Migraine偏头痛中英双语版1课件

migraine

偏头痛

ChongqingUniversityofMedicalSciencemigraine

偏头1

Migraineismanifestedbyheadachethatisarecurrence,usuallyunilateralandfrequently

pulsatile

inquality

搏动性;itisoftenassociatedwithnausea,vomiting,photophobia畏光,phonophobia惧声andlassitude乏力.Visualorotherneurologicauras神经学先兆

occurinabout10%ofpatients.

Theonsetisearlyinlifeapproximately25%beginningduringthefirstdecade,55%by20yearsofage,morethan90%beforeage40.

Migraineismanifestedby2A.Causeandpathogenesis

Therealcausesandthe

pathogenesisandpathophysiologiccourse

ofmigraineisunknown.

1.Certainfoods:

tyramine酪胺-containingcheeses,meat,suchashotdogsorbacon,withnitrite亚硝酸preservatives,chocolatecontainingbutnotchocolatealone.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.A.Causeandpathogenesis3

2.Genetics:About60%patientsofmigrainehave

families.Threegeneticlociforfamilialhemiplegic

migraine（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.

2.Genetics:About60%p4

4.vasomotorandautonomic

血管运动和自律神经

Intracranialvasoconstrictionandextracranialvasodilatationhavelongbeenheldtobetherespectivecausesoftheauraandheadachephasesofmigraine.ButthestudyofCBF脑血流

can’tconfirm.5.spreadingdepression扩布性抑制

MorerecentstudiesofrCBF局部脑血流

duringmigraineattackshavedemonstratedareductioninregionalflow,whichbeginsintheoccipitalregionandthentowardswith1cm/svelocity

duringtheauraphase.

4.vasomotorandautono5Migraine偏头痛中英双语版1课件6

6.Neurotransmitter（神经递质）

Serotonin血清素

inplateletsdecreases

andurinaryserotoninincreasesduringtheacutephaseofamigraineattack.Depletionofserotoninbyreserpine利血平mayprecipitatemigraineanddecreasedbyserotoninantagonists(sumatriptan,英明格)6.Neurotransmitter（7B.Theclassificationofmigraine

1.classicmigraine

（典型偏头痛）

2.common

migraine

（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.

basilarartery

M.

（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）:

B.Theclassificationofmigr8

C.Clinicfigures

临床表现

1.MigrainewithAura

(Classicmigraine典型偏头痛)

1)

Auras（先兆）:

visualalteration,particularlyhemianopic

(偏盲)

fielddefects

(视野缺损）andscotomas（黑朦),

hemiparansthesia

(半身麻木)。

2)Headache:

50%ofpatientsexperiencenomorethanonceattackperweek,thedurationofepisodesisgreaterthan2hoursandlessthan1dayinmostpatients.Usuallyunilateralandfrequentlypulsatile

inquality;Althoughhemicranialpainisahallmark标志

ofclassicmigraine,headachecanalsobebifrontal双前额,lesscommonlylocalizedtotheoccipitalorvertex头顶

oftheSkull.

9

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

thataccompanyorpersistbeyondresolutionofthepainphase.ThoseMayincludehemiparesis,hemisensoryloss偏身感觉丧失,speech

dysfunction语言功能障碍,or

visualdisturbance视觉紊乱.Samepatientshavevertigo眩晕,ataxia共济失调,oralteredconsciousness意识.3)companysymptoms伴随症状10

2.MigrainewithoutAura

(commonmig.)a.Thisisthemostfrequenttypeofmigraine(over80%).Thesymptomsandsignsaresimilaritytheclassicmigraine,butlackstheaura.

b.Headache：

bilateral(orunilateral),periorbital

achingorthrobbinginquality；longertimes;oftenoccursonweekendandholidays。

Anusefulbedsidetestforbothcommonandclassicmigraineisreducingheadacheseveritybycompressingtheipsilateralcarotidorsuperficialtemporalartery.2.MigrainewithoutAur11

3.specialtype:

a.ophthalmoplegicM.

（眼肌麻痹型偏头痛）

Duringor

aftermigraineattackoccur

ocularnerveparalysis,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:fielddefects

andscotomas,

ataxia,vertigo,tinnitus耳鸣，diplopia复视，nystagmus眼震，dysarthria构音障碍，bilaterallimbsnumbandweak,impairmentofrecognizeandconsciousness,andnausea,vomiting,ets.3.specialtype:12

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,benignparoxysmalvertigo良性发作性眩晕,cyclicedema,andsoon.

episodic,recurrence,excludedfromothersystemicdiseasesbyhistoryandexaminations.

13D.Diagnosisofmigraine

AccordingtotheInternationalassociateofheadacherecomm-endedaprogrammein1988,thediagnosisofmigrainewillbeinkeepingwithbelowcriterion.

