国际头痛新分类和诊断标准
头痛的国际分类(第三版)中文
The international Classification of Headache disorders, 3rd Editon2.1.2 Infrequent episodic tension-type headache not associated with pericranial tenderness2.2.1 Frequent episodic tension-type headache associated with pericranial tenderness2.2.2 Frequent episodic tension-type headache not associated with pericranial tenderness2.3.2 Chronic tension-type headache not associated with pericranial tenderness3.3.1 Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) 3.3.1.1 Episodic SUNCT3.3.1.2 Chronic SUNCT3.3.2 Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA)3.3.2.1 Episodic SUNA3.3.2.2 Chronic SUNA3.4 Hemicrania continua3.5 Probable trigeminal autonomic cephalalgia3.5.1 Probable cluster headache3.5.2 Probable paroxysmal hemicrania3.5.3 Probable short-lasting unilateral neuralgiform headache attacks3.5.4 Probable hemicrania continua4.其它的原发性头痛Other primary headache disorders ）4.1 Primary cough headache原发性咳嗽头痛4.1.1 Probable primary cough headache4.2 Primary exercise headache原发性运动性头痛4.2.1 Probable primary exercise headache4.3 Primary headache associated with sexual activity原发性性活动伴随的头痛4.3.1 Probable primary headache associated with sexual activity4.4 Primary thunderclap headache原发性霹雳头痛4.5 Cold-stimulus headache冷刺激性头痛4.5.1 Headache attributed to external application of a cold stimulus4.5.2 Headache attributed to ingestion or inhalation of a cold stimulus4.5.3 Probable cold-stimulus headache4.5.3.1 Headache probably attributed to external application of a cold stimulus4.5.3.2 Headache probably attributed to ingestion or inhalation of a cold stimulus则可两者均可作为诊断4.10 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 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 head5.2.2 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 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 to non-traumatic intracranial haemorrhage6.2.1 Headache 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 Headache 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 leptomeningeal 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 central nervous system (SACNS)6.7.1 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)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 (MELAS)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 intracranial 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 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 lymphocytic hypophysitis7.3.5 Syndrome of transient Headache and Neurological Deficits with cerebrospinal fluid Lymphocytosis (HaNDL)7.4 Headache attributed to intracranial neoplasia颅内新生物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癌性脑膜炎7.4.3 Headache attributed to hypothalamic or pituitary hyper- or hyposecretion7.5 Headache attributed to intrathecal injection鞘内注射7.6 Headache attributed to epileptic seizure7.6.1 Hemicrania epileptica癫痫半颅痛7.6.2 Post-ictal headache癫痫发作后头痛7.7 Headache attributed to Chiari malformation type I (CM1)7.8 Headache attributed to other non-vascular intracranial disorder8.缘于物质或物质戒断的头痛（Headache attributed to a substance or its withdrawal）8.1 Headache attributed to use of or exposure to a substance or its withdrawal缘于某种物质的应用或戒断8.1.1.2 Delayed NO donor-induced headache8.1.2 Phosphodiesterase (PDE) inhibitor-induced headache磷酸二酯酶抑制剂8.1.3 Carbon monoxide (CO)-induced headache一氧化碳诱发8.1.4 Alcohol-induced headache酒精诱发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/添加剂诱发8.1.5.1 Monosodium glutamate (MSG)-induced headache谷氨酸单钠盐（味精）8.1.6 Cocaine-induced headache可卡因诱发8.1.7 Histamine-induced headache组织胺诱发8.1.7.1 Immediate histamine-induced headache8.1.7.2 Delayed histamine-induced headache8.1.8 Calcitonin gene-related peptide (CGRP)-induced headache降钙素基因相关多肽诱发8.1.8.1 Immediate CGRP-induced 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 hormone8.1.13 Headache attributed to use of or exposure to other substance8.2.4 Opioid-overuse headache鸦片类8.2.5 Combination-analgesic-overuse headache复合制剂过度应用8.2.6 Medication-overuse headache attributed to multiple drug classes not individually over used联合用药所致8.2.7 Medication-overuse headache attributed to unverified overuse of multiple drug classes8.2.8 Medication-overuse headache attributed to other medication8.3 Headache attributed to substance withdrawal物质戒断8.3.1 Caffeine-withdrawal headache咖啡因8.3.2 Opioid-withdrawal headache鸦片类8.3.3 Oestrogen-withdrawal headache雌激素8.3.4 Headache attributed to withdrawal from chronic use of other substance9.缘于感染的头痛（Headache attributed to infection）9.1 Headache attributed to intracranial infection颅内感染9.1.1 Headache attributed to bacterial meningitis or meningoencephalitis细菌性脑膜炎/脑膜脑炎9.1.1.1 Acute headache attributed to bacterial meningitis or meningoencephalitis9.1.1.2 Chronic headache attributed to bacterial meningitis or meningoencephalitis9.1.1.3 Persistent headache attributed to past bacterial meningitis or meningoencephalitis9.1.2 Headache attributed to viral meningitis or encephalitis病毒性脑膜炎或脑炎9.1.2.1 Headache attributed to viral meningitis9.1.2.2 Headache attributed to viral encephalitis9.1.3 Headache attributed to intracranial fungal or other parasitic infection真菌或寄生虫感染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脑脓肿9.1.5 Headache attributed to subdural empyema硬膜下积脓9.2 Headache attributed to systemic infection系统感染9.2.1 Headache attributed to systemic bacterial infection系统细菌感染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 systemic viral infection系统病毒感染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其他系统感染9.2.3.1 Acute headache attributed to other systemic infection9.2.3.2 Chronic headache attributed to other systemic infection10.缘于内环境紊乱的头痛（Headache attributed to disorder of homoeostasis）10.1 Headache attributed to hypoxia and/or hypercapnia缺氧和/或高碳酸血症10.1.1 High-altitude headache高海拔头痛10.1.2 Headache attributed to aeroplane travel飞行头痛10.1.3 Diving headache潜水头痛10.1.4 Sleep apnoea headache睡眠呼吸暂停性头痛10.2 Dialysis headache10.3 Headache attributed to arterial hypertension高血压性头痛10.3.1 Headache attributed to phaeochromocytoma嗜络细胞瘤10.3.2 Headache attributed to hypertensive crisis without hypertensive encephalopathy无高血压脑病的高血压危象10.3.3 Headache attributed to hypertensive encephalopathy高血压脑病10.3.4 Headache attributed to pre-eclampsia or eclampsia先兆子痫10.3.5 Headache attributed to autonomic dysreflexia自主反射障碍10.4 Headache attributed to hypothyroidism甲状腺低下10.5 Headache attributed to fasting禁食10.6 Cardiac cephalalgia心源性头痛10.7 Headache attributed to other disorder of homoeostasis其他内环境稳定失调疾患11.