年国际头痛新分类和诊断标准
国际头痛新分类和诊断标准
• 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
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％。
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。
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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
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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。
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CATALOGUE
国际头痛新分类
偏头痛
最新头痛疾病的国际分类-PPT文档
最早的是60年代两个相似的头痛分类，列出了当 时被认可的一些头痛疾患，只能算是描述，而不 是诊断标准。
1988年国际头痛协会IHS头痛分类委员会首次出 版了“头痛疾患国际的分类（ICHD）”，立即被 全世界广泛接受并应用于临床。虽然当时的诊断 标准基于专家的意见，但随后的研究证明完全可 靠有效。而且几乎不需要进一步改进。
先兆是局灶神经系统体征典型地发生在头 痛之前或伴随头痛一起发生，或也可只有 先兆而无头痛。
先兆通常经5－20分钟发展起来，持续20－ 60分钟。
视觉先兆最为普遍,其次是无力和失语。
1.2 有先兆的偏头痛
1.2.1 有偏头痛的典型先兆的头痛
头痛满足无先兆偏头痛的诊断标准
1.2.2 无偏头痛的典型先兆的头痛
1.5.1 慢性偏头痛
偏头痛≥15天/月，持续3个月以上，无药物滥用。
如有药物滥用（急性抗偏头痛药物和/或混合止痛 药≥10天/月）或普通止痛药服用15天/月，则诊断 为药物滥用性头痛8.2，如停药后症状改善，则更 支持该诊断。否则诊断为伴可能药物滥用的可能 偏头痛。
1.5.2 偏头痛持续状态
尽管经过治疗，头痛仍持续72小时以上。 伴虚弱。如不伴虚弱，则诊断无先兆的可
能偏头痛。
1.5.3 无梗塞的持续先兆
先兆持续2周以上 无梗塞的影像学证据
1.5.4 偏头痛性梗塞
7天内1个或更多个偏头痛先兆不能完全 恢复，和/或相关的缺血性梗死的神经影 像学定位依据。
与其它原因引起的中风的鉴别诊断：
ICHD-I使得研究的进展，并导致了更完善的 ICHD-II的提出。
ICHD-II分为：4类原发性头痛、8 类继发性头痛和另外的2类
头痛疾病的国际分类