D.Diagnosisofmigraine14a.Migrainewithaura1.Have2subjectsofbelow,breakout2atleast;2.Havebelowcharacteristicatleast3subjects:

1)Morethan1timeauraoffunctionaldisturbanceinfocalcortexorbrainstem2)Anauraatleastgradualdevelopmentandpersistmorethan4min.,orhave2auras；

3）Theaurapersistslessthan60min.;4)Thereisnotanintervaltimebetweentheauraandheadache;

3.

Haveoneofbelowatleast：

1)Noevidenceoforganicdiseasesbyhistoryandexamination；

2）Apossibleoforganicdiseasesbyhistoryandexamination,butwasdenybytest；

3）Althoughhavesomeorganicdiseases,butthe1stmigraineattackhavenotrelationwithit.

a.Migrainewithaura1.Have15

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。典型（有先兆）偏头痛诊断标准16

b.Migrainewithoutaura

1.Have2-4subjectsofbelow,breakoutmorethan

5timesatleast

;2.

Ifnottreat,itcontinues4-72h.aseizure,;3.Havebelowcharacteristicatleast2subjects:1)unilateral;2)pulsatile(throbbing)

；

3)middle-seriousdegree,dailylifelimited;4)Headacheseriousafteract

；

4.Haveoneofbelow:1)nausea&vomiting;2)photophobia,phonophobia；

5.Withoutotherknownsimilardiseases,andexcludeotherdiseasesofthebody.b.Migrainewithouta17

普通型（无先兆）偏头痛诊断标准

1.符合下述2-4项,发作至少5次以上;2.如果不治疗,每次发作持续4-72小时;3.有以下特征至少两项:1)单侧型;2)搏动型；3)中-重度头痛,日常活动受限;4)活动后头痛加重；

4.发作期间有下列之一:1)恶心和呕吐;2)畏光和惧声；

5.无其他已知的类似疾病:病史和躯体的其他方面正常。Migraine偏头痛中英双语版1课件18

C.Differencediagnosis:

1.clusterheadache(丛集性头痛）

2.tension-typeheadache(TTH,紧张型头痛）

3.othervascularpain（其他血管性头痛）

4.Painfulophthalmoplegia（痛性眼肌麻痹）

5.carotidynia（颈动脉痛）C.Differencediagnosis19

1)Clusterheadache

(丛集性头痛）

men>women;(4～5：1）

20-50yr.;recurrent;severalormanytimesdailyforseveraldaysorweekes;Prodromes先兆

areuncommon,Ictal发作

andstopsuddenly;periorbitalstrongpainwithcongestionoftheconjunctivae,lacrimation流泪,occasionalptosis上睑下垂

oftheeyelidsandsweating;1)Clusterheadache(丛集性头20Migraine偏头痛中英双语版1课件21

2）Tension-typeheadache

紧张型头痛

Tension-typeheadacheisachronicdisorderthatmostpatientsbeginsafterage20.Frequent(oftendaily)attacks,nonthrobb-ing,bilateralocciptalorfront,evenallheadpain,Sometimeslikenedtoa

press,tightbandaroundthehead,ictal

orpersistmonthsoryears.

Notassociatedwithnausea,vomiting,orprodromalvisualdisturbance.

Manypatientshavesleepdisorders(insomnia失眠,

alotofdreams多梦

),anxious,depressionandnervous神经质.

2）Tension-typeheadache22Migraine偏头痛中英双语版1课件23Migraine偏头痛中英双语版1课件24

E.Treatment

偏头痛的治疗

Theaimoftreatmentisstoppingandcontrollingheadachequickly.

keepquietandstatedarkenroom.1.

Acutetreatment

发作期治疗mild-middledegree:Itmayrespondtosimpleanalgesics止痛药.Acetaminophen(乙酰氨基酚):0.5-1.0g,PO;

Aspirin(阿司匹林):0.6-1.0g,PO;

Naproxen(萘普生):0.5-0.75mg,PO

Indomethacin(吲哚美辛)：25mgPo,tid

Flunarizine

(氟桂利嗪,Sibelium西比灵）:

5-10mg,qnE.T25Seriouslyill(inseverecaseswithvomiting,nauseafrequently)subcutaneous,nosal,intravenousorintramuscularisusedfordrugs.Dihydroergotaminemesylate(酒石酸二氢麦角胺):

0.25-1.0mg,im.oriv.

