頭痛診療Update；一次性頭痛

抄録

Headache is the most common chief complaint among the patients visiting neurology out–patient clinic. A survey done at Tatsuoka Neurology Clinic showed 84.0% were given an IHS diagnosis of migraine, 3.0% cluster headache and 7.0% tension–type headache at our clinic. Therefor it is important to understand the diagnosis and the treatment of these primary headaches for the paramedical staffs of neurology clinic.

The diagnosis of each headache is carried out according to criteria for The International Classification of Headache Disorders, 3rd edition (beta version). The diagnostic criteria of migraine without aura, infrequent episodic tension type headache and cluster headache were shown in the tables.

The treatment of migraine includes acute treatment and prophylactic therapy. Clinical Practice Guideline for Chronic Headache 2013 recommends NSAIDs for mild to moderate headache, and triptans for moderate to severe headache, or even mild to moderate headache when NSAIDs were ineffective. For acute treatment, attention has to be paid to medication–overuse headache of which diagnostic criteria is shown in Table 5. Prophylactic therapy is recommended for patients with migraine attacks two times or more or 6 days or more a month, for patients with poor response of acute treatment, and for patient with contraindication of acute treatment. The guideline recommends valproic acid, propranolol, amitriptyline and lomerizine for prophylactic treatment.

Frequent episodic tension–type headache and chronic tension–type headache require acute or prophylactic treatment. NSAIDs are recommended for acute treatment and amitriptyline for prophylactic treatment.

For cluster headache, subcutaneous injection of sumatriptan and pure oxygen delivered via a side tube of a face mask at 7L/minute for 15 minutes are recommended. Sumatriptan nasal spray and oral zolmitriptan are also useful. For prophylactic treatment of cluster headache verapamil and corticosteroids are recommended.