頭痛的國(guó)際分類（第三版）中文

1、 PAGE9 / NUMPAGES9 The international Classification of Headache disorders, 3rd Editon無(wú)先兆偏頭痛的診斷標(biāo)準(zhǔn)：A：符合B-D特征，至少發(fā)作5次發(fā)作B：頭痛（未經(jīng)治療）發(fā)作持續(xù)4-72小時(shí)C：至少有以下特征中的2項(xiàng) 單側(cè)性、搏動(dòng)性、中重度痛、日?；顒?dòng)會(huì)加重D：至少以下一項(xiàng)伴隨癥狀： 惡心和/或嘔吐、畏光和畏聲E：不能歸因于其他頭痛分類的國(guó)際標(biāo)準(zhǔn)(ICHD-III)概述：頭痛分為三大組：原發(fā)性頭痛；繼發(fā)性頭痛；腦神經(jīng)痛、中樞和原發(fā)性顏面痛及其他頭痛。每一種原發(fā)性頭痛均視為一種獨(dú)立的疾??；繼發(fā)性頭痛一般只是某種疾病的

2、一種癥狀，該頭痛稱為“緣于”此種疾病的頭痛。三大組頭痛共分為14類：一、原發(fā)性頭痛（the primary headaches）1.偏頭痛（Migraine）1.1 Migraine without aura無(wú)先兆偏頭痛1.2 Migraine with aura有先兆偏頭痛1.2.1 Migraine with typical aura先兆性偏頭痛的診斷標(biāo)準(zhǔn)：A：符合B-C特征，至少發(fā)作2次發(fā)作B：完全可逆以下癥狀的1項(xiàng)或多項(xiàng)視覺(jué)、感覺(jué)、語(yǔ)言障礙（典型先兆）肢體無(wú)力癥狀（偏癱型偏頭痛）腦干癥狀（基底型偏頭痛） 視網(wǎng)膜癥狀（視網(wǎng)膜型偏頭痛）C：至少有以下特征中的2項(xiàng)至少1個(gè)先兆逐漸發(fā)展的過(guò)程5

3、min，和/或不同先兆接連發(fā)生過(guò)程5min每個(gè)先兆癥狀持續(xù)時(shí)間5-60min至少一個(gè)先兆癥狀為單側(cè)性先兆發(fā)生同時(shí)或之后內(nèi)60min出現(xiàn)符合偏頭痛D：不能歸因于其他肢體無(wú)力癥狀可以持續(xù)至72h，部分患者肢體無(wú)力感可持續(xù)數(shù)周；若患者先兆持續(xù)1周以上，稱為無(wú)梗死的持續(xù)先兆一般先兆癥狀多為雙側(cè)，可持續(xù)數(shù)月或數(shù)年若先兆持續(xù)60min至1周以內(nèi)，則稱為propable migraine with aura若出現(xiàn)影像學(xué)梗死灶，則稱為偏頭痛性腦梗死 （年輕女性，后循環(huán)比較常見(jiàn)）1.2.1.1 Typical aura with headache1.2.1.2 Typical aura without head

4、ache1.2.2 Migraine with brainstem aura1.2.3 Hemiplegic migraine偏癱型偏頭痛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

5、migraine, other loci1.2.3.2 Sporadic hemiplegic migraine散發(fā)性1.2.4 Retinal migraine1.3 Chronic migraine慢性偏頭痛1.4 plications of migraine偏頭痛并發(fā)癥1.4.1 Status migrainosus偏頭痛持續(xù)狀態(tài)1.4.2 Persistent aura without infarction1.4.3 Migrainous infarction偏頭痛腦梗死1.4.4 Migraine aura-triggered seizure1.5 Probable migraine

6、很可能的偏頭痛1.5.1 Probable migraine without aura1.5.2 Probable migraine with aura1.6 Episodic syndromes that may be associated with migraine可能與偏頭痛有關(guān)的發(fā)作性綜合征慢性偏頭痛：偏頭痛發(fā)作每月15天，連續(xù)3個(gè)月以上偏頭痛持續(xù)狀態(tài)：?jiǎn)未伟l(fā)作持續(xù)72小時(shí)以上1.6.1 Recurrent gastrointestinal disturbance1.6.1.1Cyclical vomiting syndrome周期性嘔吐1.6.1.2 Abdominal migrai