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（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颅骨11.2 Headache attributed to disorder of the neck 颈部11.2.1 Cervicogenic 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 glaucoma急性青光眼11.3.2 Headache attributed to refractive error屈光不正11.3.3 Headache attributed to heterophoria or heterotropia (latent or persistent squint)斜视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鼻子或鼻窦11.5.1 Headache attributed to acute rhinosinusitis急性鼻窦炎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.缘于精神疾病的头痛（Headache attributed to psychiatric disorder）12.1 Headache attributed to somatization disorder躯体化障碍12.2 Headache attributed to psychotic disorder精神疾病三、脑神经痛、中枢和原发性颜面痛及其他头痛（painful cranial neuropathies, other facial pains and other headaches）13.脑神经痛和中枢性颜面痛（Painful cranial neuropathies and other facial pains）13.1 Trigeminal neuralgia三叉神经痛13.1.1 Classical trigeminal neuralgia13.1.1.1 Classical trigeminal neuralgia, purely paroxysmal13.1.1.2 Classical trigeminal neuralgia with concomitant persistent facial pain13.1.2 Painful trigeminal neuropathy13.1.2.1 Painful trigeminal neuropathy attributed to acute Herpes zoster13.1.2.2 Post-herpetic trigeminal neuropathy13.1.2.3 Painful post-traumatic trigeminal neuropathy13.1.2.4 Painful trigeminal neuropathy attributed to multiple sclerosis (MS) plaque13.1.2.5 Painful trigeminal neuropathy attributed to space-occupying lesion13.1.2.6 Painful trigeminal neuropathy attributed to other disorder13.2 Glossopharyngeal neuralgia舌咽神经痛13.3 Nervus intermedius (facial nerve) neuralgia中间神经痛（面神经痛）13.3.1 Classical nervus intermedius neuralgia13.6 Headache attributed to ischaemic ocular motor nerve palsy缺血性眼神经麻痹13.7 Tolosa-Hunt syndrome13.8 Paratrigeminal oculosympathetic (Raeder’s) syndrome13.9 Recurrent painful ophthalmoplegic neuropathy复发性痛性眼肌麻痹13.10 Burning mouth syndrome (BMS)13.11 Persistent idiopathic facial pain (PIFP)13.12 Central neuropathic pain中枢神经痛13.12.1 Central neuropathic pain attributed to multiple sclerosis (MS)13.12.2 Central post-stroke pain (CPSP)14. 其他头痛（Other headache disorders）。
头痛的国际分类(第三版)中文
The international Classification of Headache disorders, 3rd Editon头痛分类的国际标准(ICHD-III)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： 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 1.2.1.1 Typical aura with headache 1.2.1.2 Typical aura without headache 1.2.2 Migraine with brainstem aura 1.2.3 Hemiplegic 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 loci 1.2.3.2 Sporadic hemiplegic migraine —散发性 1.2.4 Retinal migraine 1.3 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 infarction 1.4.3 Migrainous infarction 偏头痛脑梗死 1.4.4 Migraine aura-triggered seizure 1.5 Probable migraine 很可能的偏头痛 1.5.1 Probable migraine without aura1.5.2 Probable migraine with aura 1.6 Episodic syndromes that may be associated with migraine 可能与偏头痛有关的发作性综合征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1.6.3 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 tenderness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）视网膜症状（视网膜型偏头痛）C ：至少有以下特征中的2项 ✓ 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 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propablemigraine 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） 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4.5 Cold-stimulus headache 冷刺激性头痛 4.5.1 Headache attributed to external application of a cold stimulus4.5.2 Headache attributed to ingestion or inhalation of a cold stimulus 4.5.3 Probable cold-stimulus headache4.5.3.1 Headache probably attributed to external application of a cold stimulus4.5.3.2 Headache probably attributed to ingestion or inhalation of a cold stimulus 4.6 External-pressure headache 4.6.1 External-compression headache 4.6.2 External-traction headache 4.6.3 Probable external-pressure headache4.6.3.1 Probable external-compression headache 4.6.3.2 Probable external-traction headache 4.7 Primary stabbing headache4.7.1 Probable primary stabbing headache4.8 Nummular headache4.8.1 Probable nummular headache4.9 Hypnic headache4.9.1 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 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 head5.2.2 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 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 to non-traumatic intracranial haemorrhage6.2.1 Headache 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NDPH 诊断标准： A ：持续性头痛，符合B-C 的标准B ：Distinct and clearly remembered onset, with pain becomingcontinuous and unremitting within 24 hours C ：Present for>3 monthsD ：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6.3 Headache attributed to unruptured vascular malformation 未破裂的血管畸形6.3.1 Headache 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 leptomeningeal 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 central 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93．5％。
头痛地国际分类第三版中文
The international Classification of Headache disorders, 3rd Editon 头痛分类的国际标准(ICHD-III)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： 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 aura1.2.1.1 Typical aura with headache 1.2.1.2 Typical aura without headache 1.2.2 Migraine with brainstem aura 1.2.3 Hemiplegic 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 loci 1.2.3.2 Sporadic hemiplegic migraine —散发性 1.2.4 Retinal migraine 1.3 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 infarction 1.4.3 Migrainous infarction 偏头痛脑梗死 1.4.4 Migraine aura-triggered seizure 1.5 Probable migraine 很可能的偏头痛 1.5.1 Probable migraine without aura1.5.2 Probable migraine with aura 1.6 Episodic syndromes that may be associated with migraine 可能与偏头痛有关的发作性综合征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1.6.3 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 tenderness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） 视网膜症状（视网膜型偏头痛） C ：至少有以下特征中的2项 ✓ 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 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propablemigraine 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） 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4.3.1 Probable primary headache associated with sexual activity 4.4 Primary thunderclap headache 原发性霹雳头痛 4.5 Cold-stimulus headache 冷刺激性头痛 4.5.1 Headache attributed to external application of a cold stimulus4.5.2 Headache attributed to ingestion or inhalation of a cold stimulus4.5.3 Probable cold-stimulus headache 4.5.3.1 Headache probably attributed to external application of a cold stimulus4.5.3.2 Headache probably attributed to ingestion or inhalation of a cold stimulus4.6 External-pressure headache 4.6.1 External-compression headache 4.6.2 External-traction headache 