Sanin L C, Mathew N T, Bellmeyer L R, Ali S
Houston Headache Clinic, Baylor College of Medicine, Texas.
Cephalalgia. 1994 Dec;14(6):443-6. doi: 10.1046/j.1468-2982.1994.1406443.x.
Four hundred patients attending a headache clinic were classified using the IHS criteria. The majority required more than two, often three or four, diagnoses. Even though migraine was the most common diagnosis, only 1/4 of those with a migraine diagnosis had it as the only diagnosis. Seventy-five percent of migraine patients had coexistent chronic tension-type headache (CTTH), drug-induced headache or both. Ninety-six percent of patients diagnosed as having migraine with aura also suffered from migraine without aura. More than 1/3 of patients (37.7%) attending the clinic suffered from chronic daily headache (CDH) (chronic cluster headache excluded), which is not included as a separate entity in the IHS classification. Pure CTTH formed only a small minority of CDH, whereas 86.6% of CDH had migraine as one of the diagnoses. Drug-induced headache was a prominent second or third diagnosis. The advantages and disadvantages of multiple verses single diagnosis in CDH and the need to recognize the natural history of headache disorders in the classification are discussed.
400名前往头痛门诊的患者依据国际头痛协会（IHS）标准进行了分类。大多数患者需要两种以上的诊断，通常是三种或四种。尽管偏头痛是最常见的诊断，但仅有四分之一被诊断为偏头痛的患者以此作为唯一诊断。75%的偏头痛患者同时患有慢性紧张型头痛（CTTH）、药物性头痛或两者皆有。被诊断为伴有先兆偏头痛的患者中，96%也患有无先兆偏头痛。超过三分之一（37.7%）前往该门诊的患者患有慢性每日头痛（CDH）（不包括慢性丛集性头痛），而CDH在IHS分类中并未作为一个单独的类别列出。单纯的CTTH仅占CDH的一小部分，而86.6%的CDH患者有偏头痛作为诊断之一。药物性头痛是突出的第二或第三诊断。本文讨论了CDH中多重诊断与单一诊断的优缺点，以及在分类中认识头痛疾病自然史的必要性。
