头痛地国际分类第三版中文Word文档格式.docx

1、一、原发性头痛（the primary headaches）1.偏头痛（Migraine）1.1 Migraine without aura无先兆偏头痛1.2 Migraine with aura有先兆偏头痛1.2.1 Migraine with typical aura先兆性偏头痛的诊断标准：符合B-C特征，至少发作2次发作完全可逆以下症状的1项或多项 视觉、感觉、语言障碍（典型先兆） 肢体无力症状（偏瘫型偏头痛） 脑干症状（基底型偏头痛） 视网膜症状（视网膜型偏头痛） 至少1个先兆逐渐发展的过程5min，和/或不同先兆接连发生过程5min 每个先兆症状持续时间5-60min 至少一个先兆症

2、状为单侧性 先兆发生同时或之后内60min出现符合偏头痛 肢体无力症状可以持续至72h，部分患者肢体无力感可持续数周； 若患者先兆持续1周以上，称为无梗死的持续先兆一般先兆症状多为双侧，可持续数月或数年 若先兆持续60min至1周以内，则称为propable migraine with aura 若出现影像学梗死灶，则称为偏头痛性脑梗死 （年轻女性，后循环比较常见）1.2.1.1 Typical aura with headache1.2.1.2 Typical aura without headache1.2.2 Migraine with brainstem aura1.2.3 Hemip

3、legic migraine偏瘫型偏头痛1.2.3.1 Familial hemiplegic migraine （FHM）家族性1.2.3.1.1 Familial hemiplegic migraine type 1 （FHM1）1.2.3.1.2 Familial hemiplegic migraine type 2 （FHM2）1.2.3.1.3 Familial hemiplegic migraine type 3 （FHM3）1.2.3.1.4 Familial hemiplegic migraine, other loci1.2.3.2 Sporadic hemiplegic m

4、igraine散发性1.2.4 Retinal migraine1.3 Chronic migraine慢性偏头痛1.4 Complications of migraine偏头痛并发症1.4.1 Status migrainosus偏头痛持续状态1.4.2 Persistent aura without infarction1.4.3 Migrainous infarction偏头痛脑梗死1.4.4 Migraine aura-triggered seizure1.5 Probable migraine很可能的偏头痛1.5.1 Probable migraine without aura1.5

5、.2 Probable migraine with aura1.6 Episodic syndromes that may be associated with migraine可能与偏头痛有关的发作性综合征慢性偏头痛：偏头痛发作每月15天，连续3个月以上偏头痛持续状态：单次发作持续72小时以上1.6.1 Recurrent gastrointestinal disturbance1.6.1.1Cyclical vomiting syndrome周期性呕吐1.6.1.2 Abdominal migraine腹型偏头痛1.6.2 Benign paroxysmal vertigo良性发作性眩晕1

6、.6.3 Benign paroxysmal torticollis良性发作性斜颈2.紧张型头痛（Tension-type headache）每次发作持续30min-7d，慢性者可持续不缓解2.1 Infrequent episodic tension-type headache偶发性 1d/月，至少10次以上（12d/年）2.1.1 Infrequent episodic tension-type headache associated with pericranial tenderness2.1.2 Infrequent episodic tension-type headache not

7、 associated with pericranial tenderness2.2 Frequent episodic tension-type headache频发性1d/月，但15d，至少发作10次以上（12d/年但180d）2.2.1 Frequent episodic tension-type headache associated with pericranial tenderness2.2.2 Frequent episodic tension-type headache not associated with pericranial tenderness2.3 Chronic

8、tension-type headache慢性紧张型头痛 每月发作15d，3个月以上2.3.1 Chronic tension-type headache associated with pericranial tenderness2.3.2 Chronic tension-type headache not associated with pericranial tenderness丛集性头痛的诊断标准：至少符合B-D的5次以上的发作单侧、眼眶、上眼眶及/或颞部重度或极重度疼痛，如不治疗持续15min-180min；伴随至少以上一项症状同侧结膜充血/流泪同侧鼻腔充血/流鼻水同侧眼皮水肿同侧前

9、额及脸部出汗同侧瞳孔缩小/眼睑下垂不安的症状或躁动发作频率隔日1至8次/日除外其他疾患2.4 Probable tension-type headache很可能的紧张型头痛2.4.1 Probable infrequent episodic tension-type headache2.4.2 Probable frequent episodic tension-type headache2.4.3 Probable chronic tension-type headache3.三叉自主神经性头痛（Trigeminal autonomic cephalalgias）3.1 Cluster he

10、adache丛集性头痛3.1.1 Episodic cluster headache发作性丛集性头痛3.1.2 Chronic cluster headache慢性丛集性头痛（复发作大于1年无缓解期，或缓解期3 months 慢性头痛，起病急，可清晰回忆发病时间为哪一天 疼痛缺乏特点，可以为偏头痛，可以为紧张性，亦可两者混合 若患者符合慢性偏头痛或慢性紧张型头痛的标准，则不诊断NDPH 若患者为药物过度使用性头痛，且符合NDPH的标准，则可两者均可作为诊断4.6 External-pressure headache4.6.1 External-compression headache4.6.2

11、 External-traction headache4.6.3 Probable external-pressure headache4.6.3.1 Probable external-compression headache4.6.3.2 Probable external-traction headache4.7 Primary stabbing headache4.7.1 Probable primary stabbing headache4.8 Nummular headache4.8.1 Probable nummular headache4.9 Hypnic headache4.