Ergotamine（麦角胺):0.6-1.0mg，takeorally

or

2mgsublingualorbyrectaSumatriptam(英明格):25-50mg,takeorally(the5-HTagonist)

or

6mgsubcutaneousinjectionPethidine(哌替啶):50-150mg,im.Chlorpromazine(氯丙嗪):10mg,intravenousinjectionCodeine(可待因):

15-60mg,PO

Whengivingthedrugsyouhavetotelltheclinicalsideeffectsforpatient.Seriouslyill(inseverecase262.

Prophylactictreatment

预防性治疗

PTisindicatedforpatientswhohavefrequentattacks–especiallymorethanonceaweek,ets.Propranolol(普萘洛尔（心得安）:-receptorblocker

10－40mg,bid-qid/d；Flunarizine(氟桂利嗪;Sibelium西比灵,nicardepine

尼卡的平）:Calciumchannelantagonists5-10mg,qnCyproheptadine(赛庚啶):

0.5-4mg,bid-qid/d;

Valproate(丙戊酸):

0.2g,tid/d；Fluoxetine(氟西汀)Topiramate（托吡酯）Naproxen（萘普生）Pizptifen(苯噻啶)：0.5-3mg/d2.Prophylactictreatment27提问与解答环节QuestionsAndAnswers提问与解答环节28谢谢聆听·学习就是为了达到一定目的而努力去干,是为一个目标去战胜各种困难的过程,这个过程会充满压力、痛苦和挫折LearningIsToAchieveACertainGoalAndWorkHard,IsAProcessToOvercomeVariousDifficultiesForAGoal谢谢聆听LearningIsToAchieveAC29migraine

偏头痛

ChongqingUniversityofMedicalSciencemigraine

偏头30

Migraineismanifestedbyheadachethatisarecurrence,usuallyunilateralandfrequently

pulsatile

inquality

搏动性;itisoftenassociatedwithnausea,vomiting,photophobia畏光,phonophobia惧声andlassitude乏力.Visualorotherneurologicauras神经学先兆

occurinabout10%ofpatients.

Theonsetisearlyinlifeapproximately25%beginningduringthefirstdecade,55%by20yearsofage,morethan90%beforeage40.

Migraineismanifestedby31A.Causeandpathogenesis

Therealcausesandthe

pathogenesisandpathophysiologiccourse

ofmigraineisunknown.

1.Certainfoods:

tyramine酪胺-containingcheeses,meat,suchashotdogsorbacon,withnitrite亚硝酸preservatives,chocolatecontainingbutnotchocolatealone.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.A.Causeandpathogenesis32

2.Genetics:About60%patientsofmigrainehave

families.Threegeneticlociforfamilialhemiplegic

migraine（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.

2.Genetics:About60%p33

4.vasomotorandautonomic

血管运动和自律神经

Intracranialvasoconstrictionandextracranialvasodilatationhavelongbeenheldtobetherespectivecausesoftheauraandheadachephasesofmigraine.ButthestudyofCBF脑血流

can’tconfirm.5.spreadingdepression扩布性抑制

MorerecentstudiesofrCBF局部脑血流

duringmigraineattackshavedemonstratedareductioninregionalflow,whichbeginsintheoccipitalregionandthentowardswith1cm/svelocity

duringtheauraphase.

4.vasomotorandautono34Migraine偏头痛中英双语版1课件35

6.Neurotransmitter（神经递质）

Serotonin血清素

inplateletsdecreases

andurinaryserotoninincreasesduringtheacutephaseofamigraineattack.Depletionofserotoninbyreserpine利血平mayprecipitatemigraineanddecreasedbyserotoninantagonists(sumatriptan,英明格)6.Neurotransmitter（36B.Theclassificationofmigraine

1.classicmigraine

（典型偏头痛）

2.common

migraine

（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.

basilarartery

M.

（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）:

B.Theclassificationofmigr37

C.Clinicfigures

临床表现

1.MigrainewithAura

(Classicmigraine典型偏头痛)

1)

Auras（先兆）:

visualalteration,particularlyhemianopic

(偏盲)

fielddefects

(视野缺损）andscotomas（黑朦),

hemiparansthesia

(半身麻木)。

2)Headache:

50%ofpatientsexperiencenomorethanonceattackperweek,thedurationofepisodesisgreaterthan2hoursandlessthan1dayinmostpatients.Usuallyunilateralandfrequentlypulsatile

inquality;Althoughhemicranialpainisahallmark标志

ofclassicmigraine,headachecanalsobebifrontal双前额,lesscommonlylocalizedtotheoccipitalorvertex头顶

oftheSkull.