4.6.3 Probable external-pressure headache4.6.3.1 Probable external-compression headache4.6.3.2 Probable external-traction headache 4.7 Primary stabbing headache 4.7.1 Probable primary stabbing headache 4.8 Nummular headache 4.8.1 Probable nummular headache4.9 Hypnic headache4.9.1 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 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 head5.2.2 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 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 to non-traumatic intracranial haemorrhage6.2.1 Headache attributed to non-traumatic intracerebral haemorrhage 非外伤性脑出血6.2.2 Headache attributed to non-traumatic subarachnoid haemorrhage (SAH)NDPH 诊断标准：A ：持续性头痛，符合B-C 的标准B ：Distinct and clearly remembered onset, with pain becomingcontinuous and unremitting within 24 hours C ：Present for>3 months D ：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 Headache 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 leptomeningeal 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 central 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93．5％。
国际头痛分类(ICHD-Ⅲ)
3.3.1.1发作性 SUNCT可能性短 暂单侧神经痛样 头痛发作
3.3.1.2慢性 SUNCT
3.3.2短暂单侧 神经痛样头痛发 作伴头面部自主 神经症状 （SUNA）
3.3.2.1发作性 SUNA
3.3.2.2慢性 SUNA
3.4持续性偏侧头 痛
3.2.2慢性发作 性偏侧头痛
A至少20次满足B-D的发作
B中或重度单侧头痛，伴眶周
、眶上、颞部和/或其他三叉神
经支配区域，持续5-240秒，
发作呈搏动性
C疼痛伴随同侧结膜充血及流
3.3短暂单侧神 经痛样头痛发作
泪 D发作频率每日3 至200 次
3.3短暂单侧神经
伴结膜充血及流 泪（SUNCT）
1.4.2持续先兆 不伴梗死
1.4.3偏头痛性 脑梗
1.4.4偏头痛触 发癫痫发作
1.5可能性偏头痛
1.5.1可能性无先 兆偏头痛 1.5.2可能性有先 兆偏头痛 1.6 与偏头痛可 能相关的周期性 疾病 1.6.1 复发型胃 肠功能障碍
1.6.1.1周期性 呕吐综合征
1.6.1.2腹型偏 头痛
B突然发生，持续1秒到30分钟
C同右
D同右
4.1.1可能的原发
区别：持续时间：2版持续时 性咳嗽头痛
间为1秒到30秒，3版持续时间
为1秒到2小时
4.3原发性奋力 头痛
A满足B和C的搏动性头痛 B持续时间为5分钟到48小时 C只在剧烈的运动中或运动后 发生 D同右
4.2 原发性运动 头痛
区别：2版中提到头痛性质为 搏动性；持续时间2版为5分钟 到48小时，3版为小于48小时
3.三叉自主神经 性头面痛 （TACs）
类下
3.1丛集性头痛
偏头痛诊断标准——国际头痛分类第3版(beta版)
1.1 无先兆偏头痛 1.2 有先兆偏头痛
1.2.1 典型有先兆偏头痛 1.2.1.1 典型先兆伴头痛 1.2.1.2 典型先兆不伴头痛
1.2.2 伴有脑干先兆偏头痛 1.2.3 偏瘫型偏头痛
1.2.3.1 家族性偏瘫型偏头痛 1.2.3.1.1 家族性偏瘫型偏头痛 1 型 1.2.3.1.2 家族性偏瘫型偏头痛 2 型 1.2.3.1.3 家族性偏瘫型偏头痛 3 型 1.2.3.1.4 其他基因位点的家族性偏瘫 型偏头痛
1. 视觉 2. 感觉 3. 语音和/或者语言
4. 运动 5. 脑干 6. 视网膜 C. 至少符合下列 4 项中的 2 项： 1. 至少有 1 个先兆持续超过 5 分钟，和
/或者 2 个或更多的症状连续发生 2. 每个独立先兆症状持续 5-60 分钟 1 3. 至少有一个先兆是单侧的 2 4. 与先兆伴发或者在先兆出现 60 分钟
无先兆偏头痛发作时，局部的脑血流图 检查未提示皮层扩布性抑制时的血流变化， 尽管脑干和皮层的血流可在在疼痛激活时发 生变化。这不同于有先兆偏头痛的特征性扩 布性血流减少。尽管大量文献提示无先兆偏 头痛不发生皮层扩布性抑制，但一些近期研 究对此又有不同观点。信使分子 NO、5-HT
2
和 CGRP 参与其中。尽管既往认为偏头痛发 病机制主要和血管有关，但近几十年，中枢 疼痛通路的敏化和疼痛可能起源于中枢神经 系统的观点得到越来越多的重视。偏头痛疼 痛环路、三叉神经血管反射系统、周围和三 叉神经脊束核尾段、中枢间脑灰质和丘脑核 团内的递质传递得到了不同程度的认识。新 型高受体特异性急性期治疗药物如 5-HT1B/D 受体激动剂曲普坦、5-HT1F 受体激动剂和 CGRP 受体拮抗剂被证实可用于偏头痛发作 的急性期治疗。因为他们的高度特异性，在 治疗上的有效性推进了对偏头痛发病机制的 深入了解。已经明确的是，无先兆偏头痛是 一种神经生物学障碍，临床和基础神经科学 已经推动了我们对偏头痛机制的认识，未来 更会如此。
IHS国际头痛疾病分类第二版 修订版(ICHD-Ⅱ)
IHS国际头痛疾病分类第二版（ICHD－Ⅱ）IHS ICHD-Ⅱ编WHO ICD－10NA编码诊断（英文原名，缩写） [继发性头痛病原的ICD－10编码] 码1. [G43]偏头痛（Migraine）1.1[G43.0] 无先兆偏头痛（Migraine without aura）1.2[G43.1] 先兆偏头痛（Migraine with aura）1.2.1[G43.10]典型先兆偏头痛（Typical aura with migraine headache）典型先兆伴非偏头痛性头痛（Typical aura with non-migraine1.2.2 [G43.10]headache）1.2.3[G43.104]典型先兆不伴头痛（Typical aura without headache）1.2.4[G43.105]家族性偏瘫性偏头痛（Familial hemiplegic migraine ，FHM）1.2.5[G43.105] 散发性偏瘫性偏头痛（Sporadic hemiplegic migraine）1.2.6 [G43.103]基底动脉型偏头痛（Basilar-type migraine）儿童周期综合症－常为偏头痛的先驱（Childhood periodic1.3[G43.82]syndromes that are commonly precursors of migraine）1.3.1 [G43.82] 周期性呕吐（Cyclical vomiting）1.3.2[G43.820] 腹型偏头痛（Abdominal migraine）1.3.3 [G43.821]儿童良性阵发性眩晕（Benign paroxysmal vertigo of childhood）1.4[G43.81] 视网膜偏头痛（Retinal migraine）1.5 [G43.3]偏头痛并发症（Complications of migraine）1.5.1[G43.3] 慢性偏头痛（Chronic migraine）1.5.2 [G43.2] 偏头痛持续状态（Status migrainosus）1.5.3 [G43.3]持续性先兆不伴脑梗死（Persistent aura without infarction）1.5.4[G43.3] 偏头痛性脑梗死（Migrainous infarction）1.5.5[G43.3]偏头痛触发癫痫发作（Migraine-triggered seizure）[G40.x orG41.x]1.6 [G43.83] 可能偏头痛（Probable migraine）1.6.1[G43.83] 可能无先兆偏头痛（Probable migraine without aura）1.6.2[G43.83] 可能先兆偏头痛（Probable migraine with aura）1.6.5 [G43.83] 可能慢性偏头痛（Probable chronic migraine）2.[G44.2]紧张型头痛（Tension-type headache，TTH）2.1[G44.2]少发复发性紧张性头痛（Infrequent episodic tension-typeheadache，TTH）2.1.1 [G44.20] 少发复发性紧张性头痛伴颅周压痛（Infrequent episodic tension-type headache associated with pericranial tenderness）2.1.2[G44.21]少发复发性紧张性头痛不伴颅周压痛（Infrequentepisodic tension-type headache not associated with pericranial tenderness）2.2[G44.2]频发复发性紧张性头痛（Frequent episodic tension-typeheadache）2.2.1 [G44.20] 频发复发性紧张性头痛伴颅周压痛（Frequent episodic tension-type headache associated with Pericranial tenderness）2.2.2[G44.21]频发复发性紧张性头痛不伴颅周压痛（Frequent episodic tension-type headache not associated with pericranial tenderness）2.3[G44.2]慢性紧张型头痛（ Chronic tension-type headache）2.3.1[G44.22] 慢性紧张型头痛伴颅周压痛（Chronic tension-type headacheassociated with pericranial tenderness）2.3.2[G44.23]慢性紧张型头痛不伴颅周压痛（Chronic tension-type headachenot associated with pericranial tenderness）2.4[G44.28] 可能紧张型头痛（Probable tension-type headache）2.4.1[G44.28]可能少发复发性紧张性头痛（Probable infrequent episodictension-type headache）2.4.2[G44.28]可能频发复发性紧张性头痛（Probable frequent episodictension-type headache）2.4.3[G44.28]可能慢性紧张型头痛（Probable chronic tension-typeheadache）3.[G44.0]丛集性头痛和其他三叉自主神经性头痛（Cluster headacheand other trigeminal autonomic Cephalalgias）3.1[G44.0] 丛集性头痛（Cluster headache）3.1.1[G44.01] 复发性丛集性头痛（Episodic cluster headache）3.1.2 [G44.02]慢性丛集性头痛（Chronic cluster headache）3.2[G44.03]阵发性半侧颅痛（ Paroxysmal hemicrania）3.2.1[G44.03]复发性阵发性半侧颅痛（Episodic paroxysmal hemicrania）3.2.2[G44.03]慢性阵发性半侧颅痛（Chronic paroxysmal hemicrania ，CPH)3.3 [G44.08]短暂单侧神经痛样头痛伴结膜充血和流泪Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing ，SUNCT)3.4 [G44.08]可能三叉自主神经性头痛（Probable trigeminal autonomiccephalalgia）3.4.1 [G44.08]可能丛集性头痛（Probable cluster headache）3.4.2[G44.08]可能阵发性半侧颅痛（Probable paroxysmal hemicrania）3.4.3[G44.08] 可能SUNCT （Probable SUNCT）4.[G44.80]其他原发性头痛（Other primary headaches）4.1[G44.800]原发性刺痛性头痛（Primary stabbing headache）4.2[G44.803]原发性咳嗽头痛（Primary cough headache）4.3 [G44.804]原发性奋力头痛（Primary exertional headache）4.4[G44.805]原发性性活动伴随的头痛（Primary headache associated withsexual activity）4.4.1[G44.805]性高潮前头痛（Preorgasmic headache）4.4.2[G44.805] 性高潮头痛（Orgasmic headache）4.5 [G44.80]睡眠头痛（Hypnic headache）4.6 [G44.80]原发性霹雳头痛（Primary thunderclap headache）4.7[G44.80]连续性半侧颅痛（Hemicrania continua）4.8 [G44.2] 新症每日持续性头痛（New daily-persistent headache ，NDPH）5.