-
The international Classification of
Headache disorders, 3rd Editon
头痛分类的国际标准
(ICHD-III)
< br>概述：
头痛分为三大组：原发性头痛；继发性头痛；脑神经痛、
< br>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
无先兆偏头痛的诊断标准：
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
）
< br>
Migraine without
aura
无先兆偏头痛
Migraine with
aura
有先兆偏头痛
Migraine with typical aura
Typical aura with
headache
Typical
aura without headache
Migraine with brainstem aura
Hemiplegic
migraine
偏瘫型偏头痛
Familial hemiplegic migraine
(FHM)
—家族性
Familial hemiplegic migraine type 1
(FHM1)
Familial
hemiplegic migraine type 2 (FHM2)
Familial hemiplegic
migraine type 3 (FHM3)
Familial hemiplegic migraine, other
loci
Sporadic
hemiplegic migraine
—散发性
Retinal migraine
Chronic
migraine
慢性偏头痛
Complications of
migraine
偏头痛并发症
Status
migrainosus
偏头痛持续状态
Persistent aura without
infarction
A
：符合
B-D
特征，至少发作
5
< br>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：
先兆性偏头痛的诊断标准：
恶心和<
/p>
/
或呕吐、畏光和畏声
E
：不能归因于其他
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<
/p>
：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
Migrainous
infarction
偏头痛脑梗死
Migraine aura-triggered
seizure
Probable
migraine
很可能的偏头痛
Probable migraine without
aura
Probable
migraine with aura
Episodic syndromes that may be
associated with
migraine
可能与偏头痛有关的发作性综合征
Recurrent gastrointestinal
disturbance
慢性偏头痛：偏头痛发作每月
>15
天，连续
3
个
月以上
vomiting
syndrome
周期性呕吐
Abdominal
migraine
腹型偏头痛
Benign paroxysmal
vertigo
良性发作性眩晕
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-7
d
，慢性者可持续不缓解
Infrequent episodic tension-type
headache
偶发性
<1d/<
/p>
月，至少
10
次以上（
< br><12d/
年）
Infrequent episodic tension-type
headache associated with pericranial
tenderness
Infrequent episodic tension-type
headache not associated with pericranial
tenderness
Frequent
episodic
tension-type
headache
频发性
≥
1d/
月，但
<15d
，至少发作
10
次以上（≥
12d/
年但
<180
d
）
Frequent episodic tension-type headache
associated with pericranial tenderness
Frequent episodic tension-
type headache not associated with pericranial
tenderness
Chronic tension-type
headache
慢性紧张型头痛
每
月发作≥
15d
，
3
< br>个月以上
Chronic
tension-type headache associated with pericranial
tenderness
Chronic tension-type headache not
associated with pericranial tenderness
Probable tension-type
headache
很可能的紧张型头痛
丛集性头痛的诊断标准：
偏头痛持续
状态：单次发作持续
72
小时以上
Probable infrequent
episodic tension-type headache
Probable frequent episodic
tension-type headache
Probable chronic tension-type
headache
A
：至少符合
B-D
的
5
次以上
的发作
B
：单侧、眼眶、上眼眶及<
/p>
/
或颞部重度或极重度疼痛，
如不治疗持
续
15min-180min
；
3.
三叉自主神经性头痛（
Trigemi
nal autonomic cephalalgias
）
Cluster
headache
丛集性头痛
Episodic cluster
headache
发作性丛集性头痛
Chronic cluster
headache
慢性丛集性头痛
（
复发作大于
1
年无缓解期，或缓解期
<
1
个月）
Paroxysmal hemicrania
Episodic paroxysmal
hemicrania
Chronic paroxysmal
hemicrania
Short-lasting unilateral neuralgiform
headache attacks
Short-lasting unilateral neuralgiform
headache attacks with conjunctival injection and
tearing (SUNCT)
Episodic SUNCT
Chronic SUNCT
Short-lasting unilateral neuralgiform
headache attacks with cranial autonomic symptoms
(SUNA)
Episodic
SUNA
Chronic
SUNA
Hemicrania
continua
Probable trigeminal autonomic
cephalalgia
Probable cluster headache
Probable paroxysmal
hemicrania
Probable short-lasting unilateral
neuralgiform headache attacks
Probable hemicrania
continua
4.
其它的原发性头痛
Other primary headache disorders
）
Primary cough
headache
原发性咳嗽头痛
Probable primary cough
headache
Primary
exercise headache
原发性运动性头痛
Probable primary exercise
headache
Primary
headache associated with sexual
activity
原发性性活动伴随的头痛
Probable primary headache
associated with sexual activity
Primary thunderclap
headache
原发性霹雳头痛
Cold-stimulus
headache
冷刺激性头痛
Headache attributed to
external application of a cold stimulus
Headache attributed to
ingestion or inhalation of a cold
stimulus
Probable cold-stimulus
headache
Headache probably attributed to
external application of a cold stimulus
Headache probably
attributed to ingestion or inhalation of a cold
stimulus
External-pressure headache
External-compression
headache
A
：持续性头痛，
符合
B-C
的标准
NDPH
诊断标准：
External-traction
headache
Probable external-pressure
headache
Probable external-compression
headache
Probable external-traction
headache
Primary
stabbing headache
Probable primary stabbing
headache
Nummular headache
Probable nummular
headache
Hypnic
headache
Probable hypnic headache
New daily persistent
headache (NDPH)
新症每日持续性头痛
Probable new daily
persistent headach
C
：
Present for>3
months
D
：除外其他疾患
B
：
Distinct and
clearly remembered onset, with pain becoming
continuous and unremitting within 24
hours
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
）
Acute headache attributed to traumatic
injury to the head
Acute headache attributed to moderate
or severe traumatic injury to the head
Acute headache attributed
to mild traumatic injury to the head
Persistent headache
attributed to traumatic injury to the
head
Persistent
headache attributed to moderate or severe
traumatic injury to the head
Persistent headache
attributed to mild traumatic injury to the
head
Acute
headache attributed to whiplash
Persistent headache
attributed to whiplash
Acute headache attributed to
craniotomy
Persistent headache attributed to
craniotomy
6.
