头痛的国际分类(第三版)中文

#TheinternationalClassificationofHeadachedisorders,3rdEditon头痛分类的国际标准QCHD-II!）概述：头痛分为三大组：原发性头痛；继发性头痛；脑神经痛、中枢和原发性颜面痛及其他头痛。每一种原发性头痛均视为一种独立的疾病；继发性头痛一般只是某种疾病的一种症状，该头痛称为“缘于"此种疾病的头痛。三大组头痛共分为14类：_、原发性头痛(theprimaryheadaches)1•偏头痛(Migraine)Migrainewithoutaura无先兆偏头痛Migrainewithaura有先兆偏头痛MigrainewithtypicalauraTypicalaurawithheadache|_TypicalaurawithoutheadacheMigrainewithbrainstemauraHemiplegicmigraine偏瘫型偏头痛1.2.3.1Familialhemiplegicmigraine(FHM)—家族性1.2.3.1.1Familialhemiplegicmigrainetype1(FHM1无先兆偏头痛的诊断标准：A：符合B-D特征，至少发作5次发作B：头痛（未经治疗）发作持续4-72小时C：至少有以下特征中的2项单侧性、搏动性、中重度痛、日常活动会加重D：至少以下一项伴随症状：恶心和/或呕吐、畏光和畏声E：不能归因于其他先兆性偏头痛的诊断标准：A：符合B-C特征，至少发作2次发作B：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）1.2.3.1.2Familialhemiplegicmigrainetype2（FHM2）视网膜症状（视网膜型偏头痛）C：至少有以下特征中的2项✓Familialhemiplegicmigrainetype3(FHM3Familialhemiplegicmigraine,otherloci1.2.3.2Sporadichemiplegicmigraine—散发性1.2.4RetinalmigraineChronicmigraine慢性偏头痛Complicationsofmigraine偏头痛并发症Statusmigrainosus偏头痛持续状态PersistentaurawithoutinfarctionMigrainousinfarction偏头痛脑梗死Migraineaura-triggeredseizureProbablemigraine很可能的偏头痛ProbablemigrainewithoutauraProbablemigrainewithaura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至少一个先兆症状为单侧性先兆发生同时或之后内60min出现符合偏头痛D：不能归因于其他丄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；丄若患者先兆持续1周以上，称为无梗死的持续先兆一般先兆症状多为双侧，可持续数月或数年丄若先兆持续60min至1周以内，则称为propablemigrainewithaura丄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）1.6Episodicsyndromesthatmaybeassociatedwithmigraine可能与偏头痛有关的发作性综合征Recurrentgastrointestinaldisturbance1.6.1.1Cyclicalvomitingsyndrome周期性呕吐Abdominalmigraine腹型偏头痛Benignparoxysmalvertigo良性发作性眩晕Benignparoxysmaltorticollis良性发作性斜颈

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2•紧张型头痛（Tension-typeheadache）每次发作持续30min-7d，慢性者可持续不缓解2.1Infrequentepisodictension-typeheadache偶发性<1d/月，至少10次以上(<12d/年)Infrequentepisodictension-typeheadacheassociatedwithpericranialtenderness

Infrequentepisodictension-typeheadachenotassociatedwithpericranialtendernessFrequentepisodictension-typeheadache频发性＞1d/月，但＜15d,至少发作10次以上(＞12d/年但＜180d)Frequentepisodictension-typeheadacheassociatedwithpericranialtendernessFrequentepisodictension-typeheadachenotassociatedwithpericranialtendernessChronictension-typeheadache慢性紧张型头痛每月发作＞15d,3个月以上Chronictension-typeheadacheassociatedwithpericranialtendernessChronictension-typeheadachenotassociatedwithpericranialtenderness丛集性头痛的诊断标准：A：至少符合B-D的5丛集性头痛的诊断标准：A：至少符合B-D的5次以上的发作B：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；C：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额及脸部出汗同侧瞳孔缩小/眼睑下垂不安的症状或躁动D：发作频率隔日1至8次/日E：除外其他疾患Probableinfrequentepisodictension-typeheadacheProbablefrequentepisodictension-typeheadacheProbablechronictension-typeheadache3.三叉自主神经性头痛(Trigeminalautonomiccephalalgias)Clusterheadache丛集性头痛Episodicclusterheadache发作性丛集性头痛Chronicclusterheadache慢性丛集性头痛(复发作大于1年无缓解期，或缓解期＜1个月)ParoxysmalhemicraniaEpisodicparoxysmalhemicraniaChronicparoxysmalhemicraniaShort-lastingunilateralneuralgiformheadacheattacksShort-lastingunilateralneuralgiformheadacheattackswithconjunctivalinjectionandtearing(SUNCT)EpisodicSUNCTChronicSUNCTShort-lastingunilateralneuralgiformheadacheattackswithcranialautonomicsymptoms(SUNA)EpisodicSUNAChronicSUNAHemicraniacontinuaProbabletrigeminalautonomiccephalalgiaProbableclusterheadacheProbableparoxysmalhemicraniaProbableshort-lastingunilateralneuralgiformheadacheattacksProbablehemicraniacontinua4•其它的原发性头痛Otherprimaryheadachedisorders)Primarycoughheadache原发性咳嗽头痛ProbableprimarycoughheadachePrimaryexerciseheadache原发性运动性头痛ProbableprimaryexerciseheadachePrimaryheadacheassociatedwithsexualactivity原发性性活动伴随的头痛ProbableprimaryheadacheassociatedwithsexualactivityPrimarythunderclapheadache原发性霹雳头痛

