发作性偏头痛转化为慢性偏头痛 - 偏头痛社区

<hr/> <iframe frameborder="0" src="https://v.qq.com/txp/iframe/player.html?vid=d3508y2fjcf" allowfullscreen="true" width="360" height="230" scrolling="no" align=""></iframe> <hr/> <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 医学上对偏头痛的分类方式有很多种，按发作频率进行分类是最常用的一种。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 发作性偏头痛：患者每月偏头痛发作天数少于<span style="font-size: 18px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "Helvetica Neue";"> 15 天 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 慢性偏头痛：患者每月有<span style="font-size: 18px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "Helvetica Neue";"> 15 天以上（含15天）的偏头痛发作天数，且至少持续出现三个月。其中至少有8天伴随有偏头痛的典型伴随症状如：恶心或呕吐、畏光畏声、对气味、运动敏感等。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 尽管这是国际标准，但发布以来一直在受到质疑，鉴于一些的数据表明，每月发作8天以上的患者，可能与每月发作<span style="font-size: 18px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "Helvetica Neue";">15天以上的患者一样，同样在工作或生活上处于失能状态。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 每年约有<span style="font-size: 18px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "Helvetica Neue";"> 2% 至<span style="font-size: 18px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "Helvetica Neue";"> 3% 的发作性偏头痛患者进展为慢性偏头痛。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 虽然专家们目前仍然不清楚发生这种转变的确切原因，但已经确定了一些风险因素，其中包括：性别因素(女性）、偏头痛的频繁诱发、对治疗反应迟钝、肥胖、突发意外（创伤后遗症）、低收入（缺乏保健）、和咖啡因过量。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 另一个风险因素是为了阻止偏头痛，而过度使用非处方、或处方类紧急止痛药物，其中一些药物如阿片类药物或巴比妥类药物，会使发作性偏头痛发展为慢性偏头痛的可能性大幅增加，使用其他如非甾体抗炎药和曲普坦类药物的风险则相对较低。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 患有慢性偏头痛的患者，一般较高概率会有其他合并症，如睡眠障碍、焦虑、抑郁、心血管疾病和其他慢性疼痛状况。而这些合并症会增加发作性偏头痛转变为慢性偏头痛的风险。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 另一个促成慢性偏头痛的风险因素，是皮肤异感症，患者由于皮肤上（尤其是在头部和颈部的皮肤），本身不会产生痛感的刺激，却因为中枢痛觉神经元的敏感化而导致频发偏头痛。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 大约有 1/4的慢性偏头痛患者成功恢复为发作性偏头痛，或完全缓解。这可能是自发的，也可能是有效治疗的结果。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 美国头痛协会建议，对于每月发作4次以上、或每周需要用药2次以上的偏头痛患者，需要采取预防性治疗措施。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 建议患者多尝试几种方案，以找到最适合自己的预防性治疗方式。这种尝试是目前阻止发作性偏头痛升级为慢性偏头痛的重要方法。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 目前有一些较新的、副作用较小的预防手段和紧急治疗方法（anti-CGRP），可以有效帮助慢性偏头痛患者恢复为发作性偏头痛，或得到完全缓解。