㈸−5 |
一次性雷鳴頭痛はどのように診断し治療するか |
論文抄録 |
Follow-up studies of idiopathic thunderclap headache (ITH) have found no subsequent subarachnoid hemorrhage (SAH) or other serious neurological disease, but the effect on life-style has not been studied. To assess the long-term outcome of patients with ITH in general practice we prospectively followed 93 patients with an episode of ITH during 1988-1993, of whom 77 were referred to hospital. ITH was defined as a sudden, unusually severe headache that started within 1 min, lasted at least 1 h, and for which no underlying cause was found. These patients were treated in 252 general practices. Outcome measures were subsequent SAH, subsequent headaches, absence from work, and diminished daily functioning. Patients were followed up by their general practitioner for a median of 5 years (range 1-10). Three patients died, all from non-neurological diseases. No subsequent SAH was diagnosed in any of the 93 patients. Recurrent attacks of ITH occurred in 8 patients, and 13 developed new tension headache or migraine. Absence from work because of headache was recorded in 11 patients, and in the overall group 6 patients were dependent on welfare. In only one-half of patients (n=52) did the general practitioner judge the level of daily functioning to be similar to that before the index episode of ITH. Thus, although no episodes of SAH occurred after ITH during long-term follow-up, one-half of patients with ITH had a lower level of daily functioning, and one-eighth had reduced working capacity, specifically because of headache. |
文献 PubMed−ID |
PMID: 10552244 |
エビデンスレベル |
IV |
文献タイトル (日本語) |
一般的診察における特発性雷鳴頭痛の追跡 |
目的 |
一般診療における雷鳴頭痛を伴った患者を長期追跡し,更に評価する事. |
研究デザイン |
追跡研究 |
研究施設 |
オランダの University Department of Neurology, Heidelberglaan |
研究期間 |
1988 年から 1993 年 |
対象患者 |
開業医から紹介された患者で,激しい頭痛が 1 分以内に発症し,少なくとも 1 時間持続した患者 93 名. |
介入 |
CT にてくも膜下出血,器質性頭蓋内病変を認めたものは除外した. |
主要評価項目とそれに用いた 統計学的手法 |
追跡期間中のくも膜下出血,雷鳴頭痛の再発,緊張性頭痛あるいは片頭痛に引き続いて起こった雷鳴頭痛,雷鳴頭痛再発にあたり専門医への相談,欠勤の有無,また経過中快適な生活が送れたか,雷鳴頭痛発症前の状態に戻ったか否かを評価した. |
結果 |
経過中,くも膜下出血をきたしたものは無かった.雷鳴頭痛の再発は91人中8人に認められた( 2 名脱落).,緊張性頭痛あるいは片頭痛に引き続いて起こった雷鳴頭痛は,89人中13人に認められた( 4 名脱落).雷鳴頭痛再発にあたり他専門医への相談は,89人中16人に認められた(神経科医,精神科医,耳鼻科医,その他).雷鳴頭痛による欠勤は,71人中11人に認められた.経過中に快適な生活を送ることが出来たのは,90人中6人であった.雷鳴頭痛発症前の状態に戻れたのは,85人中52人であった. |
結論 |
雷鳴頭痛は緊張性頭痛あるいは片頭痛を患っている人に引き続いて発症することが多い.雷鳴頭痛は,発症後に労務遂行や社会生活にまで支障を来す. |
コメント |
雷鳴頭痛患者を長期にわたりフォローアップし,雷鳴頭痛が日常生活,社会生活にまで影響を及ぼすと報告しており,重要な研究である. |
作成者 |
久保慶高 |
4) Linn FH, Rinkel GJ, Algra A, van Gijn J. Headache characteristics in |
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論文抄録 |