Cold-stimulusheadache冷刺激性头痛HeadacheattributedtoexternalapplicationofacoldstimulusHeadacheattributedtoingestionorinhalationofacoldstimulusProbablecold-stimulusheadacheHeadacheprobablyattributedtoexternalapplicationofacoldstimulusHeadacheprobablyattributedtoingestionorinhalationofacoldstimulusExternal-pressureheadacheExternal-compressionheadacheExternal-pressureheadacheExternal-compressionheadacheExternal-tractionheadacheProbableexternal-pressureheadacheProbableexternal-compressionheadacheProbableexternal-tractionheadachePrimarystabbingheadacheProbableprimarystabbingheadacheNummularheadacheProbablenummularheadacheHypnicheadacheProbablehypnicheadacheNDPH诊断标准：A：持续性头痛，符合B-C的标准B：Distinctandclearlyrememberedonset,withpainbecomingcontinuousandunremittingwithin24hoursC：Presentfor>3monthsD：除外其他疾患慢性头痛，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Newdailypersistentheadache(NDPH)新症每日持续性头痛Probablenewdailypersistentheadach二、继发性头痛(thesecondaryheadaches)缘于头、颈部外伤的头痛(Headacheattributedtotraumaorinjurytotheheadand/orneck)AcuteheadacheattributedtotraumaticinjurytotheheadAcuteheadacheattributedtomoderateorseveretraumaticinjurytotheheadAcuteheadacheattributedtomildtraumaticinjurytotheheadPersistentheadacheattributedtotraumaticinjurytotheheadPersistentheadacheattributedtomoderateorseveretraumaticinjurytotheheadPersistentheadacheattributedtomildtraumaticinjurytotheheadAcuteheadacheattributedtowhiplashPersistentheadacheattributedtowhiplashAcuteheadacheattributedtocraniotomyPersistentheadacheattributedtocraniotomy缘于头颈部血管疾病的头痛(Headacheattributedtocranialorcervicalvasculardisorder)HeadacheattributedtoischaemicstrokeortransientischaemicattackHeadacheattributedtoischaemicstroke(cerebralinfarction)Headacheattributedtotransientischaemicattack(TIA)Headacheattributedtonon-traumaticintracranialhaemorrhageHeadacheattributedtonon-traumaticintracerebralhaemorrhage非外伤性脑出血Headacheattributedtonon-traumaticsubarachnoidhaemorrhage(SAH)Headacheattributedtonon-traumaticacutesubduralhaemorrhage(ASDH)急性硬膜下血月肿

Headacheattributedtounrupturedvascularmalformation未破裂的血管畸形Headacheattributedtounrupturedsaccularaneurysm囊性动脉瘤Headacheattributedtoarteriovenousmalformation(AVM)动静脉畸形Headacheattributedtoduralarteriovenousfistula(DAVF)硬膜动静脉痿Headacheattributedtocavernousangioma海纟帛窦血管瘤Headacheattributedtoencephalotrigeminalorleptomeningealangiomatosis(SturgeWebersyndrome)脑三叉神经或软脑膜血管瘤病HeadacheattributedtoarteritisHeadacheattributedtogiantcellarteritis(GCA)颞动脉炎Headacheattributedtoprimaryangiitisofthecentralnervoussystem(PACNS)Headacheattributedtosecondaryangiitisofthecentralnervoussystem(SACNS)颞动脉炎诊断标准：美国风湿学会1990年50岁以上发病：50岁以上发现症状新发的头痛：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血沉值升高：50mm/h以上动脉活检异常：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丄5项中如满足3项以上，敏感度93.5%。特异性91.2%可能分类为颞动脉炎。Headacheattributedtocervicalcarotidorvertebralarterydisorder颈动脉或锥动脉疼痛Headacheorfacialorneckpainattributedtocervicalcarotidorvertebralarterydissection动脉夹层Post-endarterectomyheadache内膜剥脱术后头痛Headacheattributedtocarotidorvertebralangioplasty颈动脉血管成型术头痛Headacheattributedtocerebralvenousthrombosis(CVT)脑静脉血栓形成HeadacheattributedtootheracuteintracranialarterialdisorderHeadacheattributedtoanintracranialendovascularprocedureAngiographyheadacheHeadacheattributedtoreversiblecerebralvasoconstrictionsyndrome(RCVS)Headacheprobablyattributedtoreversiblecerebralvasoconstrictionsyndrome(RCVS)Headacheattributedtointracranialarterialdissection颅内动脉夹层HeadacheattributedtogeneticvasculopathyCerebralAutosomalDominantArteriopathywithSubcorticalInfarctsandLeukoencephalopathy(CADASIL)MitochondrialEncephalopathy,LacticAcidosisandStroke-likeepisodes(MELAS)HeadacheattributedtoanothergeneticvasculopathyHeadacheattributedtopituitaryapoplexy垂体卒中缘于非血管性颅内疾病的头痛(Headacheattributedtonon-vascularintracranialdisorder)Headacheattributedtoincreasedcerebrospinalfluidpressure颅内压增高Headacheattributedtoidiopathicintracranialhypertension(IIH)Headacheattributedtointracranialhypertensionsecondarytometabolic,toxicorhormonalcausesHeadacheattributedtointracranialhypertensionsecondarytohydrocephalus

