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1、migraine偏头痛 ChongqingUniversityofMedicalScience Migraineismanifestedbyheadachethatisarecurrence usuallyunilateralandfrequentlypulsatileinquality搏动性 itisoftenassociatedwithnausea vomiting photophobia畏光 phonophobia惧声andlassitude乏力 Visualorotherneurologicauras神经学先兆occurinabout10 ofpatients Theonsetisea
2、rlyinlifeapproximately25 beginningduringthefirstdecade 55 by20yearsofage morethan90 beforeage40 A Causeandpathogenesis Therealcausesandthepathogenesisandpathophysiologiccourseofmigraineisunknown 1 Certainfoods tyramine酪胺 containingcheeses meat suchashotdogsorbacon withnitrite亚硝酸preservatives chocola
3、tecontainingbutnotchocolatealone Foodadditives monosodiumglutamate谷氨酸一钠 Fasting禁食 Emotion情绪 Menses月经 Drugs especiallyoralcontraceptiveagents vasodilators nitriglycerin硝酸甘油 Brightslightsmayalsotriggerorprecipitateattacks 2 Genetics About60 patientsofmigrainehavefamilies Threegeneticlociforfamilialhem
4、iplegicmigraine 偏瘫型 havebeenidentified3 Endocrinefactor内分泌异常Gender women men 2 3to3 4ofcasesoccurinwomen Headachemostlyoccursbeforeormenacme月经期inwomen andtheheadachebecomesreductionorstoppinginpregnancyandaftermenopause绝经 Themigrainealsostopsinmenofafterclimacterium更年期 4 vasomotorandautonomic血管运动和自律
5、神经Intracranialvasoconstrictionandextracranialvasodilatationhavelongbeenheldtobetherespectivecausesoftheauraandheadachephasesofmigraine ButthestudyofCBF脑血流can tconfirm 5 spreadingdepression扩布性抑制MorerecentstudiesofrCBF局部脑血流duringmigraineattackshavedemonstratedareductioninregionalflow whichbeginsintheo
6、ccipitalregionandthentowardswith1cm svelocityduringtheauraphase 6 Neurotransmitter 神经递质 Serotonin血清素inplateletsdecreasesandurinaryserotoninincreasesduringtheacutephaseofamigraineattack Depletionofserotoninbyreserpine利血平mayprecipitatemigraineanddecreasedbyserotoninantagonists sumatriptan 英明格 B Thecla
7、ssificationofmigraine 1 classicmigraine 典型偏头痛 monmigraine 普通型偏头痛 3 specialtype a ophthalmoplegicM 眼肌麻痹型偏头痛 b hemiplegicM 偏瘫型偏头痛 c basilararteryM 基底动脉型偏头痛 d late lifeM 晚发性偏头痛 e migraineEquivalents 偏头痛等值症 C Clinicfigures临床表现1 MigrainewithAura Classicmigraine典型偏头痛 1 Auras 先兆 visualalteration particular
8、lyhemianopic 偏盲 fielddefects 视野缺损 andscotomas 黑朦 hemiparansthesia 半身麻木 2 Headache 50 ofpatientsexperiencenomorethanonceattackperweek thedurationofepisodesisgreaterthan2hoursandlessthan1dayinmostpatients Usuallyunilateralandfrequentlypulsatileinquality Althoughhemicranialpainisahallmark标志ofclassicmig
9、raine headachecanalsobebifrontal双前额 lesscommonlylocalizedtotheoccipitalorvertex头顶oftheSkull 3 companysymptoms伴随症状 Thenausea 恶心 vomiting 呕吐 photophobia 畏光 phonophobia 惧声 irritability 激惹 andlassitude 倦怠 arecommon Uncommonly migraineareassociatedwithfrankneurologicdeficits明显神经学缺陷thataccompanyorpersistb
10、eyondresolutionofthepainphase ThoseMayincludehemiparesis hemisensoryloss偏身感觉丧失 speechdysfunction语言功能障碍 orvisualdisturbance视觉紊乱 Samepatientshavevertigo眩晕 ataxia共济失调 oralteredconsciousness意识 2 MigrainewithoutAura commonmig a Thisisthemostfrequenttypeofmigraine over80 Thesymptomsandsignsaresimilarityth
11、eclassicmigraine butlackstheaura b Headache bilateral orunilateral periorbitalachingorthrobbinginquality longertimes oftenoccursonweekendandholidays Anusefulbedsidetestforbothcommonandclassicmigraineisreducingheadacheseveritybycompressingtheipsilateralcarotidorsuperficialtemporalartery 3 specialtype
12、 a ophthalmoplegicM 眼肌麻痹型偏头痛 Duringoraftermigraineattackoccurocularnerveparalysis ptosis pupildilation ets andpersistshoursormonths b hemiplegicM 偏瘫型偏头痛 withhemiplegia last10m days wk children lessinadult c basilararterymigraine 基底动脉型偏头痛 mostcommoninchildrenandyouthfulwomen visualalteration fielddef
13、ectsandscotomas ataxia vertigo tinnitus耳鸣 diplopia复视 nystagmus眼震 dysarthria构音障碍 bilaterallimbsnumbandweak impairmentofrecognizeandconsciousness andnausea vomiting ets d migraineEquivalents 偏头痛等值症 abdominalpain腹痛 thorax pelvis骨盆andlimbspain boutsfever周期性发热 attacksoftachycardia心动过速 benignparoxysmalver
14、tigo良性发作性眩晕 cyclicedema andsoon episodic recurrence excludedfromothersystemicdiseasesbyhistoryandexaminations D DiagnosisofmigraineAccordingtotheInternationalassociateofheadacherecomm endedaprogrammein1988 thediagnosisofmigrainewillbeinkeepingwithbelowcriterion a Migrainewithaura 1 Have2subjectsofbe
15、low breakout2atleast 2 Havebelowcharacteristicatleast3subjects 1 Morethan1timeauraoffunctionaldisturbanceinfocalcortexorbrainstem2 Anauraatleastgradualdevelopmentandpersistmorethan4min orhave2auras 3 Theaurapersistslessthan60min 4 Thereisnotanintervaltimebetweentheauraandheadache 3 Haveoneofbelowatl
16、east 1 Noevidenceoforganicdiseasesbyhistoryandexamination 2 Apossibleoforganicdiseasesbyhistoryandexamination butwasdenybytest 3 Althoughhavesomeorganicdiseases butthe1stmigraineattackhavenotrelationwithit 典型 有先兆 偏头痛诊断标准1 符合以下2项 发作至少两次 2 有以下特征至少3项 1 有局限性脑皮质或 和脑干功能障碍的大于1次以上的先兆 2 至少有一个先兆症状逐渐发展 持续4分钟以上 或先后有两个以上的先兆 3 先兆症状持续的时间小于60分钟 4 先兆症状与头痛间无间歇期 3 至少有下列之一 1 病史和体检不提示有器质性疾病证据 2 病史和体检提示有某种器质性疾病可能 但经检查被否定 3 虽有某种器质性疾病 但首次偏头痛发作与该疾病无密切关系 b Migrainewithoutaura1 Have2 4subjectsofbelow breakoutmorethan5time