38

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

thataccompanyorpersistbeyondresolutionofthepainphase.ThoseMayincludehemiparesis,hemisensoryloss偏身感觉丧失,speech

dysfunction语言功能障碍,or

visualdisturbance视觉紊乱.Samepatientshavevertigo眩晕,ataxia共济失调,oralteredconsciousness意识.3)companysymptoms伴随症状39

2.MigrainewithoutAura

(commonmig.)a.Thisisthemostfrequenttypeofmigraine(over80%).Thesymptomsandsignsaresimilaritytheclassicmigraine,butlackstheaura.

b.Headache：

bilateral(orunilateral),periorbital

achingorthrobbinginquality；longertimes;oftenoccursonweekendandholidays。

Anusefulbedsidetestforbothcommonandclassicmigraineisreducingheadacheseveritybycompressingtheipsilateralcarotidorsuperficialtemporalartery.2.MigrainewithoutAur40

3.specialtype:

a.ophthalmoplegicM.

（眼肌麻痹型偏头痛）

Duringor

aftermigraineattackoccur

ocularnerveparalysis,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:fielddefects

andscotomas,

ataxia,vertigo,tinnitus耳鸣，diplopia复视，nystagmus眼震，dysarthria构音障碍，bilaterallimbsnumbandweak,impairmentofrecognizeandconsciousness,andnausea,vomiting,ets.3.specialtype:41

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,benignparoxysmalvertigo良性发作性眩晕,cyclicedema,andsoon.

episodic,recurrence,excludedfromothersystemicdiseasesbyhistoryandexaminations.

42D.Diagnosisofmigraine

AccordingtotheInternationalassociateofheadacherecomm-endedaprogrammein1988,thediagnosisofmigrainewillbeinkeepingwithbelowcriterion.

D.Diagnosisofmigraine43a.Migrainewithaura1.Have2subjectsofbelow,breakout2atleast;2.Havebelowcharacteristicatleast3subjects:

1)Morethan1timeauraoffunctionaldisturbanceinfocalcortexorbrainstem2)Anauraatleastgradualdevelopmentandpersistmorethan4min.,orhave2auras；

3）Theaurapersistslessthan60min.;4)Thereisnotanintervaltimebetweentheauraandheadache;

3.

Haveoneofbelowatleast：

1)Noevidenceoforganicdiseasesbyhistoryandexamination；

2）Apossibleoforganicdiseasesbyhistoryandexamination,butwasdenybytest；

3）Althoughhavesomeorganicdiseases,butthe1stmigraineattackhavenotrelationwithit.

a.Migrainewithaura1.Have44

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。典型（有先兆）偏头痛诊断标准45

b.Migrainewithoutaura

1.Have2-4subjectsofbelow,breakoutmorethan

5timesatleast

;2.

Ifnottreat,itcontinues4-72h.aseizure,;3.Havebelowcharacteristicatleast2subjects:1)unilateral;2)pulsatile(throbbing)

；

3)middle-seriousdegree,dailylifelimited;4)Headacheseriousafteract

；

4.Haveoneofbelow:1)nausea&vomiting;2)photophobia,phonophobia；

5.Withoutotherknownsimilardiseases,andexcludeotherdiseasesofthebody.b.Migrainewithouta46

普通型（无先兆）偏头痛诊断标准

1.符合下述2-4项,发作至少5次以上;2.如果不治疗,每次发作持续4-72小时;3.有以下特征至少两项:1)单侧型;2)搏动型；3)中-重度头痛,日常活动受限;4)活动后头痛加重；

4.发作期间有下列之一:1)恶心和呕吐;2)畏光和惧声；

5.无其他已知的类似疾病:病史和躯体的其他方面正常。Migraine偏头痛中英双语版1课件47

C.Differencediagnosis:

1.clusterheadache(丛集性头痛）

2.tension-typeheadache(TTH,紧张型头痛）

3.othervascularpain（其他血管性头痛）

4.Painfulophthalmoplegia（痛性眼肌麻痹）

5.carotidynia（颈动脉痛）C.Differencediagnosis48

1)Clusterheadache

(丛集性头痛）

men>women;(4～5：1）

20-50yr.;recurrent;severalormanytimesdailyforseveraldaysorweekes;Prodromes先兆

areuncommon,Ictal发作

andstopsuddenly;periorbitalstrongpainwithcongestionoftheconjunctivae,lacrimation流泪,occasionalptosis上睑下垂

oftheeyelidsandsweating;1)Clusterheadache(丛集性头49Migraine偏头痛中英双语版1课件50

2）Tension-typeheadache

紧张型头痛

Tension-typeheadacheisachronicdisorderthatmostpatientsbeginsafterage20.Frequent(oftendaily)attacks,nonthrobb-ing,bilateralocciptalorfront,evenallheadpain,Sometimeslikenedtoa

press,tightbandaroundthehead,ictal

orpersistmonthsoryears.

Notassociatedwithnausea,vomiting,orprodromalvisualdisturbance.