Headacheattributedtolowcerebrospinalfluidpressure颅内压低下Post-duralpunctureheadache腰穿后CSFfistulaheadache脑脊液漏Headacheattributedtospontaneousintracranialhypotension自发性低颅压Headacheattributedtonon-infectiousinflammatorydisease非感染性炎性疾病HeadacheattributedtoneurosarcoidosisHeadacheattributedtoaseptic(non-infectious)meningitisHeadacheattributedtoothernon-infectiousinflammatorydiseaseHeadacheattributedtolymphocytichypophysitisSyndromeoftransientHeadacheandNeurologicalDeficitswithcerebrospinalfluidLymphocytosis(HaNDL)Headacheattributedtointracranialneoplasia颅内新生物HeadacheattributedtointracranialneoplasmHeadacheattributedtocolloidcystofthethirdventricleHeadacheattributedtocarcinomatousmeningitis癌性脑膜炎Headacheattributedtohypothalamicorpituitaryhyper-orhyposecretionHeadacheattributedtointrathecalinjection鞘内注射HeadacheattributedtoepilepticseizureHemicraniaepileptica癫痫半颅痛Post-ictalheadache癫痫发作后头痛HeadacheattributedtoChiarimalformationtypeI(CM1)Headacheattributedtoothernon-vascularintracranialdisorder缘于物质或物质戒断的头痛(Headacheattributedtoasubstanceoritswithdrawal)Headacheattributedtouseoforexposuretoasubstanceoritswithdrawal缘于某种物质的应用或戒断Nitricoxide(NO)donor-inducedheadache一氧化氮诱发ImmediateNOdonor-inducedheadacheDelayedNOdonor-inducedheadachePhosphodiesterase(PDE)inhibitor-inducedheadache磷酸二酯酶抑制剂Carbonmonoxide(CO)-inducedheadache一氧化碳诱发Alcohol-inducedheadache酒精诱发Immediatealcohol-inducedheadacheDelayedalcohol-inducedheadacheHeadacheinducedbyfoodand/oradditive由于食物成分/添加剂诱发Monosodiumglutamate(MSG)-inducedheadache谷氨酸单钠盐(味精)Cocaine-inducedheadache可卡因诱发Histamine-inducedheadache组织胺诱发Immediatehistamine-inducedheadacheDelayedhistamine-inducedheadacheCalcitoningene-relatedpeptide(CGRP)-inducedheadache降钙素基因相关多肽诱发ImmediateCGRP-inducedheadache