[G44.88]头痛由于头和/或颈部外伤（Headache attributed to headand/or neck trauma）5.1[G44.880]急性外伤后头痛（Acute post-traumatic headache）5.1.1[G44.880] 急性外伤后头痛由于中度或严重的头损伤（Acutepost-traumatic headache attributed to moderate or severe head injury） [S06]5.1.2[G44.880]急性外伤后头痛由于轻度头损伤（Acute post-traumaticheadache attributed to mild head injury） [S09.9] 5.2[G44.3]慢性外伤后头痛（Chronic post-traumatic headache）5.2.1 [G44.30]慢性外伤后头痛由于中度或严重的头损伤（Chronicpost-traumatic headache attributed to moderate or severe head injury [S06]5.2.2[G44.31]慢性外伤后头痛由于轻度头损伤（Chronic post-traumaticheadache attributed to mild head injury） [S09.9]急性头痛由于颈椎甩鞭损伤（Acute heada che attributed to5.3[G44.841]whiplash injury） [S13.4]慢性头痛由于颈椎甩鞭损伤（Chronic headache attributed to5.4 [G44.841]whiplash injury） [S13.4]头痛由于外伤性颅内血肿（Headache attributed to traumatic5.5[G44.88]intracranial haematoma）头痛由于硬膜外血肿（Headache attributed to epidural5.5.1 [G44.88]haematoma） [S06.4]头痛由于硬膜下血肿（ Headache attributed to subdural5.5.2[G44.88]haematoma） [S06.5]头痛由于其他头和/或颈部外伤（Headache attributed to other5.6[G44.88]head and/or neck trauma ）[S06]急性头痛由于其他头和/或颈部外伤（Acute headache attributed5.6.1[G44.88]to other head and/or neck trauma）[S06]慢性头痛由于其他头和/或颈部外伤（Chronic headache5.6.2[G44.88]attributed to other head and/or neck trauma) [S06]5.7[G44.88]开颅术后头痛（Post-craniotomy headache）5.7.1[G44.880]急性开颅术后头痛（Acute post-craniotomy headache）5.7.2[G44.30]慢性开颅术后头痛（Chronic post-craniotomy headache）头痛由于颅脑和颈部血管疾病（Headache attributed to6.[G44.81]cranial or cervical vascular disorder）头痛由于缺血性中风或TIA（Headache attributed to ischaemic6.1[G44.810]stroke or transient ischaemic attack）头痛由于缺血性中风〔脑梗死〕（Headache attributed to6.1.1 [G44.810]ischaemic stroke 〔cerebral infarction〕） [I63]6.1.2 [G44.810]头痛由于TIA（ Headache attributed to transient ischaemicattack ，TIA) [G45]6.2 [G44.810]头痛由于非外伤性颅内出血（Headache attributed tonon-traumatic intracranial haemorrhage [I62]6.2.1 [G44.810]头痛由于颅内出血（Headache attributed to intracerebralhaemorrhage） [I61]6.2.2[G44.810]头痛由于蛛网膜下腔出血（Headache attributed tosubarachnoid haemorrhage ，SAH) [I60]6.3[G44.811]头痛由于未破裂的血管畸形（Headache attributed tounruptured vascular malformation）[Q28]6.3.1[G44.811]头痛由于囊性动脉瘤（Headache attributed to saccularaneurysm） [Q28.3]6.3.2[G44.811]头痛由于动静脉畸形（Headache attributed to arteriovenousmalformation ，AVM) [Q28.2]6.3.3 [G44.811]头痛由于硬膜动静脉瘘（Headache attributed to duralarteriovenous fistula ）[I67.1]6.3.4[G44.811]头痛由于海绵窦血管瘤（Headache attributed to cavernousangioma） [D18.0]6.3.5[G44.811]头痛由于脑三叉神经或软脑膜血管瘤病（Headache attributed to encephalotrigeminal or leptomeningeal angiomatosis ，Sturge Weber syndrome) [Q85.8]6.4[G44.812]头痛由于动脉炎（Headache attributed to arteritis ）[M31]6.4.1[G44.812]头痛由于巨动脉炎（Headache attributed to giant cellarteritis ，GCA) [M31.6]6.4.2[G44.812]头痛由于原发性中枢神经系统血管炎（Headache attributed toprimary central nervous system (CNS) angⅡtis） [I67.7]6.4.3[G44.812]头痛由于继发性中枢神经系统血管炎（Headache attributed tosecondary central nervous system angⅡtis） [I68.2]6.5[G44.810]颈动脉或锥动脉疼痛（Carotid or vertebral artery pain）[I63.0, I63.2, I65.0, I65.2 or I67.0]6.5.1[G44.810]头痛、面痛或颈痛由于夹层动脉瘤（Headache or facial or neckpain attributed to arterial Dissection） [I67.0]6.5.2[G44.814] 内膜剥脱术后头痛（Post-endarterectomy headache）[I97.8]6.5.3 [G44.810] 颈动脉血管成型术头痛（Carotid angioplasty headache）6.5.4[G44.810]头痛由于颅内血管内操作（Headache attributed tointracranial endovascular procedures）6.5.5 [G44.810] 动脉造影头痛（Angiography headache）6.6 [G44.810]头痛由于脑静脉血栓形成（Headache attributed to cerebralvenous thrombosis ，CVT) [I63.6]6.7[G44.81]头痛由于其他颅内血管疾病（Headache attributed to otherintracranial vascular disorder）6.7.1[G44.81]脑常染色体显性遗传动脉病伴皮层下梗塞和白质脑病（Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy，CADASIL) [I67.8]6.7.2[G44.81] 线粒体脑病，乳酸酸中毒和中风样发作（Mitochondrial Encephalopathy, Lactic Acidosis and Strokelike episodes ，MELAS) [G31.81]6.7.3 [G44.81]头痛由于良性中枢神经系统血管病（Headache attributed tobenign angiopathy of the central nervous system） [I99]6.7.4 [G44.81]头痛由于垂体中风（Headache attributed to pituitaryapoplexy） [E23.6]7. [G44.82]头痛由于非血管性颅内疾病（Headache attributed tonon-vascular intracranial Disorder）7.1[G44.820]头痛由于脑脊液压力增高（Headache attributed to highcerebrospinal fluid pressure）7.1.1 [G44.820]头痛由于自发性颅内压增高（Headache attributed toidiopathic intracranial hypertension，ⅡH) [G93.2]7.1.2[G44.820]头痛由于继发于代谢、中毒或内分泌病因的颅内压增高（ Headache attributed to intracranial hypertension secondary to metabolic, toxic or hormonal causes)7.1.3[G44.820]头痛由于继发于脑积水的颅内压增高（Headache attributed to intracranial hypertension secondary to hydrocephalus）[G91.8]7.2[G44.820]头痛由于脑脊液压力低下(Headache attributed to lowcerebrospinal fluid pressure)7.2.1[G44.820]腰穿（硬膜穿刺）后头痛（Post-dural puncture headache）[G97.0]7.2.2[G44.820]脑脊液瘘头痛（CSF fistula headache） [G96.0]7.2.3[G44.820]头痛由于自发性或原发性低颅压（Headache attributed tospontaneous or idiopathic low CSF pressure）7.3 [G44.82]头痛由于非感染性炎性疾病（Headache attributed tonon-infectious inflammatory disease）7.3.1[G44.823]头痛由于神经类肉瘤病（Headache attributed toneurosarcoidosis） [D86.8]7.3.2[G44.823]头痛由于非化脓性，或非感染性脑膜炎（Headache attributed toaseptic (non-infectious) meningitis）[按特定病原编码]7.3.3 [G44.823]头痛由于其他非感染性炎性疾病（Headache attributed to othernon-infectious inflammatory disease）[按特定病原编码]7.3.4 [G44.82]头痛由于淋巴细胞性垂体炎（Headache attributed tolymphocytic hypophysitis） [E23.6]7.4[G44.822]头痛由于颅内新生物（Headache attributed to intracranialneoplasm） [C00-D48]7.4.1 [G44.822] 头痛由于新生物造成的颅内压增高或脑积（Headache attributed to increased intracranial pressure or hydrocephalus caused by neoplasm）[按特定新生物编码]7.4.2[G44.822]头痛直接由于新生物所致（Headache attributed directly toneoplasm）[按特定新生物编码]7.4.3[G44.822]头痛由于癌性脑膜炎（ Headache attributed to carcinomatousmeningitis） [C79.3]7.4.4 [G44.822]头痛由于下丘脑、垂体的高－或低分泌（ Headache attributed tohypothalamic or pituitary hyper- or hyposecretion） [E23.0] 7.5[G44.824]头痛由于鞘内注射（ Headache attributed to intrathecalinjection） [G97.8]7.6[G44.82]头痛由于癫痫发作（Headache attributed to epileptic seizure[G40.x or G41.x to specify seizure type]7.6.1[G44.82]癫痫半颅痛（ Hemicrania epileptica ）[G40.x or G41.x 按特定发作类型编码]7.6.2 [G44.82]癫痫发作后头痛（Post-seizure headache） [G40.x or G41.x按特定发作类型编码]7.7[G44.82]头痛由于I型Chiari畸形（Headache attributed to Chiarimalformation type I，CM1)[Q07.0]7.8[G44.82]暂时性头痛和神经功能缺损伴脑脊液淋巴细胞增高(Syndrome of transient Headache and Neurological Deficits with cerebrospinal fluid Lymphocytosis ,HaNDL)7.9[G44.82]头痛由于其他非血管性颅内疾病(Headache attributed to othernon-vascular intracranial Disorder)8[G44.4 or G44.83]头痛由于物质或物质的的戒断（Headache attributed to asubstance or its withdrawal）8.1[G44.40] 头痛由于物质的急性应用或暴露（Headache induced by acutesubstance use or exposure）头痛由于一氧化氮（NO）原料物质诱发（ Nitric oxide (NO) 8.1.1[G44.400]donor-induced headache） [X44]头痛由于即刻性一氧化氮原料物质诱发Immediate NO8.1.1.1 [G44.400]donor-induced headache） [X44]头痛由于拖延性一氧化氮原料物质诱发（Delayed NO8.1.1.2[G44.400]donor-headache） [X44]头痛由于磷酸二酯酶抑制剂（Phosphodiesterase ，8.1.2[G44.40]inhibitor-induced headache） [X44]头痛由于一氧化碳诱发（Carbon monoxide-induced headache）8.1.3 [G44.402][X47]8.1.4[G44.83]头痛由于酒精诱发（Alcohol-induced headache）[F10]头痛由于即刻性酒精诱发（Immediate alcohol-induced8.1.4.1[G44.83]headache） [F10]头痛由于拖延性酒精诱发（Delayed