缘于头颈
部血管疾病的头痛（
Headache attributed to cranial
or cervical vascular disorder
）
Headache attributed to ischaemic stroke
or transient ischaemic attack
Headache attributed to
ischaemic stroke (cerebral infarction)
Headache attributed to
transient ischaemic attack (TIA)
Headache attributed to non-
traumatic intracranial haemorrhage
Headache attributed to non-
traumatic intracerebral
haemorrhage
非外伤性脑出血
Headache attributed to non-
traumatic subarachnoid haemorrhage
(SAH)
Headache
attributed to non-traumatic acute subdural
haemorrhage (ASDH)
急性硬膜下血肿
Headache attributed to
unruptured vascular
malformation
未破裂的血管畸形
Headache attributed to
unruptured saccular
aneurysm
囊性动脉瘤
Headache attributed to arteriovenous
malformation (AVM)
动静脉畸形
Headache attributed to
dural arteriovenous fistula (DAVF)
硬膜动静脉瘘
Headache attributed to cavernous
angioma
海绵窦血管瘤
Headache attributed to
encephalotrigeminal or leptomeningeal angiomatosis
(Sturge Weber syndrome)
脑三叉神经或软脑膜血管瘤病
Headache attributed to
arteritis
Headache attributed to giant cell
arteritis (GCA)
颞动脉炎
Headache attributed to
primary angiitis of the central nervous system
(PACNS)
Headache
attributed to secondary angiitis of the central
nervous system (SACNS)
1.
5
0
岁以上发病：
50
岁以上发现症状<
/p>
颞动脉炎诊断标准：美国风湿学会
19
90
年
2
．新发的头痛：出现新发的局限性头痛
Headache
attributed to cervical carotid or vertebral artery
disorder
颈动脉或锥动脉疼痛
Headache or facial or neck
pain attributed to cervical carotid or vertebral
artery
dissection
动脉夹层
Post-endarterectomy
headache
内膜剥脱术后头痛
Headache attributed to carotid or
vertebral
angioplasty
颈动脉血管成型术头痛
Headache attributed to
cerebral venous thrombosis (CVT)
脑静脉血栓形成
Headache attributed to
other
acute intracranial arterial
disorder
Headache attributed to an intracranial
endovascular procedure
Angiography headache
Headache attributed to
reversible cerebral vasoconstriction syndrome
(RCVS)
Headache
probably attributed to reversible cerebral
vasoconstrictionsyndrome (RCVS)
Headache attributed to
intracranial arterial
dissection
颅内动脉夹层
Headache attributed to genetic
vasculopathy
Cerebral Autosomal Dominant
Arteriopathy with Subcortical Infarcts and
Leukoencephalopathy (CADASIL)
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：
50m
m/h
以上
Mitochondrial Encephalopathy, Lactic
Acidosis and Stroke-like episodes
(MELAS)
Headache
attributed to another genetic
vasculopathy
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
）
Headache attributed to increased
cerebrospinal fluid
pressure
颅内压增高
Headache attributed to idiopathic
intracranial hypertension (IIH)
Headache attributed to
intracranial hypertension secondary to metabolic,
toxic or hormonal causes
Headache attributed to intracranial
hypertension secondary to hydrocephalus
Headache attributed to low
cerebrospinal fluid
pressure
颅内压低下
Post-dural puncture
headache
腰穿后
CSF fistula
headache
脑脊液漏
Headache attributed to spontaneous
intracranial
hypotension
自发性低颅压
Headache attributed to non-
infectious inflammatory
disease
非感染性炎性疾病
Headache attributed to
neurosarcoidosis
Headache attributed to aseptic (non-
infectious) meningitis
Headache attributed to other non-
infectious inflammatory disease
Headache attributed to
lymphocytic hypophysitis
Syndrome
of
transient
Headache
and
Neurological
Deficits
with
cerebrospinal
fluid
Lymphocytosis
(HaNDL)
Headache attributed to intracranial
neoplasia
颅内新生物
Headache attributed to intracranial
neoplasm
Headache attributed to colloid cyst of
the third ventricle
Headache attributed to carcinomatous
meningitis
癌性脑膜炎
Headache attributed to hypothalamic or
pituitary hyper- or hyposecretion
Headache attributed to
intrathecal injection
鞘内注射
Headache attributed to
epileptic seizure
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