DelayedCGRP-inducedheadacheHeadacheattributedtoexogenousacutepressoragentHeadacheattributedtooccasionaluseofnon-headachemedicationHeadacheattributedtolong-termuseofnon-headachemedicationHeadacheattributedtoexogenoushormoneHeadacheattributedtouseoforexposuretoothersubstanceMedication-overuseheadache(MOH)药物过度使用性头痛MOH诊断标准符合3-4项的头痛表现三15天规律使用1种或多种用于头痛急性期的止痛药超过3个月在药物过度使用期间，头痛进展或明显加重停用所用过度使用药物之后的2个月内，头痛必需改善（缓解或重归于之前的头痛模式MOH头痛表现多样，常有特征转换的独特模式过度是指规律且频繁，即每周2天或以上最常见的药物：对乙酰氨基酚一曲坦类一巴比妥类一阿片类，此外阿司匹林、麦角类、镇痛药及复方制剂8.2.均EgotOmta-overuseheadache麦角胺类Triptan-overuseheadache曲普坦类Simpleanalgesic-overuseheadache单纯止痛药类Paracetamol(acetaminophen)-overuseheadache对乙酰氨基酚Acetylsalicylicacid-overuseheadache乙酰水杨酸/阿司匹林Othernon-steroidalanti-inflammatorydrug(NSAID)-overuseheadacheOpioid-overuseheadache鸦片类Combination-analgesic-overuseheadache复合制剂过度应用Medication-overuseheadacheattributedtomultipledrugclassesnotindividuallyoverused联合用药所致Medication-overuseheadacheattributedtounverifiedoveruseofmultipledrugclassesMedication-overuseheadacheattributedtoothermedicationHeadacheattributedtosubstancewithdrawal物质戒断Caffeine-withdrawalheadache咖啡因Opioid-withdrawalheadache鸦片类Oestrogen-withdrawalheadache雌激素Headacheattributedtowithdrawalfromchronicuseofothersubstance缘于感染的头痛(Headacheattributedtoinfection)Headacheattributedtointracranialinfection颅内感染Headacheattributedtobacterialmeningitisormeningoencephalitis细菌性脑膜炎/脑膜脑炎AcuteheadacheattributedtobacterialmeningitisormeningoencephalitisChronicheadacheattributedtobacterialmeningitisormeningoencephalitisPersistentheadacheattributedtopastbacterialmeningitisormeningoencephalitisHeadacheattributedtoviralmeningitisorencephalitis病毒性脑膜炎或脑炎HeadacheattributedtoviralmeningitisHeadacheattributedtoviralencephalitisHeadacheattributedtointracranialfungalorotherparasiticinfection真菌或寄生虫感染

AcuteheadacheattributedtointracranialfungalorotherparasiticinfectionChronicheadacheattributedtointracranialfungalorotherparasiticinfectionHeadacheattributedtobrainabscess脑脓月肿Headacheattributedtosubduralempyema硬膜下积脓Headacheattributedtosystemicinfection系统感染Headacheattributedtosystemicbacterialinfection系统细菌感染AcuteheadacheattributedtosystemicbacterialinfectionChronicheadacheattributedtosystemicbacterialinfectionHeadacheattributedtosystemicviralinfection系统病毒感染AcuteheadacheattributedtosystemicviralinfectionChronicheadacheattributedtosystemicviralinfectionHeadacheattributedtoothersystemicinfection其他系统感染AcuteheadacheattributedtoothersystemicinfectionChronicheadacheattributedtoothersystemicinfection缘于内环境紊乱的头痛(Headacheattributedtodisorderofhomoeostasis)Headacheattributedtohypoxiaand/orhypercapnia缺氧和/或高碳酸血症High-altitudeheadache高海拔头痛Headacheattributedtoaeroplanetravel飞行头痛Divingheadache潜水头痛Sleepapnoeaheadache睡眠呼吸暂停性头痛DialysisheadacheHeadacheattributedtoarterialhypertension高血压性头痛Headacheattributedtophaeochromocytoma嗜络细胞瘤Headacheattributedtohypertensivecrisiswithouthypertensiveencepha无高t血压脑病的高血压危象Headacheattributedtohypertensiveencephalopathy高血压脑病Headacheattributedtopre-eclampsiaoreclampsia先兆子痫Headacheattributedtoautonomicdysreflexia自主反射障碍Headacheattributedtohypothyroidism甲状腺低下Headacheattributedtofasting禁食Cardiaccephalalgia心源性头痛Headacheattributedtootherdisorderofhomoeostasis其他内环境稳定失调疾患缘于头、颈、眼、耳、鼻、鼻窦、牙、口或其他头面部结构病变的头面痛(Headacheorfacialpainattributedtodisorderofthecranium,neck,eyes,ears,nose,sinuses,teeth,mouthorotherfacialorcervicalstructure)Headacheattributedtodisorderofcranialbone颅骨Headacheattributedtodisorderoftheneck颈部CervicogenicheadacheHeadacheattributedtoretropharyngealtendonitisHeadacheattributedtocraniocervicaldystoniaHeadacheattributedtodisorderoftheeyes眼睛Headacheattributedtoacuteglaucoma急性青光眼

Headacheattributedtorefractiveerror屈光不正Headacheattributedtoheterophoriaorheterotropia(latentorpersistentsquint)斜视HeadacheattributedtoocularinflammatorydisorderHeadacheattributedtotrochleitisHeadacheattributedtodisorderoftheears耳朵Headacheattributedtodisorderofthenoseorparanasalsinuses鼻子或鼻窦Headacheattributedtoacuterhinosinusitis急性鼻窦炎HeadacheattributedtochronicorrecurringrhinosinusitisHeadacheattributedtodisorderoftheteethorjawHeadacheattributedtotemporomandibulardisorder(TMD)HeadorfacialpainattributedtoinflammationofthestylohyoidligamentHeadacheorfacialpainatt