头痛的诊断策略课件.ppt

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,常见的头痛,-“,你头痛，所以我头痛”,1,一、头痛定义,头痛,（,headache,）,狭义：头颅上半部，包括眉弓、耳轮 上缘和枕外隆突连线以上部位的疼痛,广义,:,泛指头、面部，甚至枕、颈部疼痛,2,二、,颅外,痛敏感结构,皮肤、五官粘膜,皮下组织、帽状腱膜,头、颈部肌肉：颞肌、斜方肌、头,/,颈夹肌和颈深部肌,动脉：非常丰富,前额,-ICA,分支,颞枕部,-ECA,分支,颅外感觉神经：,三叉神经头面部分支,颈神经丛分支,颅骨骨膜：颅底骨膜,痛觉不敏感,:,颅骨、板障静脉,3,二、头痛,-,颅内,痛敏感结构,硬脑膜,duramater,：,颅底最敏感,颅顶硬膜动脉旁,5mm,内,静脉窦边缘,蛛网膜,arachnoid,：,颅底大血管周围的部分,颅内动脉,颅神经：,V,、,VII,、,IX,、,X,无痛感,:,脑实质,parenchyma,、室管膜,ependyma,脉络 丛,choroid,、脑静脉,4,三、头痛机制,1.,颅内外动脉的扩张（,血管性头痛,）；,2.,颅内痛觉敏感组织被牵引或移位（牵引性头痛,占位、高颅压、低颅压）；,3.,颅内外感觉敏感组织发生炎症（例如脑膜刺激性头痛）；,4.,颅外肌肉的收缩（紧张性或肌收缩性头痛）；,5.,传导痛觉的颅神经和颈神经直接受损或发生炎症（,神经炎,性头痛）；,6.,五官病变疼痛的扩散（牵涉性头痛）等。,7.,精神因素,5,四、头痛分类,(1)原发性头痛：,偏头痛；,紧张型头痛；,丛集性头痛和其他三叉 自主神经性头痛；,其他原发性头痛,（,刺激性,、咳嗽、奋力、性活动、睡眠、连续性半侧头痛、,原发性霹雳头痛、新症每日持续性头痛）。,(2)继发性头痛：,缘于头颈部外伤的头痛；,缘于头颈部血管病变的头痛；,缘于非血管性颅 内疾病的头痛；,缘于某一物质或某一物质戒断的头痛；,缘于感染的头痛；,缘于内环境紊乱的头痛；,缘于头颅、颈、眼、耳、鼻、鼻窦、牙、口或其他头面部结构病变的头面痛；,缘于,精神疾患,的头痛；,(,3,)脑神经痛,、,颜面痛,和,其他类头痛,6,五、头痛的诊断程序,详细询问病史和体检,有无值得警惕的发现,考虑原发性头痛、推敲,有无不典型之处,明确原发性头痛类型,结合辅助检查判断有无引起,继发性的疾病,明确继发性头痛类型,无,无,无,有,有,有,?,7,六、头痛,-,问诊要点,起病方式,【onset】,：,急性、亚急性、慢性,起病后：,进行性加重,持续存在,反复发作,8,头痛,-,问诊要点,头痛部位,【location】,：,前额？后枕？颞侧？,单侧？双侧？,全头？,对于定位和定性仅有参考价值,颅外病变的头痛与病灶位置一致,颅内病变的头痛部位和病灶不一定一致,9,头痛,-,问诊要点,头痛性质,【character】,：,闪电样？,-,神经性,搏动性,压榨性？,放射性？,-,紧张性,胀痛？,具有多样性,10,头痛,-,问诊要点,程度,【extent】,：,轻度：可忍受，不影响日常工作和生活,中度：较重，影响日常生活和工作,重度：难以忍受，严重影响生活和工作,不一定与病情严重度平行,11,头痛,-,问诊要点,加重、诱发或缓解因素：,屏气？,腰穿？,可乐？,特殊食物？,月经？,一般的镇痛药无效，应怀疑偏头痛和神经痛,12,头痛,-,问诊要点,伴随症状：,发热,恶心、呕吐（颅高压、偏头痛）,视力改变,眩晕（后颅窝）,抽搐,精神症状（额叶肿瘤、不典型梅尼埃）,13,头痛,-,问诊要点,其他：,治疗经过和疗效,个人史：,职业特点,特殊嗜好,毒物接触史,家族史,14,七、头痛诊断的困惑,依赖于医生对临床症状和病史的了解与分析(,头痛常缺乏体症或无体异性,病史可能是诊断的唯一基础,),头痛的强度不一定与引发疾病的严重性一致,医生与患者的沟通能力和技巧的缺乏,医生对头痛分类及其诊断标准掌握与理解的差异,缺乏可靠的神经影像学和实验室证据,问询病史不仔细，漏诊,/,误诊现象严重,对头痛的,时程关系,及,类型特点,了解不够,过分依赖影像学的检查结果,诊断不准确、不科学，大多数医生还在沿用国际上早已取消的“血管性头痛”、“血管神经性头痛”,、“混合性头痛”等诊断,大多数医生缺乏头痛诊断相关知识,15,八、头痛诊断的临床思维,（一）排除全身性疾病引起的头痛，常见的有：,1.,心血管系统疾病：如高血压、高血压脑病；,2.,急性感染性疾病：如细菌、病毒及寄生虫感染，尤其伴发热时常出现头痛；,3.,血液病：贫血、白血病等，尤其是白血病侵润脑膜或合并颅内出血时；,4.,内分泌及代谢性疾病；,5.,变态反应性疾病；,6.,外源性中毒；,7.,物理因素。,16,八、头痛诊断的临床思维,（二）排除眼、耳、鼻、咽喉及口腔等五官引起的头痛：,1.,眼源性：如屈光不正、青光眼、斜视等；,2.,耳源性：如急性及慢性化脓性中耳炎等；,3.,鼻源性：急慢性鼻炎、鼻窦炎、鼻中甲肥大或偏曲等；,4.,咽喉源性：急慢性喉炎、鼻咽癌转移；,5.,口腔、颌面部疾病：牙髓炎、颞颌关节疾病等。,17,八、头痛诊断的临床思维,（三）排除颅内器质性病变引起的头痛,1.,颅内感染；,2.,颅内占位病变；,3.,颅脑外伤；,4.,脱髓鞘病变。,18,八、头痛诊断的临床思维,病史的采集及体检中的注意事项：,1.,头痛的发生速度；,2.,头痛的部位；,3.,头痛发生的时间和持续时间；,4.,头痛的程度：,5.,头痛的性质：,6.,头痛的伴随症状：,7.,头痛诱发、加重及缓解因素：,8.,头痛的周期性。,19,病史的采集及体检中的注意事项：,9.,头痛是首发症状、还是在某个疾病过程中出现的；,10.,是否有高血压病、严重的心、肾、肝脏等疾病，有无糖尿病、甲状腺功能亢进等内分泌疾病。,临床检查时，除了注意神经科检查外，还必须同时注意一般体格检查。,八、头痛诊断的临床思维,20,头痛疾患的国际分类,（,国际头痛疾病的分类第二版（,ICHD,）,国际头痛疾病的分类如下：,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,）,1.2.2 G43.10,典型先兆伴非偏头痛性头痛（,Typical aura with non-migraine 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,）,1.3 G43.82,儿童周期综合症常为偏头痛的先驱（,Childhood periodic 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 or G41.