Guidetti V, Galli F
Interuniversity Center for the Study of Headaches and Neurotransmitter Disorders, Section of Rome, Italy.
Cephalalgia. 1998 Sep;18(7):449-54. doi: 10.1046/j.1468-2982.1998.1807449.x.
Headache is a notable problem in clinical practice and a frequent symptom in childhood and adolescence. The main aim of the present study is to analyze the evolution of migraine and tension headache (TH) using an 8-year follow-up.
100 subjects (F60, M40; mean age 17.9; SD 2.6; range 12-26), randomly selected among all patients first seen in 1988 at the Headache Center, were directly contacted. We employed IHS criteria both in 1988 (the data were taken by the clinical charts) and 1996. We took into account changes in headache types and improvement, unchanging, worsening or remission of headache. This analysis was made with regard to gender differences and age at onset of headache, too. The chi-squared test is employed.
High tendency to remit (34%) or improve (45%) was recorded. A worsening situation was seen in 6% and an unchanging situation in 15%. In 1988, we had 57% migraine without aura (MwoA), 7% migraine with aura, 28% episodic tension-type headache (ETTH), and 8% chronic TH (CTTH). In 1996, we saw 30% MwoA, 2% MwA, 31% ETTH, and 3% CTH. Migraine shows a lower tendency to remit than TH (28.1% vs 44.4%). MwoA persists in the same form in 43.8% and becomes ETH in 26.3%. ETTH persists in the same form in 26.3% and changes in MwoA in 10.7%. Of headache-free subjects, we recorded a high tendency to remit (34%) and improve (95%); 13 were females (21.7%) and 21 were males (52.5%). The course of headache is not related to age at onset.
Headache with juvenile onset changes its characteristics over time, with a high tendency to remit (mostly in males) or improve. The implications for pathophysiology and the role of hormonal factors are called into question.
头痛是临床实践中的一个显著问题，也是儿童和青少年时期的常见症状。本研究的主要目的是通过8年的随访来分析偏头痛和紧张性头痛（TH）的演变情况。
在1988年首次就诊于头痛中心的所有患者中随机选取100名受试者（女性60名，男性40名；平均年龄17.9岁；标准差2.6；年龄范围12 - 26岁），并直接与他们取得联系。我们在1988年（数据取自临床病历）和1996年都采用了国际头痛协会（IHS）的标准。我们考虑了头痛类型的变化以及头痛的改善、不变、恶化或缓解情况。该分析也针对性别差异和头痛发作时的年龄进行。采用卡方检验。
记录到有很高的缓解倾向（34%）或改善倾向（45%）。6%的情况恶化，15%的情况不变。1988年，我们有57%无先兆偏头痛（MwoA）、7%有先兆偏头痛、28%发作性紧张型头痛（ETTH）和8%慢性紧张性头痛（CTTH）。1996年，我们看到30% MwoA, 2%有先兆偏头痛、31% ETTH和3%慢性紧张性头痛。偏头痛的缓解倾向低于紧张性头痛（28.1%对44.4%）。无先兆偏头痛以相同形式持续存在的占43.8%，转变为发作性紧张型头痛的占26.3%。发作性紧张型头痛以相同形式持续存在的占26.3%，转变为无先兆偏头痛的占10.7%。在无头痛的受试者中，我们记录到有很高的缓解倾向（34%）和改善倾向（95%）；13名是女性（21.7%），21名是男性（52.5%）。头痛的病程与发病年龄无关。
青少年期发作的头痛随时间推移会改变其特征，有很高的缓解倾向（主要在男性中）或改善倾向。这对病理生理学的影响以及激素因素的作用受到质疑。
