名患者（56.3%）为发作性病程（与 32 名患者中的 6 名 [18.8%]急性病程和 8 名 [25%]慢性病程相比）。共有 17 名患者开始接受药物治疗（53.1%），其中 10 名（58.8%）患者的疼痛得到完全或部分改善。结果发现，与多处疼痛的患者相比，疼痛部位固定的患者对治疗的反应更好，具有统计学意义（11 例中的 8 例 vs. 6 例中的 2 例，p=0.023）。
在我们的样本中，PSH 的发病年龄平均超过 50 岁，发作持续时间范围广泛。每次发作持续时间（>5 s）、疼痛部位固定、每次发作非每日疼痛发作次数和头痛间歇性发作是最常见的临床特征。最后，刺痛局限于局部区域的患者对治疗的反应更好。