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,）,21,头痛疾患的国际分类,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-type headache,，,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-type headache,）,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 headache associated with pericranial tenderness,）,2.3.2 G44.23,慢性紧张型头痛不伴颅周压痛（,Chronic tension-type headache not 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 episodic tension-type headache,）,2.4.2 G44.28,可能频发复发性紧张性头痛（,Probable frequent episodic tension-type headache,）,2.4.3 G44.28,可能慢性紧张型头痛（,Probable chronic tension-type headache,）,22,头痛疾患的国际分类,3.G44.0,丛集性头痛和其他三叉自主神经性头痛（,Cluster headache and 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 autonomic cephalalgia,）,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 with sexual 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,）,23,头痛疾患的国际分类,5.G44.88,头痛由于头和,/,或颈部外伤（,Headache attributed to head and/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（,Acute post-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-traumatic headache 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（,Chronic post-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-traumatic headache attributed to mild head injury,）,S09.9,5.3 G44.841,急性头痛由于颈椎甩鞭损伤（,Acute heada che attributed to whiplash injury,）,S13.4,5.4 G44.841,慢性头痛由于颈椎甩鞭损伤（,Chronic headache attributed to whiplash injury,）,S13.4,5.5 G44.88,头痛由于外伤性颅内血肿（,Headache attributed to traumatic intracranial haematoma,）,5.5.1 G44.88,头痛由于硬膜外血肿（,Headache attributed to epidural haematoma,）,S06.4,5.5.2 G44.88,头痛由于硬膜下血肿（,Headache attributed to subdural haematoma,）,S06.5,5.6 G44.88,头痛由于其他头和,/,或颈部外伤（,Headache attributed to other head and/or neck trauma,）,S06,5.6.1 G44.88,急性头痛由于其他头和,/,或颈部外伤（,Acute headache attributed to other head and/or neck trauma,）,S06,5.6.2 G44.88,慢性头痛由于其他头和,/,或颈部外伤（,Chronic headache attributed to other head and/or neck trauma)S06,24,头痛疾患的国际分类,G44.81,头痛由于颅脑和颈部血管疾病（,Headache attributed to cranial or cervical vascular disorder,）,6.1G44.810,头痛由于缺血性中风或,TIA,（,Headache attributed to ischaemic stroke or transient ischaemic attack,）,6.1.1 G44.810,头痛由于缺血性中风,脑梗死,（,Headache attributed to ischaemic stroke cerebral infarction,）,I63,6.1.2 G44.810,头痛由于,TIA,（,Headache attributed to transient ischaemic attack,，,TIA)G45,6.2 G44.810,头痛由于非外伤性颅内出血（,Headache attributed to non-traumatic intracranial haemorrhage I62,6.2.1 G44.810,头痛由于颅内出血（,Headache attributed to intracerebral haemorrhage,）,I61,6.2.2G44.810,头痛由于蛛网膜下腔出血（,Headache attributed to subarachnoid haemorrhage,，,SAH)I60,6.3G44.811,头痛由于未破裂的血管畸形（,Headache attributed to unruptured vascular malformation,）,Q28,6.3.1G44.811,头痛由于囊性动脉瘤（,Headache attributed to saccular aneurysm,）,Q28.3,6.3.2G44.811,头痛由于动静脉畸形（,Headache attributed to