7、ne腹型偏頭痛1.6.2 Benign paroxysmal vertigo良性發(fā)作性眩暈1.6.3 Benign paroxysmal torticollis良性發(fā)作性斜頸2.緊X型頭痛（Tension-type headache）每次發(fā)作持續(xù)30min-7d，慢性者可持續(xù)不緩解2.1 Infrequent episodic tension-type headache偶發(fā)性1d/月，至少10次以上（12d/年）2.1.1 Infrequent episodic tension-type headache associated with pericranial tenderness2.1.2I

8、nfrequent episodic tension-type headache not associated with pericranialtenderness2.2 Frequent episodic tension-type headache頻發(fā)性1d/月，但15d，至少發(fā)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 associa

9、ted with pericranial tenderness2.3 Chronic tension-type headache慢性緊X型頭痛每月發(fā)作15d，3個(gè)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叢集性頭痛的診斷標(biāo)準(zhǔn)：A：至少符合B-D的5次以上的發(fā)作B：?jiǎn)蝹?cè)、眼眶、上眼眶及/或顳部重度或極重度疼痛，如不治療持續(xù)15min

10、-180min；C：伴隨至少以上一項(xiàng)癥狀同側(cè)結(jié)膜充血/流淚同側(cè)鼻腔充血/流鼻水同側(cè)眼皮水腫同側(cè)前額及臉部出汗同側(cè)瞳孔縮小/眼瞼下垂不安的癥狀或躁動(dòng)D：發(fā)作頻率隔日1至8次/日E：除外其他疾患2.4 Probable tension-type headache很可能的緊X型頭痛2.4.1 Probable infrequent episodic tension-type headache2.4.2 Probable frequent episodic tension-type headache2.4.3 Probable chronic tension-type headache3.三叉自主神經(jīng)

11、性頭痛（Trigeminal autonomic cephalalgias）3.1 Cluster headache叢集性頭痛3.1.1 Episodic cluster headache發(fā)作性叢集性頭痛3.1.2 Chronic cluster headache慢性叢集性頭痛（復(fù)發(fā)作大于1年無(wú)緩解期，或緩解期3 months D：除外其他疾患慢性頭痛，起病急，可清晰回憶發(fā)病時(shí)間為哪一天疼痛缺乏特點(diǎn)，可以為偏頭痛，可以為緊X性，亦可兩者混合若患者符合慢性偏頭痛或慢性緊X型頭痛的標(biāo)準(zhǔn)，則不診斷NDPH若患者為藥物過(guò)度使用性頭痛，且符合NDPH的標(biāo)準(zhǔn)，則可兩者均可作為診斷4.6 External-

12、pressure headache4.6.1 External-pression headache4.6.2 External-traction headache4.6.3 Probable external-pressure headache4.6.3.1 Probable external-pression headache4.6.3.2 Probable external-traction headache4.7 Primary stabbing headache4.7.1 Probable primary stabbing headache4.8 Nummular headache4.

13、8.1 Probable nummular headache4.9 Hypnic headache4.9.1 Probable hypnic headache4.10 New daily persistent headache (NDPH) 新癥每日持續(xù)性頭痛4.10.1 Probable new daily persistent headach二、繼發(fā)性頭痛（the secondary headaches）5.緣于頭、頸部外傷的頭痛（Headache attributed to trauma or injury to the head and/or neck）5.1 Acute headac

14、he attributed to traumatic injury to the head5.1.1 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

15、 moderate or severe traumatic injury to the head5.2.2 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

16、.緣于頭頸部血管疾病的頭痛（Headache attributed to cranial or cervical 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

17、 to non-traumatic intracranial haemorrhage6.2.1 Headache attributed to non-traumatic intracerebral haemorrhage非外傷性腦出血6.2.2 Headache attributed to non-traumatic subarachnoid haemorrhage (SAH)6.2.3 Headache attributed to non-traumatic acute subdural haemorrhage (ASDH)急性硬膜下血腫6.3 Headache attributed to

18、unruptured vascular malformation未破裂的血管畸形6.3.1 Headache attributed to unruptured saccular aneurysm囊性動(dòng)脈瘤6.3.2 Headache attributed to arteriovenous malformation (AVM)動(dòng)靜脈畸形6.3.3 Headache attributed to dural arteriovenous fistula (DAVF)硬膜動(dòng)靜脈瘺6.3.4 Headache attributed to cavernous angioma海綿竇血管瘤6.3.5 Heada

