王秀丽头痛的国际分类(第三版)中文

2021年2月6日发(作者：梅毒潜伏期)
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
。

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

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
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）

1.2.3.1 Familial hemiplegic migraine (FHM)
—家族性

?

肢体无力症状（偏瘫型偏头痛）

1.2.3.1.1 Familial hemiplegic migraine type 1 (FHM1)
?

脑干症状（基底型偏头痛）

1.2.3.1.2 Familial hemiplegic migraine type 2 (FHM2)


视网膜症状（视网膜型偏头痛）

C
：至少有以下特征中的
2
项

1.2.3.1.3 Familial hemiplegic migraine type 3 (FHM3)
?

至少
1
个先兆逐渐发展的过程
>5min
，和
/
或

1.2.3.1.4 Familial hemiplegic migraine, other loci
不同先兆接连发生过程
>5min
1.2.3.2 Sporadic hemiplegic migraine
—散发性

?

每个先兆症状持续时间
5-60min
1.2.4 Retinal migraine
?

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

1.3 Chronic migraine
慢性偏头痛

D
：不能归因于其他

1.4 Complications of migraine
偏头痛并发症


肢体无力症状可以持续至
72h
，部分患者肢体无力
1.4.1 Status migrainosus
偏头痛持续状态

感可持续数周；

1.4.2 Persistent aura without infarction

若患者先兆持续
1
周以上，称为无梗死的持续先兆
1.4.3 Migrainous infarction
偏头痛脑梗死

一般先兆症状多为双侧，可持续数月或数年

1.4.4 Migraine aura-triggered seizure

若先兆持续
60min
至
1
周以内，则称为
propable
1.5 Probable migraine
很可能的偏头痛

migraine with aura

若出现影像学梗死灶，则称为
偏头痛性脑梗死


1.5.1 Probable migraine without aura
（年轻女性，后循环比较常见）

1.5.2 Probable migraine with aura
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

1.6 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 disturbance
慢性偏头痛：偏头痛发作每月
>15
天，连续
3
个月以上

1.6.1.1Cyclical vomiting syndrome
周期性呕吐

偏头痛持续状态：单次发作持续
72
小时以上

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
1

2.1.2 Infrequent episodic tension- type headache not associated with pericranial tenderness
2.2
Frequent episodic tension- type headache
频发性
≥
1d/
月，
但
<15 d
，
至少发作
10
次以上
（≥
12d/
年但
<180d
）

2.2.1 Frequent episodic tension-type headache associated with pericranial tenderness
2.2.2 Frequent episodic tension- type headache not associated with pericranial tenderness
2.3
Chronic tension-type headache
慢性紧张型头痛

每月发作≥
15d
，
3
个月以上

2.3.1 Chronic tension-type headache associated with pericranial tenderness
2.3.2 Chronic tension- type headache not associated with pericranial tenderness
2.4 Probable tension-type headache
很可能的紧张型头痛

丛集性头痛的诊断标准：

2.4.1 Probable infrequent episodic tension- type headache
A
：至少符合
B-D
的
5
次以上的发作

2.4.2 Probable frequent episodic tension-type headache
B
：单侧、眼眶、上眼眶及
/
或颞部重度或极重度疼痛，
2.4.3 Probable chronic tension-type headache
如不治疗持续
15min-180min
；

3.
三叉自主神经性头痛（
Trigeminal autonomic cephalalgias
）

C
：伴随至少以上一项症状

同侧结膜充血
/
流泪

3.1 Cluster headache
丛集性头痛

3.1.1 Episodic cluster headache
发作性丛集性头痛

3.1.2 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）

同侧鼻腔充血
/
流鼻水

同侧眼皮水肿

同侧前额及脸部出汗

同侧瞳孔缩小
/
眼睑下垂

不安的症状或躁动

D
：发作频率隔日
1
至
8
次
/
日

E
：除外其他疾患

3.2 Paroxysmal hemicrania
3.2.1 Episodic paroxysmal hemicrania
3.2.2 Chronic paroxysmal hemicrania
3.3 Short- lasting unilateral neuralgiform headache attacks
3.3.1 Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)
3.3.1.1 Episodic SUNCT
3.3.1.2 Chronic SUNCT
3.3.2 Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA)
3.3.2.1 Episodic SUNA
3.3.2.2 Chronic SUNA
3.4 Hemicrania continua
3.5 Probable trigeminal autonomic cephalalgia
3.5.1 Probable cluster headache
3.5.2 Probable paroxysmal hemicrania
3.5.3 Probable short-lasting unilateral neuralgiform headache attacks
3.5.4 Probable hemicrania continua
4.
其它的原发性头痛