arteriovenous malformation,，,AVM)Q28.2,6.3.3 G44.811,头痛由于硬膜动静脉瘘（,Headache attributed to dural arteriovenous fistula,）,I67.1,6.3.4G44.811,头痛由于海绵窦血管瘤（,Headache attributed to cavernous angioma,）,D18.0,6.3.5G44.811,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 6.4G44.812,头痛由于动脉炎（,Headache attributed to arteritis,）,M31,25,头痛疾患的国际分类,6.4.1G44.812,头痛由于巨动脉炎（,Headache attributed to giant cell arteritis,，,GCA)M31.6,6.4.2G44.812,头痛由于原发性中枢神经系统血管炎（,Headache attributed to primary central nervous system(CNS)angtis,）,I67.7,6.4.3G44.812,头痛由于继发性中枢神经系统血管炎（,Headache attributed to secondary central nervous system angtis,）,I68.2 6.5G44.810,颈动脉或锥动脉疼痛（,Carotid or vertebral artery pain,）,I63.0,I63.2,I65.0,I65.2 or I67.0,6.5.1G44.810,头痛、面痛或颈痛由于夹层动脉瘤（,Headache or facial or neck pain attributed to arterial Dissection,）,I67.0,6.5.2G44.814,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,）,6.5.4G44.810,头痛由于颅内血管内操作（,Headache attributed to intracranial 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 cerebral venous thrombosis,，,CVT)I63.6,6.7G44.81,头痛由于其他颅内血管疾病（,Headache attributed to other intracranial vascular disorder,）,6.7.1G44.81,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)I67.8,6.7.2G44.81,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 to benign angiopathy of the central nervous system,）,I99,6.7.4 G44.81,头痛由于垂体中风（,Headache attributed to pituitary apoplexy,）,E23.6,26,头痛疾患的国际分类,7.G44.82,头痛由于非血管性颅内疾病（,Headache attributed to non-vascular intracranial Disorder,）,7.1G44.820,头痛由于脑脊液压力增高（,Headache attributed to high cerebrospinal fluid pressure,）,7.1.1 G44.820,头痛由于自发性颅内压增高（,Headache attributed to idiopathic intracranial hypertension,，,H)G93.2,7.1.2G44.820,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),7.1.3G44.820,头痛由于继发于脑积水的颅内压增高（,Headache attributed to intracranial hypertension secondary to hydrocephalus,）,G91.8,7.2G44.820,头痛由于脑脊液压力低下,(Headache attributed to low cerebrospinal fluid pressure),7.2.1G44.820,腰穿（硬膜穿刺）后头痛（,Post-dural puncture headache,）,G97.0,7.2.2G44.820,脑脊液瘘头痛（,CSF fistula headache,）,G96.0,7.2.3G44.820,头痛由于自发性或原发性低颅压（,Headache attributed to spontaneous or idiopathic low CSF pressure,）,7.3 G44.82,头痛由于非感染性炎性疾病（,Headache attributed to non-infectious inflammatory disease,）,7.3.1G44.823,头痛由于神经类肉瘤病（,Headache attributed to neurosarcoidosis,）,D86.8,7.3.2G44.823,头痛由于非化脓性，或非感染性脑膜炎（,Headache attributed to aseptic(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 other non-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 to lymphocytic hypophysitis,）,E23.6,7.4G44.822,头痛由于颅内新生物（,Headache attributed to intracranial neoplasm,）,C00-D48,27,头痛疾患的国际分类,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,7.4.2G44.822,头痛直接由于新生物所致（,Headache attributed directly to neoplasm,）,按特定新生物编码,7.4.3G44.822,头痛由于癌性脑膜炎（,Headache attributed to carcinomatous