19、che attributed to encephalotrigeminal or leptomeningeal angiomatosis (Sturge Weber syndrome) 腦三叉神經(jīng)或軟腦膜血管瘤病6.4 Headache attributed to arteritis6.4.1 Headache attributed to giant cell arteritis (GCA) 顳動(dòng)脈炎6.4.2 Headache attributed to primary angiitis of the central nervous system (PAS)6.4.3 Headache at

20、tributed to secondary angiitis of the central nervous system (SAS)顳動(dòng)脈炎診斷標(biāo)準(zhǔn)：美國(guó)風(fēng)濕學(xué)會(huì)1990年1. 50歲以上發(fā)?。?0歲以上發(fā)現(xiàn)癥狀2新發(fā)的頭痛：出現(xiàn)新發(fā)的局限性頭痛3顳動(dòng)脈異常：顳動(dòng)脈壓痛或者與頸動(dòng)脈的動(dòng)脈硬化無(wú)關(guān)的搏動(dòng)減弱4血沉值升高：50mm/h以上5動(dòng)脈活檢異常：?jiǎn)魏思?xì)胞為主的細(xì)胞浸潤(rùn)或者伴多核巨細(xì)胞的肉芽腫出現(xiàn)為特征的血管炎證據(jù)5項(xiàng)中如滿足3項(xiàng)以上，敏感度935。特異性912可能分類為顳動(dòng)脈炎。6.5 Headache attributed to cervical carotid or vertebral

21、 artery disorder頸動(dòng)脈或錐動(dòng)脈疼痛6.5.1 Headache or facial or neck pain attributed to cervical carotid or vertebral arterydissection動(dòng)脈夾層6.5.2 Post-endarterectomy headache內(nèi)膜剝脫術(shù)后頭痛6.5.3 Headache attributed to carotid or vertebral angioplasty頸動(dòng)脈血管成型術(shù)頭痛6.6 Headache attributed to cerebral venous thrombosis (CVT)腦

22、靜脈血栓形成6.7 Headache attributed to other 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

23、cerebral vasoconstrictionsyndrome (RCVS)6.7.4 Headache attributed to intracranial arterial dissection顱內(nèi)動(dòng)脈夾層6.8 Headache attributed to genetic vasculopathy6.8.1 Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts andLeukoencephalopathy (CADASIL)6.8.2 Mitochondrial Encephalopathy, Lacti

24、c Acidosis and Stroke-like episodes (MELAS)6.8.3 Headache attributed to another genetic vasculopathy6.9 Headache attributed to pituitary apoplexy垂體卒中7.緣于非血管性顱內(nèi)疾病的頭痛（Headache attributed to non-vascular intracranial disorder ）7.1 Headache attributed to increased cerebrospinal fluid pressure顱內(nèi)壓增高7.1.1

25、Headache attributed to idiopathic intracranial hypertension (IIH)7.1.2 Headache attributed to intracranial hypertension secondary to metabolic, toxic orhormonal causes7.1.3 Headache attributed to intracranial hypertension secondary to hydrocephalus7.2 Headache attributed to low cerebrospinal fluid p

26、ressure顱內(nèi)壓低下7.2.1 Post-dural puncture headache腰穿后7.2.2 CSF fistula headache腦脊液漏7.2.3 Headache attributed to spontaneous intracranial hypotension自發(fā)性低顱壓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 asepti

27、c (non-infectious) meningitis7.3.3 Headache attributed to other non-infectious inflammatory disease7.3.4 Headache attributed to lymphocytic hypophysitis7.3.5 Syndrome of transient Headache and Neurological Deficits with cerebrospinal fluidLymphocytosis (HaNDL)7.4 Headache attributed to intracranial

28、neoplasia顱內(nèi)新生物7.4.1 Headache attributed to intracranial neoplasm7.4.1.1 Headache attributed to colloid cyst of the third ventricle7.4.2 Headache attributed to carcinomatous meningitis癌性腦膜炎7.4.3 Headache attributed to hypothalamic or pituitary hyper- or hyposecretion7.5 Headache attributed to intrath

29、ecal injection鞘內(nèi)注射7.6 Headache attributed to epileptic seizure7.6.1 Hemicrania epileptica癲癇半顱痛7.6.2 Post-ictal headache癲癇發(fā)作后頭痛7.7 Headache attributed to Chiari malformation type I (CM1)7.8 Headache attributed to other non-vascular intracranial disorder8.緣于物質(zhì)或物質(zhì)戒斷的頭痛（Headache attributed to a substanc

30、e or its withdrawal）8.1 Headache attributed to use of or exposure to a substanceor its withdrawal緣于某種物質(zhì)的應(yīng)用或戒斷8.1.1 Nitric oxide (NO) donor-induced headache一 HYPERLINK drugs.dxy./drug/86999.htm o 查看 t _blank 氧化氮誘發(fā)8.1.1.1 Immediate NO donor-induced headache8.1.1.2 Delayed NO donor-induced headache8.1.