alcohol-induced headache）8.1.4.2[G44.83][F10]头痛由于食物成分和附加物诱发（Headache induced by food8.1.5 [G44.4]components and additives）头痛由于谷氨酸单钠盐（味精）诱（Monosodium8.1.5.1[G44.401]glutamate-induced headache）[X44]8.1.6[G44.83] 头痛由于可卡因诱发（Cocaine-induced headache） [F14]8.1.7[G44.83]头痛由于大麻诱发（Cannabis-induced headache）[F12]8.1.8 [G44.40]头痛由于组织胺诱发（Histamine-induced headache） [X44]头痛由于即刻性组织胺诱发（Immediate histamine-induced8.1.8.1 [G44.40]headache） [X44]头痛由于拖延性组织胺诱发（Delayed histamine-induced8.1.8.2[G44.40]headache） [X44]8.1.9[G44.40]头痛由于降钙素基因相关多肽诱发（Calcitonin gene-relatedpeptide [CGRP]-induced headache）[X44]8.1.9.1[G44.40]头痛由于即刻性CGRP诱发（ Immediate CGRP-induced headache）[X44]8.1.9.2[G44.40]头痛由于拖延性CGRP诱发（Delayed CGRP-induced headache）[X44]8.1.10[G44.41] 头痛由于药物的急性不良反应（Headache as an acute adverse event attributed to medication used for other indications [code to specify substance]）8.1.11[G44.4 or G44.83]头痛由于其他物质急性应用或暴露（Headache induced by otheracute substance use or exposure [code to specify substance]）8.2[G44.41 or G44.83]头痛由于药物过度使用（Medication-overuse headache ，MOH)8.2.1[G44.411]头痛由于麦角胺过度使用（Ergotamine-overuse headache）[Y52.5]8.2.2 [G44.41]头痛由于曲普坦过度使用（Triptan-overuse headache）8.2.3[G44.410]头痛由于止痛药过度使用（Analgesic-overuse headache）[F55.2]8.2.4 [G44.83] 头痛由于类鸦片过度应用（Opioid-overuse headache） [F11.2]8.2.5 [G44.410]头痛由于复合制剂过度应用（Combination medication-overuseheadache） [F55.2]8.2.6[G44.410]头痛由于其他药物的过度应用（Headache attributed to othermedication overuse [按特定物质编码]8.2.7[G44.41 or G44.83]头痛由于可能药物应用过度（Probable medication-overuseheadache） [code to specify substance]8.3[G44.4]头痛由于慢性用药的不良反应（Headache as an adverse eventattributed to chronic medication ）[按特定物质编码]8.3.1 [G44.418]头痛由于外源性激素诱发（Exogenous hormone-inducedheadache） [Y42.4]8.4[G44.83]头痛由于物质戒断（Headache attributed to substancewithdrawal）8.4.1 [G44.83]头痛由于咖啡戒断（Caffeine-withdrawal headache） [F15.3]8.4.2 [G44.83]头痛由于类鸦片戒断（Opioid-withdrawal headache） [F11.3]8.4.3 [G44.83]头痛由于雌激素戒断（Oestrogen-withdrawal headache）[Y42.4]8.4.4 [G44.83]头痛由于慢性应用其他物质的戒断（Headache attributed to withdrawal from chronic use of other substances） [按特定物质编码]9. 头痛由于感染（Headache attributed to infection）9.1[G44.821]头痛由于颅内感染（Headache attributed to intracranialinfection） [G00-G09]9.1.1 [G44.821]头痛由于细菌性脑膜炎（Headache attributed to bacterialmeningitis） [G00.9]9.1.2[G44.821]头痛由于淋巴细胞性脑膜炎（Headache attributed tolymphocytic meningitis） [G03.9]9.1.3[G44.821]头痛由于脑炎（Headache attributed to encephalitis） [G04.9]9.1.4[G44.821]头痛由于脑脓肿（Headache attributed to brain abscess）[G06.0]9.1.5 [G44.821]头痛由于硬膜下积脓（Headache attributed to subduralempyema） [G06.2]9.2[G44.881]头痛由于系统感染（ Headache attributed to systemicinfection） [A00-B97]9.2.1[G44.881]头痛由于系统细菌感染（Headache attributed to systemicbacterial infection） [按特定病原编码]9.2.2[G44.881]头痛由于系统病毒感染（ Headache attributed to systemicviral infection ）[按特定病原编码]9.2.3[G44.881]头痛由于其他系统感染（Headache attributed to other systemicinfection [按特定病原编码]9.3[G44.821] 头痛由于HIV/AIDS(Headache attributed to HIV/AIDS) [B22]9.4[G44.821 or G44.881]慢性感染后头痛（Chronic post-infection headache） [按特定病原编码]9.4.1 [G44.821]慢性细菌性脑膜炎后头痛（Chronic post-bacterial meningitisheadache） [G00.9]10.[G44.882]头痛由于内环境稳定失调疾患（Headache attributed todisorder of homoeostasis）10.1[G44.882]头痛由于缺氧和/或高碳酸血症（Headache attributed tohypoxia and/or hypercapnia）10.1.1 [G44.882]高海拔头痛（High-altitude headache） [W94]10.1.2 [G44.882] 潜水头痛（Diving headache）10.1.3[G44.882]睡眠呼吸暂停性头痛（Sleep apnoea headache） [G47.3]10.2[G44.882]Dialysis headache [Y84.1]10.3[G44.813]头痛由于动脉高血压（Headache attributed to arterialhypertension） [I10]10.3.1[G44.813]头痛由于嗜络细胞瘤（Headache attributed tophaeochromocytoma [D35.0 (良性) or C74.1 (恶性)]10.3.2[G44.813]头痛由于无高血压脑病的高血压危象（Headache attributed to hypertensive crisis without hypertensive encephalopathy）[I10]10.3.3 [G44.813]头痛由于高血压脑病（Headache attributed to hypertensiveencephalopathy） [I67.4]10.3.4[G44.813]头痛由于先兆子痫（Headache attributed to pre-eclampsia）[O13-O14]10.3.5[G44.813]头痛由于子痫（Headache attributed to eclampsia）[O15]10.3.6[G44.813] 头痛由于外源性制剂造成的血压增高反应（Headache attributed to acute pressor response to an exogenous agent）[按特定病原编码]10.4[G44.882]头痛由于甲状腺低下（Headache attributed to hypothyroidism）[E03.9]10.5 [G44.882] 头痛由于禁食（Headache attributed to fasting）[T73.0] 10.6[G44.882]心源性头痛（Cardiac cephalalgia） [code to specifyaetiology]10.7[G44.882]头痛由于其他内环境稳定失调疾患（Headache attributed toother disorder of homoeostasis）[按特定病原编码]11.[G44 84]头或面痛由于头颅、颈部、眼、耳、鼻窦、牙、口腔或其他面部或头颅构造疾患（Headache or facial pain attributed to disorder of cranium，neck，eyes，ear， nose，sinuses，teeth，mouthor other facial or cranial structures）11.1 [G44.840]头痛由于颅骨疾病(Headache attributed to disorder ofcranial bone) [M80-M89.8]11.2[G44.841]头痛由于颈部疾病（Headache attributed to disorder of neck）[M99]11.2.1[G44.841]颈源性头痛（Cervicogenic headache） [M99]11.2.2 [G44.842]头痛由于咽后腱炎（Headache attributed to retropharyngealtendonitis） [M79.8]11.2.3[G44.841]头痛由于颅颈部肌紧张不全（Headache attributed tocraniocervical dystonia ）[G24]11.3 [G44.843] 头痛由于眼疾患（Headache attributed to disorder of eyes）11.3.1[G44.843]头痛由于急性青光眼（Headache attributed to acute glaucoma）[H40]11.3.2 [G44.843]头痛由于屈光不正（Headache attributed to refractive errors）[H52]11.3.3[G44.843]头痛由于隐斜视或斜视（Headache attributed to heterophoriaor heterotropia，latent or manifest squint) [H50.3-H50.5]11.3.4[G44.843]头痛由于眼的炎性疾病（Headache attributed to ocularinflammatory disorder） [按特定病原编码]11.4[G44.844]头痛由于耳疾患（Headache attributed to disorder of ears）[H60-H95]11.5[G44.845]头痛由于鼻－鼻窦炎（Headache attributed to rhinosinusitis）[J01]11.6[ G44.846]头痛由于牙齿、颌以及相关结构的疾病（Headache attributed todisorder of teeth, jaws or related structures [K00 K14]11.7[G44.846] 头或面痛由于颞下颌关节疾病（Headache or facial pain attributed to temporomandibular joint ，TMJ) disorder）[K07.6]11.8 [G44.84] 头痛由于其他头颅、颈部、眼、耳、鼻、鼻窦、牙、口腔、或其他面部或颈部构造疾病（Headache attributed to other disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structures） [code to specify aetiology]12.[R51]头痛由于精神疾病（Headache attributed to psychiatricdisorder）12.1[R51]头痛由于躯体化疾病（Headache attributed to somatisationdisorder）[F45.0]12.2[R51]头痛由于精神疾病（Headache attributed to psychoticdisorder） [按特定病原编码]13.