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目的 研究小儿慢性头痛的临床特点与病因特点。方法 对 2 0 0 0年 10月至 2 0 0 1年 9月复旦大学附属儿科医院收治的 81例慢性头痛患儿进行随访 ,慢性头痛 3～ 4个月以上 ,包括详细的病史、体检与实验室检查资料。结果 ( 1) 81例中器质性头痛病因占 13例 ( 16 % ) ,分别为隐球菌性脑膜炎 3例、多发性大动脉炎 1例、颅内肿瘤 3例、远视 2例、前庭神经炎 1例、鼻窦炎 2例 ;6 8例 ( 84 % )为非器质性原因 ,癔症性头痛 3例、儿童偏头痛 6 5例。 ( 2 )小儿偏头痛的特点 :多数头痛持续时间较短 ,先兆症状不多见 ;常见头痛部位依次为前额( 2 6 % )、颞部 ( 16 % ) ,且 5 7%以双侧头痛为主 ;大多数儿童并非表现搏动性头痛 ,伴随症状以胃肠道症状突出。( 3)实验室检查中经脑多普勒显示的大脑痉挛血管的部位与头痛部位无相关性 ;EEG检查多无明显异常。结论 偏头痛是儿童慢性周期性头痛的常见原因 ,详细询问病史及体格检查 ,必要的实验室及影像学检查外 ,强调对头痛病例的随访至关重要 ,以免误诊 ;儿童偏头痛有其年龄特点
Objective To study the clinical features and etiology of chronic headache in children. Methods Totally 81 children with chronic headache who were admitted to the Pediatric Hospital of Fudan University from October 2000 to September 2001 were followed up for more than 3 to 4 months, including detailed medical history, physical examination and experiment Room check information. Results (1) 81 cases of organic headache accounted for 13 cases (16%), were cryptococcal meningitis in 3 cases, 1 case of multiple arteritis, 3 cases of intracranial tumors, hyperopia in 2 cases, vestibular neuritis 1 case, 2 cases of sinusitis; 68 cases (84%) were non-organic causes, 3 cases of hysteria headache and 65 cases of child migraine. (2) The characteristics of pediatric migraine: the short duration of most of the headaches, rare symptoms of aura; common headache followed by forehead (26%), temporal (16%), and 57% of bilateral headache Lord; most children do not show pulsatile headache, with symptoms of gastrointestinal symptoms prominent. (3) There was no correlation between the site of cerebral vasospasm and the site of headache in laboratory examination by cerebral Doppler. There was no obvious abnormality in EEG examination. Conclusions Migraine is a common cause of chronic headaches in children. Examine medical history and physical examination in detail. Besides the necessary laboratory and imaging studies, it is important to emphasize the follow-up of headache cases so as to avoid misdiagnosis. Migraine children have their age characteristics