單邊頭痛不一定就是偏頭痛
楊先生楊太太長期受頭痛所苦，遍訪名醫，吃過各式止痛藥物、抗癲癇藥物、交感神經抑制劑，但楊太太每逢月經來潮時，一邊的頭就會出現嚴重的抽痛情形，合併有畏光、怕吵等等的症狀，發作起來還會噁心嘔吐，讓楊太太根本沒辦法工作。
楊先生則是每逢秋冬，單側頭部就會嚴重頭痛合併眼睛充血的症狀，嚴重起來還會流眼淚，每天都因為頭痛問題而睡不好覺，非常困擾。
常見頭痛原因
常見的頭痛原因分成幾類：第一、偏頭痛 (Migraine)，第二、張力型頭痛 (Tension-type headache)，第三、叢集性頭痛 （Cluster headache 分類屬 Trigeminal autonomic cephalalgias)。
楊先生楊太太都是單側發作的嚴重頭痛，但楊太太是「偏頭痛」，楊先生的頭痛則屬於「叢集性頭痛」，所以頭痛問題如果一直治不好還是需要找專科醫師進行詳細的評估與診斷！
無預兆偏頭痛診斷標準
根據國際頭痛學會於2013年推出國際頭痛疾病分類第三 beta 版 診斷標準，無預兆偏頭痛是指頭痛發作前沒有任何預兆之偏頭痛，其診斷標準有五項，分別為：
A：曾發作至少五次，並且符合B至D項之條件
B：未經治療或治療無效下頭痛持續4至72小時
C：至少有下列二項頭痛特徵:
1.單側 (Unilateral pain)
2.搏動性 (Throbbing pain)
3.中度或重度疼痛 (Moderate or severe intensity)
4.日常活動會加劇或會避免此類活動 (如走路或爬樓梯) (Aggravation by movement)
D：在發作時至少下列一項特徵:
1.噁心及/或嘔吐 (Nausea/vomiting)
2.畏光及怕吵 (Photophobia and phonophobia)
E：非歸因於其他疾病所致
介入性治療方式
星狀神經節注射術
大枕神經注射術
科學證據
"Stellate ganglion block is a usefulness of amelioration of the sensory nerves of the intracranial vessels and prevention of migraine headache." Nihon Rinsho. 2001 Sep;59(9):1717-21. [Migraine and nerve block].
"Greater occipital block seems to be an effective option for acute management of migraine headache, with promising reductions in pain scores."J Am Board Fam Med. 2018 Mar-Apr;31(2):211-218. doi: 10.3122/jabfm.2018.02.170188. Greater Occipital Nerve Block for Acute Treatment of Migraine Headache: A Large Retrospective Cohort Study.
"GON block intervention is able to significantly reduce pain intensity and analgesic medication consumption in migraine patients."Clin Neurol Neurosurg. 2018 Feb;165:129-133. doi: 10.1016/j.clineuro.2017.12.026. Epub 2018 Jan 5. The efficacy of greater occipital nerve block for the treatment of migraine: A systematic review and meta-analysis.
完整療程效果會更好
大枕神經注射術
A significant correlation was found between receiving ≥2 GON blocks and reduction in pain score (P < .001). In fact, when we compared the rate of response in patients who received 1 GON block with those who received ≥2, the NNT was calculated as 2.6. We hypothesize that repeated peripheral nerve blockade and associated central neuromodulation may increase pain thresholds and thereby improve desensitization.
效益
The findings from this large, retrospective cohort study suggest that GON block is an effective treatment for acute management of migraine headache.
Of the cohort who received GON block, 82% quantified their response to treatment as moderate or significant, indicating a reduction in their baseline pain score of ≥30%. A total of 328 patients (58%) had a significant response, indicating a reduction in baseline pain score of ≥50%.
去哪看疼痛？
蕙林診所・疼痛交給我
院長：邱柏鈞醫師 疼痛專科醫師 (台灣疼痛醫學會核可疼痛專科醫師 第00590號)地址：高雄市左營區立大路90號 （近捷運紅線R15生態園區站）
電話：07-3450777
本院為自費診所，為節省您寶貴的時間，請先來電預約
按【讚】追蹤蕙林診所臉書專頁：
