儿童发作性头痛的诊断探讨

Diagnosis of Childhood Paroxysmal Headache

摘要:

目的：探讨儿童发作性头痛的诊断和鉴别诊断。方法：分析122例发作性头痛患儿的临床过程、脑电图(EEG)或视频脑电图(V-EEG)、经颅超声多普勒(TCD)描记资料，并予以诊断、治疗和临床随访。结果：122例患者中，85例为偏头痛，35例为神经性头痛，1例头痛性癫痫，1例为颅内肿瘤。EEG和V-EEG结果显示大部分在正常范围，部分异常EEG中以弥散性慢波增多为主，仅有1例EEG显示有癫痫波；而TCD结果表明74例患儿脑动脉血流速度有不同程度增快。结论：儿童发作性头痛以偏头痛、神经性头痛多见；头痛的诊断必须依靠临床表现、EEG和TCD等检查结果综合判断。头痛性癫痫临床少见，以头痛为主诉的儿童不应轻易诊断为癫痫。

Abstract:

OBJECTIVE: To study the diagnosis and differential diagnosis of childhood paroxysmal headache. METHODS: The clinical data of 122 children with paroxysmal headache, including the case history, manifestation and physical examination, electroencephalography (EEG), video electroencephalography (V EEG) and transcranial Doppler (TCD) findings, were studied retrospectively.RESULTS: Migraine was found in 85 of the 122 patients, nervous headache in 35, headache epilepsy in 1, and intracranial tumour in 1. Most patients displayed normal EEG and V EEG; the others showed mainly an increase of diffused inactive echoes in EEG and only 1 showed scattered epileptic waves. The TCD of 74 patients showed a significant increase of cerebral blood flow velocity. CONCLUSIONS: Migraine and nervous headache are frequent causes of childhood paroxysmal headache. Diagnosis should be made based on clinical manifestations, EEG and TCD findings. Headache epilepsy is a rare clinical condition and it is not reliable to make a diagnosis of childhood epilepsy for the child who only has heahache as the chief complaint.