One third of patients with aneurysmal subarachnoid haemorrhage (ASAH) present with headache only. A prompt diagnosis is crucial, but these patients must be distinguished from patients with non-haemorrhagic benign thunderclap headache (BTH). The headache characteristics and associated features at onset in subarachnoid haemorrhage and benign thunderclap headache were studied to delineate the range of early features in these conditions. In this prospective study, one of two observers interviewed 102 patients with acute severe headache by means of a standard questionnaire. The patients were alert on admission and had no focal deficits. ASAH was subsequently diagnosed in 42 patients, non-aneurysmal perimesencephalic haemorrhage (PMH) in 23 patients, and BTH in 37 patients. Headache developed almost instantaneously in 50% of patients with ASAH, 35% of patients with PMH, and 68% of patients with BTH and within 1 to 5 minutes in 19%, 35%, and 19%, respectively. Loss of consciousness was reported in 26% of patients with ASAH, 4% of patients with PMH and 16% of patients with BTH, and transient focal symptoms in 33%, 9%, and 22% respectively. Seizures and double vision had occurred only in ASAH. Vomiting and physical exertion preceding the onset of headache were more frequent in patients with ASAH (69% and 50%) and those with PMH (83% and 39%) than in those with BTH (43% and 22%). Headache developed almost instantaneously in only half the patients with aneurysmal rupture and in two thirds of patients with benign thunderclap headache. In patients with acute severe headache, female sex, the presence of seizures, a history of loss of consciousness or focal symptoms, vomiting, or exertion increases the probability of ASAH, but these characteristics are of limited value in distinguishing ASAH from BTH. Aneurysmal rupture should be considered even if focal signs are absent and the headache starts within minutes. |
文献 PubMed − ID |
PMID: 9810961 |
エビデンスレベル |
IV |
文献タイトル ( 日本語 ) |
くも膜下出血と良性雷鳴頭痛の頭痛の特徴 |
目的 |
脳動脈瘤破裂患者,中脳周囲限局型くも膜下出血患者,良性雷鳴頭痛 患者における頭痛の特徴を調べる |
研究デザイン |
適切な患者スペクトラムについての客観的な比較 |
研究施設 |
オランダの Utrecht University Hospital |
研究期間 |
1992 年 1 月から 1994 年 10 月 |
対象患者 |
脳動脈瘤破裂によるくも膜下出血を暗示させるような突然の頭痛を呈し,救急外来を受診した102人 |
介入 |
全員に CT を行い,その所見でくも膜下出血を認めない場合は腰椎穿刺を行った |
主要評価項目とそれに用いた統計学的手法 |
脳動脈瘤破裂,中脳周囲限局型くも膜下出血,良性雷鳴頭痛患者( CT scan ,腰椎穿刺でくも膜下出血が否定)において,頭痛の性状,程度,発症形式,持続時間,以前の頭痛の既往,随伴症状などを調べた |
結果 |
102人中,脳動脈瘤破裂患者が42人(41%),予後良好といわれる中脳周囲限局型くも膜下出血患者が23人(23%),良性雷鳴頭痛患者が37人(36%)認めた.良性雷鳴頭痛患者に比べて,脳動脈瘤破裂によるくも膜下出血患者は女性 (relative risk [RR]=1.6) ,重労働 / 力み時の発症 (RR=2.3) ,嘔吐 (RR=1.6) ,意識消失 (RR=1.6) ,神経脱落症状 (RR=1.5) が多かった.てんかん発作と複視は脳動脈瘤破裂によるくも膜下出血患者でのみ認められた. |
結論 |
雷鳴頭痛患者が受診した際,女性,てんかん発作,意識消失の既往,神経脱落症状,嘔吐,重労働 / 力み時の発症なら脳動脈瘤破裂によるくも膜下出血を鑑別しなければならない. CT または腰椎穿刺が必要である. |
コメント -1 |
予後良好といわれる中脳周囲限局型くも膜下出血患者の割合が多すぎる. |
コメント -2 |
MRI の FLAIR 画像も有用である |
作成者 |
久保慶高 |