31、2 Phosphodiesterase (PDE) inhibitor-induced headache磷酸二酯酶抑制劑8.1.3 Carbon monoxide (CO)-induced headache一氧化碳誘發(fā)8.1.4 Alcohol-induced headache酒精誘發(fā)8.1.4.1 Immediate alcohol-induced headache8.1.4.2 Delayed alcohol-induced headache8.1.5 Headache induced by food and/or additive由于食物成分/添加劑誘發(fā)8.1.5.1 Monosodiu

32、m glutamate (MSG)-induced headache谷氨酸單鈉鹽（味精）8.1.6 Cocaine-induced headache可卡因誘發(fā)8.1.7 Histamine-induced headache組織胺誘發(fā)8.1.7.1 Immediate histamine-induced headache8.1.7.2 Delayed histamine-induced headache8.1.8 Calcitonin gene-related peptide (CGRP)-induced headache降鈣素基因相關(guān)多肽誘發(fā)8.1.8.1 Immediate CGRP-ind

33、uced headache8.1.8.2 Delayed CGRP-induced headache8.1.9 Headache attributed to exogenous acute pressor agent8.1.10 Headache attributed to occasional use of non-headache medication8.1.11 Headache attributed to long-term use of non-headache medication8.1.12 Headache attributed to exogenous hormone8.1.

34、13 Headache attributed to use of or exposure to other substance8.2 Medication-overuse headache (MOH) 藥物過(guò)度使用性頭痛MOH診斷標(biāo)準(zhǔn)符合3-4項(xiàng)的頭痛表現(xiàn)15天規(guī)律使用1種或多種用于頭痛急性期的止痛藥超過(guò)3個(gè)月在藥物過(guò)度使用期間，頭痛進(jìn)展或明顯加重停用所用過(guò)度使用藥物之后的2個(gè)月內(nèi)，頭痛必需改善（緩解或重歸于之前的頭痛模式MOH頭痛表現(xiàn)多樣，常有特征轉(zhuǎn)換的獨(dú)特模式過(guò)度是指規(guī)律且頻繁，即每周2天或以上最常見(jiàn)的藥物：對(duì)乙酰氨基酚曲坦類巴比妥類阿片類，此外阿司匹林、麥角類、鎮(zhèn)痛藥及復(fù)方制劑均可引起M

35、OH8.2.1 Ergotamine-overuse headache麥角胺類8.2.2 Triptan-overuse headache曲普坦類8.2.3 Simple analgesic-overuse headache單純止痛藥類8.2.3.1 Paracetamol (acetaminophen)-overuse headache對(duì)乙酰氨基酚8.2.3.2 Acetylsalicylic acid-overuse headache乙酰水楊酸/阿司匹林8.2.3.3 Other non-steroidal anti-inflammatory drug (NSAID)-overuse he

36、adache8.2.4 Opioid-overuse headache鴉片類8.2.5 bination-analgesic-overuse headache復(fù)合制劑過(guò)度應(yīng)用8.2.6 Medication-overuse headache attributed to multiple drug classes not individuallyoverused聯(lián)合用藥所致8.2.7 Medication-overuse headache attributed to unverified overuse of multiple drug classes8.2.8 Medication-overu

37、se headache attributed to other medication8.3 Headache attributed to substance withdrawal物質(zhì)戒斷8.3.1 Caffeine-withdrawal headache咖啡因8.3.2 Opioid-withdrawal headache鴉片類8.3.3 Oestrogen-withdrawal headache雌激素8.3.4 Headache attributed to withdrawal from chronic use of other substance9.緣于感染的頭痛（Headache att

38、ributed to infection）9.1 Headache attributed to intracranial infection顱內(nèi)感染9.1.1 Headache attributed to bacterial meningitis or meningoencephalitis細(xì)菌性腦膜炎/腦膜腦炎9.1.1.1 Acute headache attributed to bacterial meningitis or meningoencephalitis9.1.1.2 Chronic headache attributed to bacterial meningitis or