12、9.1 Probable hypnic headache4.10 New daily persistent headache （NDPH） 新症每日持续性头痛4.10.1 Probable new daily persistent headach二、继发性头痛（the secondary headaches）5.缘于头、颈部外伤的头痛（Headache attributed to trauma or injury to the head and/or neck）5.1 Acute headache attributed to traumatic injury to the head5.1.1

13、Acute headache attributed to moderate or severe traumatic injury to the head5.1.2 Acute headache attributed to mild traumatic injury to the head5.2 Persistent headache attributed to traumatic injury to the head5.2.1 Persistent headache attributed to moderate or severe traumatic injury to the head5.2

14、.2 Persistent headache attributed to mild traumatic injury to the head5.3 Acute headache attributed to whiplash5.4 Persistent headache attributed to whiplash5.5 Acute headache attributed to craniotomy5.6 Persistent headache attributed to craniotomy6.缘于头颈部血管疾病的头痛（Headache attributed to cranial or cer

15、vical vascular disorder ）6.1 Headache attributed to ischaemic stroke or transient ischaemic attack6.1.1 Headache attributed to ischaemic stroke （cerebral infarction）6.1.2 Headache attributed to transient ischaemic attack （TIA）6.2 Headache attributed to non-traumatic intracranial haemorrhage6.2.1 Hea

16、dache attributed to non-traumatic intracerebral haemorrhage非外伤性脑出血6.2.2 Headache attributed to non-traumatic subarachnoid haemorrhage （SAH）6.2.3 Headache attributed to non-traumatic acute subdural haemorrhage （ASDH）急性硬膜下血肿6.3 Headache attributed to unruptured vascular malformation未破裂的血管畸形6.3.1 Heada

17、che attributed to unruptured saccular aneurysm囊性动脉瘤6.3.2 Headache attributed to arteriovenous malformation （AVM） 动静脉畸形6.3.3 Headache attributed to dural arteriovenous fistula （DAVF） 硬膜动静脉瘘6.3.4 Headache attributed to cavernous angioma 海绵窦血管瘤 6.3.5 Headache attributed to encephalotrigeminal or leptom

18、eningeal angiomatosis （Sturge Weber syndrome） 脑三叉神经或软脑膜血管瘤病 6.4 Headache attributed to arteritis6.4.1 Headache attributed to giant cell arteritis （GCA） 颞动脉炎6.4.2 Headache attributed to primary angiitis of the central nervous system （PACNS）6.4.3 Headache attributed to secondary angiitis of the centra

19、l nervous system （SACNS）颞动脉炎诊断标准：美国风湿学会1990年1. 50岁以上发病：50岁以上发现症状2新发的头痛：出现新发的局限性头痛3颞动脉异常：颞动脉压痛或者与颈动脉的动脉硬化无关的搏动减弱4血沉值升高：50mm/h以上5动脉活检异常：单核细胞为主的细胞浸润或者伴多核巨细胞的肉芽肿出现为特征的血管炎证据 5项中如满足3项以上，敏感度935。特异性912可能分类为颞动脉炎。6.5 Headache attributed to cervical carotid or vertebral artery disorder颈动脉或锥动脉疼痛6.5.1 Headache o

20、r facial or neck pain attributed to cervical carotid or vertebral artery dissection动脉夹层6.5.2 Post-endarterectomy headache内膜剥脱术后头痛6.5.3 Headache attributed to carotid or vertebral angioplasty颈动脉血管成型术头痛6.6 Headache attributed to cerebral venous thrombosis （CVT） 脑静脉血栓形成6.7 Headache attributed to other

21、acute intracranial arterial disorder6.7.1 Headache attributed to an intracranial endovascular procedure6.7.2 Angiography headache6.7.3 Headache attributed to reversible cerebral vasoconstriction syndrome （RCVS）6.7.3.1 Headache probably attributed to reversible cerebral vasoconstrictionsyndrome （RCVS

22、）6.7.4 Headache attributed to intracranial arterial dissection颅内动脉夹层6.8 Headache attributed to genetic vasculopathy6.8.1 Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy （CADASIL）6.8.2 Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like episodes （M

23、ELAS）6.8.3 Headache attributed to another genetic vasculopathy6.9 Headache attributed to pituitary apoplexy垂体卒中7.缘于非血管性颅内疾病的头痛（Headache attributed to non-vascular intracranial disorder ）7.1 Headache attributed to increased cerebrospinal fluid pressure颅内压增高7.1.1 Headache attributed to idiopathic intr

24、acranial hypertension （IIH）7.1.2 Headache attributed to intracranial hypertension secondary to metabolic, toxic or hormonal causes7.1.3 Headache attributed to intracranial hypertension secondary to hydrocephalus7.2 Headache attributed to low cerebrospinal fluid pressure颅内压低下7.2.1 Post-dural puncture

25、 headache腰穿后7.2.2 CSF fistula headache脑脊液漏7.2.3 Headache attributed to spontaneous intracranial hypotension自发性低颅压7.3 Headache attributed to non-infectious inflammatory disease非感染性炎性疾病7.3.1 Headache attributed to neurosarcoidosis7.3.2 Headache attributed to aseptic （non-infectious） meningitis7.3.3 Headache attributed to other non-infectious inflammatory disease7.3.4 Headache attributed to