meningitis,）,C79.3,7.4.4 G44.822,头痛由于下丘脑、垂体的高或低分泌（,Headache attributed to hypothalamic or pituitary hyper-or hyposecretion,）,E23.0,7.5G44.824,头痛由于鞘内注射（,Headache attributed to intrathecal injection,）,G97.8,7.6G44.82,头痛由于癫痫发作（,Headache attributed to epileptic seizure G40.x or G41.x to specify seizure type,7.6.1G44.82,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,7.7G44.82,头痛由于,I,型,Chiari,畸形（,Headache attributed to Chiari malformation type I,，,CM1)Q07.0,7.8G44.82,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),7.9G44.82,头痛由于其他非血管性颅内疾病,(Headache attributed to other non-vascular intracranial Disorder),28,头痛疾患的国际分类,8G44.4 or G44.83,头痛由于物质或物质的的戒断（,Headache attributed to a substance or its withdrawal,）,8.1G44.40,头痛由于物质的急性应用或暴露（,Headache induced by acute substance use or exposure,）,8.1.1G44.400,头痛由于一氧化氮（,NO,）原料物质诱发（,Nitric oxide(NO)donor-induced headache,）,X44,8.1.1.1 G44.400,头痛由于即刻性一氧化氮原料物质诱发,Immediate NO donor-induced headache,）,X44,8.1.1.2G44.400,头痛由于拖延性一氧化氮原料物质诱发（,Delayed NO donor-headache,）,X44,8.1.2G44.40,头痛由于磷酸二酯酶抑制剂（,Phosphodiesterase,，,inhibitor-induced headache,）,X44,8.1.3 G44.402,头痛由于一氧化碳诱发（,Carbon monoxide-induced headache,）,X47,8.1.4G44.83,头痛由于酒精诱发（,Alcohol-induced headache,）,F10,8.1.4.1G44.83,头痛由于即刻性酒精诱发（,Immediate alcohol-induced headache,）,F10,8.1.4.2G44.83,头痛由于拖延性酒精诱发（,Delayed alcohol-induced headache,）,F10,8.1.5 G44.4,头痛由于食物成分和附加物诱发（,Headache induced by food components and additives,）,8.1.5.1G44.401,头痛由于谷氨酸单钠盐（味精）诱（,Monosodium glutamate-induced headache,）,X44,8.1.6G44.83,头痛由于可卡因诱发（,Cocaine-induced headache,）,F14,8.1.7G44.83,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,）,X44,8.1.8.1 G44.40,头痛由于即刻性组织胺诱发（,Immediate histamine-induced headache,）,X44,8.1.8.2G44.40,头痛由于拖延性组织胺诱发（,Delayed histamine-induced headache,）,X44,8.1.9G44.40,头痛由于降钙素基因相关多肽诱发（,Calcitonin gene-related peptide CGRP-induced headache,）,X44,8.1.9.1G44.40,头痛由于即刻性,CGRP,诱发（,Immediate CGRP-induced headache,）,X44,8.1.9.2G44.40,头痛由于拖延性,CGRP,诱发（,Delayed CGRP-induced headache,）,X44,8.1.10G44.41,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,）,29,头痛疾患的国际分类,8.1.11G44.4 or G44.83,头痛由于其他物质急性应用或暴露（,Headache induced by other acute substance use or exposure code to specify substance,）,8.2G44.41 or G44.83,头痛由于药物过度使用（,Medication-overuse headache,，,MOH),8.2.1G44.411,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,）,8.2.3G44.410,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-overuse headache,）,F55.2,8.2.6G44.410,头痛由于其他药物的过度应用（,Headache attributed to other medication overuse,按特定物质编码,8.2.7G44.41 or G44.83,头痛由于可能药物应用过度（,Probable medication-overuse headache,）,code to specify substance,8.3G44.4,头痛由于慢性用药的不良反应（,Headache as an adverse event attributed 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-induced headache,）,Y42.4,8.4G44.83,头痛由于物质戒断（,Headache