[G44.847,G44.848orG44.85]颅神经痛和中枢源性面痛（Cranial neuralgias and central causes of facial pain）13.1[G44.847] 三叉神经痛（Trigeminal neuralgia）13.1.1[G44.847]典型三叉神经痛(Classical trigeminal neuralgia)[G50.00]13.1.2[G44.847]症状性三叉神经痛（Symptomatic trigeminal neuralgia[G53.80] ＋ [按特定病原编码]13.2[G44.847]舌咽神经痛（Glossopharyngeal neuralgia）13.2.1[G44.847]典型舌咽神经痛（Classical glossopharyngeal neuralgia）[G52.10]13.2.2[G44.847]症状性舌咽神经痛（Symptomatic glossopharyngeal neuralgia ）[G53.830] + [按特定病原编码]13.3[G44.847]中间神经痛（Nervus intermedius neuralgia） [G51.80]13.4 [G44.847] 喉上神经痛（Superior laryngeal neuralgia） [G52.20]13.5[G44.847]鼻睫神经痛（Nasociliary neuralgia） [G52.80]13.6[G44.847]眶上神经痛（Supraorbital neuralgia） [G52.80]13.7[G44.847]其他终末支神经痛（Other terminal branch neuralgias）[G52.80]13.8[G44.847]枕神经痛（Occipital neuralgia ）[G52.80]13.9[G44.851]颈－舌综合症（Neck-tongue syndrome）13.10 [G44.801] 外源压挤性头痛（External compression headache）13.11[G44.802] 冷刺激头痛（Cold-stimulus headache）13.11.1[G44.8020]头痛由于外源应用冷刺激（Headache attributed to externalapplication of a cold stimulus13.11.2[G44.8021] 头痛由于吸入冷刺激（Headache attributed to ingestion orinhalation of a cold Stimulus）13.12[G44.848] 持续性疼痛由于构造性病变压迫、激惹或扭曲颅神经或上颈神经根（Constant pain caused by compression, irritation or distortion of cranial nerves or upper cervical roots by structural lesions) [G53.8] + [code to specify aetiology]13.13[G44.848] 视神经炎（Optic neuritis） [H46]13.14[G44.848] 眼糖尿病性神经病（Ocular diabetic neuropathy）[E10-E14] 13.15 [G44.881 or G44.847]头或面痛由于带状疱疹（Head or facial pain attributed toherpes zoster）13.15.1[G44.881]头痛或面痛由于急性带状疱疹（Head or facial pain attributedto acute herpes zoster） [B02.2]13.15.2[G44.847]带状疱疹后神经痛（Post-herpetic neuralgia ）[B02.2]13.16[G44.850] Tolosa-Hunt 综合症（Tolosa-Hunt syndrome）13.17[G43.80]眼肌麻痹性“偏头痛”（Ophthalmoplegic ‘migraine’）13.18[G44.810 or G44.847]中枢源性面痛（Central causes of facial pain）13.18.1[G44.847]痛性感觉缺失（Anaesthesia dolorosa） [G52.800] + [code tospecify aetiology]13.18.2[G44.810] 中枢性中风后疼痛（Central post-stroke pain） [G46.21]13.18.3 [G44.847]面痛由于多发硬化（Facial pain attributed to multiplesclerosis） [G35]13.18.4[G44.847]持续性原发性面痛（Persistent idiopathic facial pain）[G50.1]13.18.5[G44.847]烧灼性口腔综合症（Burning mouth syndrome）[code to specifyaetiology]13.19[G44.847]其他颅神经痛或其他中枢介导的面痛（Other cranial neuralgiaor other centrally mediated facial pain [按特定病原编码]其他头痛、颅神经痛、中枢性或原发性面痛（Other headache, 14.[R51]cranial neuralgia, central or primary facial pain）14.1[R51] 以上未分类的头痛（Headache not elsewhere classified）14.2 [R51]非特殊性头痛（Headache unspecified）。
头痛分类的国际标准
头痛分类的国际标准按照头痛分类的国际标准（ ICHD-III）的分类标准，临床上头痛一共有14种类型，每种类型又包含若干种头痛。
偏头痛▎概述临床最常见的原发性头痛，人群中患病率高达5%-10%，也就是说在中国有至少有6500万的患者。
头痛发作位置大多如图所示，疼痛为中重度搏动样头痛，可持续4-72小时，非常影响患者生活。
▎诱因偏头痛的诱因非常复杂，据美国流行病调查统计，大约70%-80%的患者有家族史，同时外界因素（声、光刺激等）和生活规律（食物、睡眠、压力等）也可能引发偏头痛。
▎治疗因此对偏头痛的治疗方案也较多，如果考虑针对病因的治疗，可以让患者记录下每次发作的时间、地点和状况，以便分析其诱因。
针对中轻度头痛，一般治疗可单用非特异性止痛药，如非甾体类消炎药（对乙酰氨基酚、萘普生、布洛芬等）。
对中重度头痛，可选用偏头痛特异性治疗药物如麦角类制剂和曲谱坦类药物。
由于这两类药物有强烈的血管收缩作用，并且长期大量使用可引起严重不良后果，因此，对于以往服用非甾体类消炎药（NSAIDs）效果较好的中重度头痛患者，可以继续给予NSAIDs类药物。
由于偏头痛诱因复杂，部分患者可建议进行心理疏导，对于慢性长期性偏头痛，美国有研究者认为认知行为治疗也是可行的替代方案。
丛集性头痛▎概述此病之所以得这么个名字，是因为它的疼痛成群结队而来，表现为一连串的密集的非搏动性剧痛。
丛集性期长达2周至3个月，每次发作持续15-180分钟。
位置如图，在一侧眼眶或额颞部。
发作时患者坐立不安，部分患者甚至会用拳击打头部以减轻疼痛。
此病发病率比偏头痛较少，近6.8/10万。
▎诱因丛集性头痛一般无家族史，可由饮酒、吸烟、缺氧、热度或高海拔等因素诱发。
其病因尚不明确，一般认为是颅内、外血管扩张导致。
Horton认为与组胺释放有关。
▎治疗对于安定类药物效果不佳的丛集性头痛可给予吸氧（100%氧气8-10L/min，10-15分钟）。
曲普坦类药物可以迅速缓解头痛。
头痛地国际分类(第三版)中文
The international Classification of Headache disorders, 3rd Editon4.6.3.2 Probable external-traction headache 4.7.1 Probable primary stabbing headache6.2 Headache attributed to non-traumatic intracranial haemorrhage6.2.1 Headache 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 Headache 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 leptomeningeal 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 central nervous system (SACNS)6.8.2 Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like episodes (MELAS)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 intracranial 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 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 lymphocytic hypophysitis7.3.5 Syndrome of transient Headache and Neurological Deficits with cerebrospinal fluid Lymphocytosis (HaNDL)7.4 Headache attributed to intracranial neoplasia颅内新生物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癌性脑膜炎7.4.3 Headache attributed to hypothalamic or pituitary hyper- or hyposecretion7.5 Headache attributed to intrathecal injection鞘内注射7.6 Headache attributed to epileptic seizure7.6.1 Hemicrania epileptica癫痫半颅痛7.6.2 Post-ictal headache癫痫发作后头痛7.7 Headache attributed to Chiari malformation type I (CM1)7.8 Headache attributed to other non-vascular intracranial disorder8.缘于物质或物质戒断的头痛（Headache attributed to a substance or its withdrawal）8.1 Headache attributed to use of or exposure to a substance or its withdrawal缘于某种物质的应用或戒断8.1.1 Nitric oxide (NO) donor-induced headache一氧化氮诱发8.1.1.1 Immediate NO donor-induced headache8.1.1.2 Delayed NO donor-induced headache8.1.2 Phosphodiesterase (PDE) inhibitor-induced headache磷酸二酯酶抑制剂8.1.3 Carbon monoxide (CO)-induced headache一氧化碳诱发8.1.4 Alcohol-induced headache酒精诱发8.3.4 Headache attributed to withdrawal from chronic use of other substance9.缘于感染的头痛（Headache attributed to infection）9.1 Headache attributed to intracranial infection颅内感染9.1.1 Headache attributed to bacterial meningitis or meningoencephalitis细菌性脑膜炎/脑膜脑炎9.1.1.1 Acute headache attributed to bacterial meningitis or meningoencephalitis9.1.1.2 Chronic headache attributed to bacterial meningitis or meningoencephalitis9.1.1.3 Persistent headache attributed to past bacterial meningitis or meningoencephalitis9.1.2 Headache attributed to viral meningitis or encephalitis病毒性脑膜炎或脑炎9.1.2.1 Headache attributed to viral meningitis9.1.2.2 Headache attributed to viral encephalitis9.1.3 Headache attributed to intracranial fungal or other parasitic infection真菌或寄生虫感染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脑脓肿9.1.5 Headache attributed to subdural empyema硬膜下积脓9.2 Headache attributed to systemic infection系统感染9.2.1 Headache attributed to systemic bacterial infection系统细菌感染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 systemic viral infection系统病毒感染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其他系统感染9.2.3.1 Acute headache attributed to other systemic infection9.2.3.2 Chronic headache attributed to other systemic infection10.缘于内环境紊乱的头痛（Headache attributed to disorder of homoeostasis）10.1 Headache attributed to hypoxia and/or hypercapnia缺氧和/或高碳酸血症10.1.1 High-altitude headache高海拔头痛10.1.2 Headache attributed to aeroplane travel飞行头痛10.1.3 Diving headache潜水头痛10.1.4 Sleep apnoea headache睡眠呼吸暂停性头痛10.2 Dialysis headache10.3 Headache attributed to arterial hypertension高血压性头痛10.3.1 Headache attributed to phaeochromocytoma嗜络细胞瘤10.3.2 Headache attributed to hypertensive crisis without hypertensive encephalopathy无高血压脑病的高血压危象10.3.3 Headache attributed to hypertensive encephalopathy高血压脑病10.3.4 Headache attributed to pre-eclampsia or eclampsia先兆子痫10.3.5 Headache attributed to autonomic dysreflexia自主反射障碍10.4 Headache attributed to hypothyroidism甲状腺低下10.5 Headache attributed to fasting禁食10.6 Cardiac cephalalgia心源性头痛10.7 Headache attributed to other disorder of homoeostasis其他内环境稳定失调疾患11.