39、meningoencephalitis9.1.1.3 Persistent headache attributed to past bacterial meningitis or meningoencephalitis9.1.2 Headache attributed to viral meningitis or encephalitis病毒性腦膜炎或腦炎9.1.2.1 Headache attributed to viral meningitis9.1.2.2 Headache attributed to viral encephalitis9.1.3 Headache attributed

40、 to intracranial fungal or other parasitic infection真菌或寄生蟲(chóng)感染9.1.3.1 Acute headache attributed to intracranial fungal or other parasitic infection9.1.3.2 Chronic headache attributed to intracranial fungal or other parasitic infection9.1.4 Headache attributed to brain abscess腦膿腫9.1.5 Headache attribut

41、ed to subdural empyema硬膜下積膿9.2 Headache attributed to systemic infection系統(tǒng)感染9.2.1 Headache attributed to systemic bacterial infection系統(tǒng)細(xì)菌感染9.2.1.1 Acute headache attributed to systemic bacterial infection9.2.1.2 Chronic headache attributed to systemic bacterial infection9.2.2 Headache attributed to

42、systemic viral infection系統(tǒng)病毒感染9.2.2.1 Acute headache attributed to systemic viral infection9.2.2.2 Chronic headache attributed to systemic viral infection9.2.3 Headache attributed to other systemic infection其他系統(tǒng)感染9.2.3.1 Acute headache attributed to other systemic infection9.2.3.2 Chronic headache a

43、ttributed to other systemic infection10.緣于內(nèi)環(huán)境紊亂的頭痛（Headache attributed to disorder of homoeostasis）10.1 Headache attributed to hypoxia and/or hypercapnia缺氧和/或高碳酸血癥10.1.1 High-altitude headache高海拔頭痛10.1.2 Headache attributed to aeroplane travel飛行頭痛10.1.3 Diving headache潛水頭痛10.1.4 Sleep apnoea headach

44、e睡眠呼吸暫停性頭痛10.2 Dialysis headache10.3 Headache attributed to arterial hypertension高血壓性頭痛10.3.1 Headache attributed to phaeochromocytoma嗜絡(luò)細(xì)胞瘤10.3.2 Headache attributed to hypertensive crisis without hypertensive encephalopathy無(wú)高血壓腦病的高血壓危象10.3.3 Headache attributed to hypertensive encephalopathy高血壓腦病10

45、.3.4 Headache attributed to pre-eclampsia or eclampsia先兆子癇10.3.5 Headache attributed to autonomic dysreflexia自主反射障礙10.4 Headache attributed to hypothyroidism甲狀腺低下10.5 Headache attributed to fasting禁食10.6 Cardiac cephalalgia心源性頭痛10.7 Headache attributed to other disorder of homoeostasis其他內(nèi)環(huán)境穩(wěn)定失調(diào)疾患11.

46、緣于頭、頸、眼、耳、鼻、鼻竇、牙、口或其他頭面部結(jié)構(gòu)病變的頭面痛（Headache or facial pain attributed to disorder of the cranium, neck,eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure ）11.1 Headache attributed to disorder of cranial bone顱骨11.2 Headache attributed to disorder of the neck 頸部11.2.1 Cervicog

47、enic headache11.2.2 Headache attributed to retropharyngeal tendonitis11.2.3 Headache attributed to craniocervical dystonia11.3 Headache attributed to disorder of the eyes眼睛11.3.1 Headache attributed to acute glaua急性青光眼11.3.2 Headache attributed to refractive error屈光不正11.3.3 Headache attributed to he

48、terophoria or heterotropia (latent or persistent squint)斜視11.3.4 Headache attributed to ocular inflammatory disorder11.3.5 Headache attributed to trochleitis11.4 Headache attributed to disorder of the ears耳朵11.5 Headache attributed to disorder of the nose or paranasal sinuses鼻子或鼻竇11.5.1 Headache att

49、ributed to acute rhinosinusitis急性鼻竇炎11.5.2 Headache attributed to chronic or recurring rhinosinusitis11.6 Headache attributed to disorder of the teeth or jaw11.7 Headache attributed to temporomandibular disorder (TMD)11.8 Head or facial pain attributed to inflammation of the stylohyoid ligament11.9 Headache or facial pain attributed to other disorder of cranium, neck, eyes, ears, nose,sinuses, teeth, mouth or other facial or cervical structure12.緣于精神疾病的頭痛（Headache attributed to psychiatric disorder）12.1 Headache attributed to somatization disorder軀體化障礙12.2 Headache attribut