Other primary headache disorders
）

4.1 Primary cough headache
原发性咳嗽头痛

4.1.1 Probable primary cough headache
4.2 Primary exercise headache
原发性运动性头痛

4.2.1 Probable primary exercise headache
4.3 Primary headache associated with sexual activity
原发性性活动伴随的头痛

4.3.1 Probable primary headache associated with sexual activity
4.4 Primary thunderclap headache
原发性霹雳头痛

2

4.5 Cold- stimulus headache
冷刺激性头痛


4.5.1 Headache attributed to external application of a cold stimulus
4.5.2 Headache attributed to ingestion or inhalation of a cold stimulus
4.5.3 Probable cold-stimulus headache
4.5.3.1 Headache probably attributed to external application of a cold stimulus
4.5.3.2 Headache probably attributed to ingestion or inhalation of a cold stimulus
4.6 External-pressure headache
NDPH
诊断标准：

4.6.1 External-compression headache
A
：持续性头痛，符合
B-C
的标准

4.6.2 External-traction headache
B
：
Distinct and clearly remembered onset, with pain becoming
continuous and unremitting within 24 hours
4.6.3 Probable external-pressure headache
4.6.3.1 Probable external-compression headache
C
：
Present for>3 months

D
：除外其他疾患

4.6.3.2 Probable external-traction headache

慢性头痛，起病急，可清晰回忆发病时间为哪一天

4.7 Primary stabbing headache
4.7.1 Probable primary stabbing headache
4.8 Nummular headache
4.8.1 Probable nummular headache
4.9 Hypnic headache
4.9.1 Probable hypnic headache
4.10 New daily persistent headache (NDPH)
新症每日持续性头痛

4.10.1 Probable new daily persistent headach

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

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 head
5.1.1 Acute headache attributed to moderate or severe traumatic injury to the head
5.1.2 Acute headache attributed to mild traumatic injury to the head
5.2 Persistent headache attributed to traumatic injury to the head
5.2.1 Persistent headache attributed to moderate or severe traumatic injury to the head
5.2.2 Persistent headache attributed to mild traumatic injury to the head
5.3 Acute headache attributed to whiplash
5.4 Persistent headache attributed to whiplash
5.5 Acute headache attributed to craniotomy
5.6 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
）

6.1 Headache attributed to ischaemic stroke or transient ischaemic attack
6.1.1 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 haemorrhage
6.2.1 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

3

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 arteritis
6.4.1
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
％。
特异性
91
．
2
％可能分类为颞动脉炎。< br>



6.5 Headache attributed to cervical carotid or vertebral artery disorder
颈动脉或锥动脉疼痛

6.5.1 Headache or facial or neck pain attributed to cervical carotid or vertebral
artery dissection
动脉夹层

6.5.2 Post-endarterectomy headache
内膜剥脱术后头痛

6.5.3 Headache attributed to carotid or vertebral angioplasty
颈动脉血管成型术头痛

6.6 Headache attributed to cerebral venous thrombosis (CVT)
脑静脉血栓形成

6.7 Headache attributed to
other
acute intracranial arterial disorder
6.7.1 Headache attributed to an intracranial endovascular procedure
6.7.2 Angiography headache
6.7.3 Headache attributed to reversible cerebral vasoconstriction syndrome (RCVS)
6.7.3.1 Headache probably attributed to reversible cerebral vasoconstrictionsyndrome (RCVS)
6.7.4 Headache attributed to intracranial arterial dissection
颅内动脉夹层

6.8 Headache attributed to genetic vasculopathy
6.8.1 Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL)
6.8.2 Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like episodes (MELAS)
6.8.3 Headache attributed to another genetic vasculopathy
6.9 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 causes
7.1.3 Headache attributed to intracranial hypertension secondary to hydrocephalus
4