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（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颅骨11.2 Headache attributed to disorder of the neck 颈部11.2.1 Cervicogenic 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 glaucoma急性青光眼11.3.2 Headache attributed to refractive error屈光不正11.3.3 Headache attributed to heterophoria or heterotropia (latent or persistent squint)斜视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鼻子或鼻窦11.5.1 Headache attributed to acute rhinosinusitis急性鼻窦炎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.缘于精神疾病的头痛（Headache attributed to psychiatric disorder）12.1 Headache attributed to somatization disorder躯体化障碍12.2 Headache attributed to psychotic disorder精神疾病三、脑神经痛、中枢和原发性颜面痛及其他头痛（painful cranial neuropathies, other facial pains and other headaches）13.脑神经痛和中枢性颜面痛（Painful cranial neuropathies and other facial pains）13.1 Trigeminal neuralgia三叉神经痛13.1.1 Classical trigeminal neuralgia13.1.1.1 Classical trigeminal neuralgia, purely paroxysmal13.1.1.2 Classical trigeminal neuralgia with concomitant persistent facial pain。
国际头痛新分类和诊断标准
诊断标准
偏头痛
具有典型的前驱症状，如视觉先 兆、感觉异常等，头痛呈单侧、 搏动性，并可能伴有恶心、呕吐
等症状。
紧张性头痛
头痛呈非搏动性，通常表现为双侧 枕部或全头部的压迫感或紧束感， 常伴有颈部的肌肉紧张和疼痛。
丛集性头痛
头痛呈单侧的剧烈疼痛，通常在眼 眶或颞部，并伴有同侧的球结膜水 肿和流泪等症状。
改善患者就医体验
医生准确、个性化的诊断和治疗建议有助于提高患者就医体验，增 强患者对医疗服务的满意度。
THANKS
感谢观看
详细描述
偏头痛的疼痛性质多为搏动性或跳动性，通常位于头部的一侧，可伴随恶心、 呕吐、畏光、畏声等症状。偏头痛的发作频率和持续时间各不相同，可因多种 因素诱发，如情绪压力、缺乏睡眠、饮食不当等。
紧张型头痛
总结词
紧张型头痛是一种常见的原发性头痛，通常表现为头部紧束感或压迫感，伴随颈 部僵硬和肌肉疼痛等症状。
03
CATALOGUE
国际头痛诊断标准
诊断流程
01
02
03
病史采集
详细了解患者的头痛症状 、发作频率、持续时间、 伴随症状等，以及可能的 诱发和缓解因素。
体格检查
进行全面的体格检查，以 排除其他可能导致头痛的 疾病或病因。
诊断分类
根据患者的病史和体格检 查结果，将头痛进行分类 ，如偏头痛、紧张性头痛 、丛集性头痛等。
诊断的准确性和可靠性。
ICHD-III引入了新的头痛类型 ，如药物过度使用性头痛和原
发性咳嗽性头痛等。
ICHD-III还对儿童和青少年头 痛的分类和诊断标准进行了特
别规定。
02
CATALOGUE
国际头痛新分类
偏头痛
【图文解读】头痛分类
【图文解读】头痛分类头痛是一种最常见的症状，但是引起头痛的病因却十分复杂，因此分类也比较困难。
1988年，国际头痛协会发表了一份由头痛分类委员会修订的文件，题为《头痛疾患，脑神经痛与面痛的分类及诊断标准》，该文件将头面部疼痛分为以下12大类：1．偏头痛(1）没有先兆的偏头痛。
(2）有先兆的偏头痛：①有典型先兆的偏头痛；②有持续性先兆的偏头痛；③家族性偏瘫性偏头痛；④基底动脉性偏头痛；⑤有偏头痛先兆但无头痛；⑥急性先兆发作的偏头痛。
(3）眼肌瘫痪性偏头痛。
(4）视网膜性偏头痛。
(5）可能为偏头痛前驱症状或与偏头痛有关的儿童期周期性综合征：①良性儿童期发作性眩晕；②儿童期交替性偏瘫。
(6）偏头痛的并发症：①偏头痛持续状态；②偏头痛性脑梗死。
(7）不符合上述标准的偏头痛样疾患。
2．紧张性头痛(l）发作性紧张性头痛：①与颅周肌肉疾患有关的发作性紧张性头痛；②与颅周肌肉疾患无关的发作性紧张性头痛。
(2）慢性紧张性头痛：①与颅周肌肉疾患有关的慢性紧张性头痛；②与颅周肌肉疾患无关的慢性紧张性头痛。
(3）不符合上述标准的紧张性头痛。
3．丛集性头痛和慢性发作性偏侧头痛(1）丛集性头痛：①周期不定的丛集性头痛；②发作性丛集性头痛；③慢性丛集性头痛。
一是发作开始后不缓解的慢性丛集性头痛；二是从发作性再演变为慢性丛集性头痛。
(2）慢性发作性偏侧头痛。
(3）不符合上述标准的丛集性头痛样疾患。
4．与器质性疾患无关的杂类头痛(1）原发性搏（跳）动性头痛。
(2）压迫性头痛。
(3）冷刺激性头痛。
(4）咳嗽引起的头痛。
(5）用力引起的头痛。
(6）与性活动有关的头痛：①钝痛；②爆发性（突然严重）头痛；③体位性疼痛（注：指性交后低颅压引起的头痛）。
5．与头颅外伤有关的头痛(1）急性头颅外伤后头痛：①明显的头颅外伤和（或）有肯定的体征；②轻度头颅外伤，无肯定的体征。
(2）慢性头颅外伤后头痛：①明显的头颅外伤和有肯定的体征；②轻度头颅外伤，无肯定的体征。
头痛分类和诊断专家共识
生华健经挝盘点！塑！生！且盥塑鲞筮！翦￡也』蔓塑吐：！止！业！：！些塑。
盟！：！头痛分类和诊断专家共识头痛分类和诊断专家共识组头痛是神经内科门、急诊最常见的症状之一。
长期眦来，关于头痛疾患的分类和诊断系统比较混乱。
１９８８年，国际头痛学会（ＩｎｔｅｍａｔｉｏｎａｌＨｅａｄａｃｈｅｓｏｃｉｅ竹，ＩＨｓ）颁布了“头痛疾患、脑神经痛及颜面痛的分类和诊断标准”，对主要的头痛疾患类型绐出了描述性定义和可操作性的诊断标准。
泼分类和诊断标准推出后便被广泛接受，并为世界卫生组织所采用，成为头痛疾患分类和诊断的国际规范。
２００４年，ｍｓ又推出了第２版“头痛疾患的国际分类”（ｔｈｅｈｔｅｍ“０ｎ日ｌＣｌ舶ｓ讯ｃ“ｏｎｏｆＨｅａｄａｃｈｅＤｉｓ【Ⅱｄｅｒｓ：２ｎｄＥｄｉｔｉｏｎ．ＩＣＨＤ一Ⅱ）…。
近年来，由于部分专家的推动，国内对于ＩＨｓ的分类和诊断标准已有所了解，并以此标准进行了一些研究工作。
然而，在临床工作中，绝大多数的医生仍未能较好地掌握常见头痛疾患的诊断方法，不规范的诊断名称在各医院病历中随处可见。
不同类型的头痛有着不同的病因，需要不同的治疗。
统一、规范的分类诊断和命名体系，不仅是国际间交流台作的需要，更是头痛临床治疗和科研工作的需要。
中华医学会神经病学分会、中华神经科杂志编辑委员会组织部分专家进行了专题讨论，一致认为我国应全面推广使用头痛的国际分类，为便于临床医生更好地理解和应用此分类，有必要对ＩｃＨＤ－Ⅱ进行适当的解读和简化。
一、头痛疾患的分类头痛疾患分为３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可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。
原发性头痛的分类以临床症状为主要依据，继发性头痛的分类以病因为主要依据。
３大组头痛共分为１４类：（１）原发性头痛：①偏头痛；②紧张型头痛；⑧丛集性头痛和其他三叉自主神经性头痛；④其他原发性头痛。
头痛的最新国际分类_诊断标准和治疗新进展
总之,免疫疫苗为A D的预防和治疗开辟了一条新的思路,它的出现具有非常重要的意义。
如果通过不断地探索,证实这种新的方法对人类AD有效,它必将成为一种直接针对AD病因的治疗方法,还能在A D发病之前给予干预,阻止疾病的发生。
并且,目前已知多种神经系统变性疾病均与异常蛋白的沉积有关,如帕金森患者脑中L ewy小体中A-突触素蛋白,亨廷顿患者脑中的H unting ton蛋白等[19],这种新的治疗措施对其他神经系统变性疾病的治疗,指明了一条可探索之路。
参考文献:[1]Schenck D,Barbour R,Dunn W,et al.Immunizatio n w ithamy lo id-B attenuates Alzheimer disease like patholo gy in P DA PP mo use[J].N ature,1999,400(173):173[2]Shibata M,Y amada S,Kumar SR,et al.Clear ance o fA lzheimer c s amyloid ss(1-40)peptide f rom brain by L DLrecept or-related pr otein-1at the bloo d-br ain barr ier[J].JClin Invest,2000,106(12):1489[3]M clean CA,Chermy R A,Fr aser FW,et al.So luble po olo f A B as a det erminant o f sever ity o f neuro deg ener ation inA lzheimer c s disease[J].Ann Neuro l,1999,46:860[4]O ddo S,Billings L,Kesslak JP,et al.A beta immuno ther-apy leads to clearance o f early,but not late,hy per phos-pho ry lated tau ag gr egates v ia the pro teasome[J].N eu-ro n,2004,43(3):321[5]M o rg an D,D iamond DM,G ottschall PE,et al.A betapept ide v accination pr ev ents memor y lo ss in an animal mo del of Alzheimer c s disease[J].N atur e,2000,408 (6815):982[6]Jensen M T,M o ttin M D,Cracchiio lo JR,et al.Lifelongimmunizatio n w ith human beta-amy loid(1-42)pr otects Alzheimer c s transgenic mice against cog nitiv e impairment thr ougho ut ag ing[J].Neuro science,2005,130(3):667 [7]L i SB,w ang H Q,L in X,et al.Specific humo ral immuner esponses in rhesus mo nkey s vaccinated with the A lzhe-imer c s disease-associated B-amy lo id1-15peptide vaccine [J].Chin M ed J(Eng l),2005,118(8):660[8]L emere CA,Beierschmitt A,Iglesias M,et a l.Alzheimer cs disease abeta vaccine reduces central ner vous system abeta lev els in a non-human pr imate,the Car ibbean v er-vet[J].Am J Pat ho l,2004,165(1):283[9]Check E.N erve inflammat ion halts t rial fo r A lzheimer c sdrug[J].Nat ur e,2002,415:462[10]M aslian E,Hansen L,Adame A,et al.A1bet a2v accina-tio n effects o n plaque patholo gy in t he absence o f enceph-alitis in A lzheimer disease[J].Neuro lo gy,2005,64(1): 129[11]Ro ber to F,Elena B,F rancesca S,et al.V accination w ithamy lo id-B peptide induces auto immune encephalomy ekitis in C57/BL6mice[J].Brain,2003,126(2):285[12]G andy S,Demattos RB,L emere CA,et a l.Alzheimer Abeta vaccination o f rhesus monkeys(M acaca mulatta) [J].A lzheimer Dis A ssoc Diso rd,2004,18(1):44 [13]Ho ck C,K onietzko U,Papasso tir opoulos A,et al.G en-er ation of ant-i bodies specific for B-amy loid by vaccinat ion of patients w ith Alzheimer disease[J].N ature M edicine, 2002,8:1270[14]M claurin,Cecal R,K ierstead M E,et al.T herapeutica llyeffect ive antibodies agianse amy lo id B peptide ta rg et amy-loid B r esidues4-10and inhibit cy totox icity and fibr illo-g enesis[J].Nature M edicine,2002,8:1263[15]李国营,胡金家,林贤,等.A B不同片段肽疫苗免疫鼠后血清对A B42诱导细胞毒性作用的影响[J].中山大学学报(医学科学版),2004,25(2):102[16]胡金家,汪华侨,曲怀刚,等.A B及亚单位疫苗诱导小鼠抗体产生及其中和A B42的细胞毒性[J].细胞与分子免疫学杂志,2004,20(2):178[17]林贤,汪华侨,徐杰,等.A B42及其C端亚单位疫苗接种正常大鼠后产生高滴度的抗A B42抗体[J].解剖学报, 2003,34(3):231[18]F renkel D,Dewacher I,V an L euv en F,et al.R educt iono f beta-amy lo id plaques in br ain o f tr ansg enic mo use mo del of A lzheimer c s disease by EF RH-phag e immuniza-tio n[J].Vaccine,2003,21(11-12):1060[19]史树贵,李露斯.细胞凋亡与神经系统变性疾病[J].重庆医学,2003,32(7):928#综述#头痛的最新国际分类、诊断标准和治疗新进展彭瑞强综述,黄祖春审校(重庆医科大学附属第一医院神经内科,重庆市神经病学重点实验室400016)关键词:头痛;分类;诊断;治疗;进展中图分类号:R741.041文献标识码:A文章编号:1671-8348(2006)12-1130-04头痛是临床常见的症状之一,严重影响着患者的生活质量,其原因涉及临床各科,许多颅内疾病、全身性疾病、功能性或精神疾病等均可引起头痛。
头痛的分类、诊断要点和常见
偏头痛何时需要预防性治疗
频繁发作 急性期治疗无效或无法进行急性期治疗 可能导致永久性神经功能缺损的特殊变异性偏头痛
偏头痛预防性治疗的药物选择
β肾上腺素受体阻滞剂：普萘洛尔、纳多洛尔、阿 肾上腺素受体阻滞剂：普萘洛尔、纳多洛尔、 替洛尔、美托洛尔、 替洛尔、美托洛尔、噻吗洛尔等 抗抑郁药：阿米替林、 抗抑郁药：阿米替林、氟西汀等 钙离子拮抗剂：如氟桂利嗪、尼莫地平、 钙离子拮抗剂：如氟桂利嗪、尼莫地平、维拉帕米 等 抗癫痫药：如丙戊酸钠、托吡酯、 抗癫痫药：如丙戊酸钠、托吡酯、加巴喷丁等 5-HT受体拮抗剂：包括苯噻啶和美西麦角等 HT受体拮抗剂 受体拮抗剂： 其他：肉毒毒素A局部注射、辅酶Q10、 其他：肉毒毒素A局部注射、辅酶Q10、大剂量维 生素B2等 生素B2等
主要内容和目的
鉴别伴发严重疾病的头痛和良性头痛 偏头痛、紧张型头痛和丛集性头痛的诊断 和处理
头痛的定义和病理生理机制
通常指眉弓、外耳道上缘与枕外隆突连线以上部 位的疼痛 由于颅内外痛敏结构内的痛觉感受器受到刺激， 经痛觉传导通路传导到大脑皮层而引起
“头痛疾患的国际分类”第二版
Ⅰ原发性头痛 1.偏头痛 1.偏头痛 2.紧张型头痛 2.紧张型头痛 3.丛集性头痛和其他三叉自主神经性头痛 3.丛集性头痛和其他三叉自主神经性头痛 4.其他原发性头痛 4.其他原发性头痛
“头痛疾患的国际分类”第二版
Ⅱ继发性头痛 1.头痛由于头和/ 1.头痛由于头和/或颈部外伤 2.头痛由于颅脑和颈部血管疾病 2.头痛由于颅脑和颈部血管疾病 3.头痛由于非血管性颅内疾病 3.头痛由于非血管性颅内疾病 4.头痛由于物质或物质的的戒断 4.头痛由于物质或物质的的戒断 5. 头痛由于感染 6.头痛由于内环境稳定失调疾患 6.头痛由于内环境稳定失调疾患 7.头或面痛由于头颅、颈部、眼、耳、鼻窦、牙、口腔或其他 7.头或面痛由于头颅、颈部、眼、耳、鼻窦、牙、口腔或其他 颜面部结构病变 8.头痛由于精神疾病 8.头痛由于精神疾病
国际头痛新分类和诊断标准简介
2013年国际头痛新分类和诊断标准简介历史1. 1988第一版2. 2004第二版3. 2013第三版诊断分类原则1.分级，最多5级，一般诊断1-2级2.主要根据最近一年内的病情进行诊断3.明确诊断优于“很可能”诊断4.可以同时两个诊断基本结构一，原发性头痛1.偏头痛2.紧张型头痛3.三叉自主神经性头痛4.其他原发性头痛二，继发性头痛三，痛性脑神经病、其他面部疼痛和其他类头痛偏头痛分类1.1无先兆偏头痛1.2有先兆偏头痛1.3慢性偏头痛1.4偏头痛并发症1.5很可能的偏头痛1.6可能与偏头痛有关的发作性综合症无先兆偏头痛诊断标准A.有符合B-D项特征的至少5次发作B.头痛发作持续4-72小时（2-72）C.有下列中的至少两项头痛特征1.单侧性2.搏动性3.中或重度疼痛4.日常体力活动会加重头痛D.头痛过程中至少伴随下列一项1.恶心或呕吐2.畏光和畏声E.其他ICHD-3诊断不能更好解释典型先兆偏头痛诊断标准A.有符合B-C项的至少2次发作B.先兆由视觉、感觉或言语症状组成，每种先兆完全可逆，没有运动、脑干及视网膜症状C.至少符合下列4项中的2项1.至少一种先兆症状逐渐发展的过程≥5分钟，或两种或多种先兆症状接连发生2.每种先兆症状持续5-60分钟3.至少一种先兆症状是单侧的4.先兆时伴有头痛或在先兆发生后60分钟内出现头痛D.其他ICHD-3诊断不能更好解释，且已排除短暂性脑缺血发作脑干先兆偏头痛诊断标准A.有符合B-D项的至少2次发作B.先兆由视觉、感觉或言语症状组成，每种先兆完全可逆，没有运动及视网膜症状C.至少符合下列脑干症状中的2项1.构音障碍2.眩晕3.耳鸣4.听觉迟钝5.复视6.共济失调7.意识水平下降D.至少符合下列4项中的2项1.至少一种先兆症状逐渐发展的过程≥5分钟，或两种或多种先兆症状接连发生2.每种先兆症状持续5-60分钟3.至少一种先兆症状是单侧的4.先兆时伴有头痛或在先兆发生后60分钟内出现头痛E.其他ICHD-3诊断不能更好解释，且已排除短暂性脑缺血发作偏瘫性偏头痛诊断标准A.有符合B-C项的至少2次发作B.先兆包括下列全部两种症状1.完全可逆的运动无力2.完全可逆的视觉、感觉或言语症状C.至少符合下列4项中的2项1.至少一种先兆症状逐渐发展的过程≥5分钟，或两种或多种先兆症状接连发生2.每种非运动先兆症状持续5-60分钟，运动症状持续＜72小时3.至少一种先兆症状是单侧的4.先兆时伴有头痛或在先兆发生后60分钟内出现头痛D.其他ICHD-3诊断不能更好解释，且已排除短暂性脑缺血发作和卒中可能慢性偏头痛诊断标准A.至少有3个月头痛发作每月≥15天，并且符合B，C标准B.至少有5次发作符合1.1无先兆偏头痛标准的B-D项或1.2有先兆偏头痛标准的B-C项C.至少有3个月每月≥8天头痛符合下列的任何一项1. 1.1无先兆偏头痛标准的C和D项2. 1.2有先兆偏头痛标准的B和C项3. 头痛开始时患者本人认为是偏头痛，且头痛在使用曲普坦类或麦角胺类药物后缓解D.其他ICHD-3诊断不能更好解释很可能的偏头痛紧张型头痛分类2.1偶发性紧张型头痛2.2频发性紧张型头痛2.3慢性紧张型头痛2.4很可能的紧张型头痛偶发性紧张型头痛诊断标准A.有符合标准B-D的至少10次发作，平均每月头痛发作不到1天（每年头痛＜12天）B.持续30分钟-7天C.至少符合下列四项中的两项1.双侧性2.压迫或紧缩性3.轻中度4.不会因为日常体力活动加重D.符合下列两项1.无恶心和呕吐2.无畏光和畏声，或仅有其中之一E.其他ICHD-3诊断不能更好解释频发性紧张型头痛诊断标准A.有符合标准B-D的至少10次发作，至少3个月每月头痛发作1-14天（每年头痛≥12天，＜180天）B.持续30分钟-7天C.至少符合下列四项中的两项1.双侧性2.压迫或紧缩性3.轻中度4.不会因为日常体力活动加重D.符合下列两项1.无恶心和呕吐2.无畏光和畏声，或仅有其中之一E.其他ICHD-3诊断不能更好解释慢性紧张型头痛诊断标准A.有符合标准B-D的至少10次发作，至少3个月每月头痛发作≥15天（每年头痛≥180天）B.持续数小时或数天或持续不断C.至少符合下列四项中的两项1.双侧性2.压迫或紧缩性3.轻中度4.不会因为日常体力活动加重D.符合下列两项1.无畏光、畏声及轻度恶心症状，或仅有其中之一2.无中重度恶心和呕吐E.其他ICHD-3诊断不能更好解释三叉自主神经性头痛分类3.1丛集性头痛3.2阵发性偏侧头痛3.3短时单侧神经痛样头痛发作3.4持续性偏侧头痛3.5很可能的三叉自主神经性头痛丛集性头痛诊断标准A.符合B-D项特征的至少5次发作B.重度或极重度偏侧眶部、眶上或颞部疼痛，疼痛持续15-180分钟C.符合下列一项或两项1.在头痛侧至少有下列一项a.结膜充血或流泪b.鼻塞或流涕c.眼睑水肿d.前额和面部出汗e.前额和面部发红f.感觉耳部胀满g.瞳孔缩小或眼睑下垂2.感觉不安或躁动D.疾病活动期过半数时间头痛发作频率在隔日一次到每日8次之间E.其他ICHD-3诊断不能更好解释。
头痛鉴别诊断
先兆表现为完全可逆的视觉、感觉或言语症状 与先兆同时或先兆后60分钟内出现符合偏头痛特征的头痛， 即为典型先兆偏头痛
临床表现为反复发作的一侧或双侧额颞部疼痛，呈搏动性，疼痛持续
时伴颈肌收缩。常有伴随症状：恶心、呕吐、畏光等；与月经有明显
（2）脑干先兆性偏头痛（基底型偏头痛）
的关系
先兆症状明显源自脑干，临床可见构音障碍、眩晕、耳鸣、
弓、耳轮上缘和枕外隆突连线以上部位的疼痛。
原发性头痛：不明病因引起的头痛，常见的如
2
偏头痛、紧张型头痛
继发性头痛：各种颅内病变引起的头痛，如脑
3
血管疾病、颅内感染、颅脑外伤等，全身性疾病如
发热、内环境紊乱以及滥用精神活性药物。
概述
1 2 3
头痛疾患的国际分类：
Ⅰ原发性头痛 偏头痛 紧张型头痛 三叉自主神经头面痛 其他原发性头痛
发作频率高，可严重影响患者工作和生活，常需要频繁应用止痛药治
听力减退、复视、双眼鼻侧及颞侧视野同时出现视觉症状、
疗
共济失调、意识障碍、双侧同时出现感觉异常，但无运动无
易合并出现药物过量使用性头痛
力症状。在先兆同时或先兆60分钟内出现符合偏头痛特征的
2.有先兆偏头痛
偏头痛头痛，常伴恶心、呕吐 （3）偏瘫性偏头痛
患者性别及年龄； 头痛的部位 、性质、程度、发生 的方式及经过、发生的时间和持 续时间 、诱发、加重及缓解因素、 伴随症状
排除眼、耳、鼻、咽喉及口腔等五官引起 的头痛: 1.眼源性:如屈光不正、青光眼、斜视等; 2.耳源性:如急性及慢性化腋性中耳炎等; 3.鼻源性:急慢性鼻炎、鼻窦炎、鼻中甲肥 大或偏曲等; 4.咽喉源性:急慢性喉炎、鼻咽癌转移; 5.口腔、颌面部疾病:牙髓炎、颞颌关节疾 病等
国际头痛新分类简介(1)
头痛。
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1.2.1.2不伴头痛的典型先兆
A.满足1.2.1典型先兆偏头痛的标 准
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2013版
Migraine without aura Migraine with aura:
typical,brainstem,motor,retinal Complications of migraine Chronic migraine Episodic syndromes that may be
时间和严重程度外，发作典型 C.有以下2项特征： ①超过72h不缓解 ②头痛和（或）伴随症状使人极度衰弱 D.其他ICHD-3的诊断不能更好解释。
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1.4.2无脑梗死的持续先兆
A. 先兆满足标准B。 B. 发生在1.2有先兆偏头痛患者，除1种或多种先兆症状持续≥1周外，其他先兆表现典型 C. 影像学检查无梗死证据 D没有另一个ICHD-3的头痛疾患诊断能更好解释。 Comments: Persistent aura symptoms are rare but well documented. They are often bilateral
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1.2.3.2散发型偏瘫偏头痛
A.符合1.2.3偏瘫性偏头痛诊断标准 B.无1、2级亲属符合1.2.3偏瘫性偏头痛诊断标准的头痛
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1.2.4视网膜偏头痛
A.至少2次符合标准B和C的发作 B.先兆包括可以完全可逆的单眼阳性（闪
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• 如果考虑一个患者有两种以上的头痛，应要求患者记录头痛日记， 记录诊断要求的所有重要头痛特征。这样还可以了解患者的药物 使用情况，并帮助教育患者区分不同的头痛发作。
• 原有的原发性头痛显著恶化（通常指频率或程度增加2倍以上），如在时间点 上与某可引起此种情形的疾病存在密切关系，如有足够证据表明该疾病可引 起头痛，则同时给予原有的偏头痛诊断和继发性头痛诊断。
继发性头痛的诊断不再需要“该疾病治愈或缓解后头痛缓解”这一 条，这样可使诊断尽早确立。
1. 偏头痛
无先兆偏头痛诊断标准
– 2010年开始修订，2013年中正式颁布 – 为配合ICD-11，先推出β版，预计2、3年后出正式版。IHS建议立即使用现版。 – 共180页
ICHD-3 基本结构
ICHD-3部分诊断分类原则
• ICHD3的诊断分类是分级的，最多5级。除了头痛专科和科研目的 外，一般临床诊断1－2级就可以了
国际头痛学会（IHS）的头痛分类
• Classification and Diagnostic criteria for headache disorders, cranial neuralgias and facial pain
– 1988年推出，96页，13类，165条。 – 结构参照DSM-Ⅲ（ the Diagnostic and Statistical Manual of Mental Disorders, Third
– 1999年开始修订，2004年正式发布 – 共151页，14章，原发性头痛45条，继发性头痛120条，颅神经痛和中枢性颜面
痛及其他头痛29条
• The International Classification of Headache Disorders, 3rd edition (beta version)
Edition） – IHS第一版分类与诊断标准被广泛接受。1993年的WHO ICD－10和1997年WHO
ICD-10NA采用了IHS分类的主要原则。 – 建立了一套统一的命名和诊断体系，极大地推动了头痛领域科研和治疗的进展。
• The International Classification of Headache Dsiorders 2nd Edition(ICHD-2)
ICHD-3 基本结构
• 主要根据最近或一年内的病情进行诊断。如是为了遗传研究或其 他目的，可追溯有生以来所有的头痛情况
• 每个患者可有不同的头痛疾患，需要分别予以诊断、编码。患者 的多个头痛诊断应按照重要性进行排列。如果患者的头痛症状符 合多个类型的诊断标准时，需要结合其他情况（如年龄、性别、 长期病程、家族史药物史、月经等）综合考虑。明确的诊断优先 于“很可能”的诊断。如果完全符合两种明确的诊断标准，则同 时予以诊断。
典型先兆偏头痛诊断标准
脑干先兆偏头痛诊断标准
偏瘫性偏头痛诊断标准
慢性偏头痛诊断标准
药物过量使用性头痛
偏头痛分型
2.紧张型头痛
偶发性紧张型偏头痛诊断标准
频发性紧张型头痛诊断标准
慢性紧张型头痛诊断标准
3. 三叉自主神经性头痛
丛集性头痛诊断标准
4. 其他原发ቤተ መጻሕፍቲ ባይዱ头痛
继发性头痛一般性诊断标准
ICHD-3部分诊断分类原则
原发性头痛 or 继发性头痛
• 头痛新发，如其首次发作与某可能引起头痛的疾病在时间点上存在密切关系， 或者符合由该疾病引起的其他因果性标准，则该头痛可诊为缘于该疾病的继 发性头痛。 新发头痛的表现符合某一原发性头痛的特点时也遵循本原则
• 原有的原发性头痛转为慢性，如在时间点上与某可引起此种情形的疾病存在 密切关系，则同时给予两个诊断：原有的原发性头痛诊断以及继发性头痛诊 断