偏头痛是一种以剧烈、常常令人难以忍受的头痛为特征的神经系统疾病。头痛通常表现为搏动性或跳动性疼痛，通常位于头部的一侧。偏头痛常伴有恶心、呕吐和对光和声音的极度敏感。它们可以持续数小时至数天，疼痛可能会严重到干扰日常活动。

偏头痛有几种类型，包括：
1. 有先兆偏头痛（经典型偏头痛）：这种类型涉及到大约在头痛开始前10至60分钟出现的视觉干扰和其他神经系统症状。症状可能包括视觉现象，如看到各种形状、明亮的斑点或光的闪烁；感觉障碍，如刺针感；或语言问题。
2. 无先兆偏头痛（普通型偏头痛）：这是更常见的类型，没有经典型偏头痛的早期症状（先兆）。
3. 慢性偏头痛：当一个人每月有15天或更多天出现偏头痛，持续超过三个月时，就属于这种类型。由于其频繁发作，慢性偏头痛对日常生活的影响更大。
4. 偏瘫性偏头痛：这是一种罕见的偏头痛类型，可以模仿中风，因为它会导致身体一侧的暂时性麻痹（偏瘫）或神经或感觉变化。症状可能非常严重且令人恐惧，尽管它们通常是可逆的。
5. 视网膜偏头痛：另一种罕见类型，涉及到一只眼睛的暂时性、部分或完全失明，伴随着偏头痛头痛。

偏头痛的治疗涉及管理症状和预防额外的发作。选项包括非处方药或处方药、生活方式调整，有时还包括替代疗法。

偏头痛主要基于临床病史、症状、体格检查，有时还需进行诊断测试以排除其他状况。以下是详细信息：

症状:
• 严重、反复发作的，通常是单侧（一侧）头痛。
• 搏动性或跳动性痛感。
• 对光、声音，有时对气味敏感。
• 恶心和/或呕吐。
• 在某些情况下，头痛前有先兆（视觉干扰，如闪光、锯齿形线条，或暂时性视觉丧失）。

病史:
• 发作频率和持续时间。
• 症状描述。
• 家族偏头痛史。
• 对之前治疗的反应。

体格检查:
• 神经系统检查以排除其他头痛原因。
• 检查是否有鼻窦问题、感染或神经功能缺失的迹象。

诊断测试: 虽然没有特定测试可以确认偏头痛，但可能进行某些测试以排除其他原因：
• MRI 或 CT 扫描排除肿瘤、中风或大脑结构问题。
• 血液测试检查是否有感染或可能引起类似症状的其他医疗状况。
• 如果怀疑有中枢神经系统感染或出血，极少数情况下可能需要腰穿。

在鉴别诊断偏头痛时，应考虑排除其他可能导致头痛的疾病。这些包括：
1. 紧张型头痛 - 通常表现为头部周围轻度至中度的带状痛。
2. 簇状头痛 - 以一侧眼睛或太阳穴周围的剧烈、刺穿性疼痛为特征，呈群发性出现。
3. 鼻窦头痛 - 常与鼻窦感染症状如面部疼痛、鼻塞和发热相关。
4. 脑瘤 - 虽然罕见，但头痛有时可以是脑瘤的症状。
5. 蛛网膜下腔出血 - 突然出现的剧烈头痛，常被描述为“有生以来最糟糕的头痛”，可能表明脑部周围空间有出血。
6. 颞动脉炎 - 包括颞部动脉的炎症，可能导致头痛、咀嚼肌疼痛和视力问题。
7. 药物滥用头痛 - 这是由于慢性滥用头痛药物引起的。

通过评估这些疾病，医疗提供者可以更准确地诊断偏头痛及其类型，确保合适的管理和治疗。

病史采集：
• 症状：患者通常描述反复出现的中到重度头痛，表现为搏动性或跳动性疼痛。头痛通常是单侧的，但也可以是双侧的。
• 持续时间：发作通常持续4至72小时。
• 相关特征：常见的相关症状包括恶心、呕吐以及对光（畏光）和声音（畏声）的敏感。
• 触发因素：患者可能报告特定的触发因素，如压力、某些食物、荷尔蒙变化、天气变化、睡眠干扰或强烈气味。
• 家族史：可能有明显的偏头痛家族史，这支持了诊断。

体格检查：
• 一般检查：通常是正常的。检查更多是为了排除其他神经系统异常。
• 神经系统检查：偏头痛患者通常是正常的。医生会检查是否有任何局部神经系统缺损的迹象，这在偏头痛中是不期望的，并会促使进一步的调查。

诊断测试：
• 诊断测试通常不直接用于诊断偏头痛，而是用来排除其他头痛原因。
• 影像测试：如MRI或CT扫描可能用于排除脑肿瘤、中风或动脉瘤等严重病状。
• 血液测试：可能进行血液测试，以排除可能导致头痛症状的感染、甲状腺问题或电解质失衡。

病人详情：
姓名：John Doe
年龄：32岁
性别：男
就诊日期：2024年4月30日

症状：
• 每月发作2-3次，主要集中在头的一侧。
• 疼痛感强烈，呈搏动性。
• 头痛发作时常伴有恶心、对光和声音敏感。
• 头痛持续时间从4小时到3天不等。

病史：
• 25岁时被诊断为偏头痛。
• 家族史中母亲和姐姐均有偏头痛病史。
• 未报告其他重大医疗问题。

体格检查：
• 一般情况：营养良好，发育正常，无急性病痛。
• 神经系统检查：颅神经完整，未观察到局部神经功能缺失。
• 耳鼻喉检查：正常。
• 心血管系统：心率和节律正常，未听到杂音。

所需诊断测试：
• 血液检查，排除如贫血或甲状腺功能失调等代谢原因。
• 头部 MRI，排除结构性异常。
• 如果怀疑有脑膜炎或其他中枢神经系统感染，可能需要腰穿。

一位32岁的女性患者因为过去一年头痛加剧来诊所就诊。她描述这种头痛为一侧头部的跳动疼痛，常伴有恶心和对光与声音的敏感。这种状况通常持续数小时甚至数天。她指出压力和缺乏睡眠似乎会触发她的头痛。她的家族史显示她的母亲也有偏头痛的问题。经检查，未发现神经系统缺陷，诊断为无先兆偏头痛。医生建议患者监测触发因素，并开具了三联素类药物，在头痛发作时使用，同时建议她进行压力管理和改善睡眠卫生。

慢性偏头痛、有先兆偏头痛和无先兆偏头痛的鉴别诊断基于头痛天数的频率、先兆的存在与否以及头痛的特点。
1. 慢性偏头痛：
• 定义为每月头痛天数达到15天或以上，持续超过三个月，其中至少有八天的头痛符合偏头痛的标准。
• 头痛可能伴有或不伴有先兆。

2. 有先兆偏头痛：
• 包括称为先兆的神经系统症状，这些症状通常在头痛阶段之前出现。先兆症状可能包括视觉干扰（如闪光或盲点）、感觉变化（如刺痛或麻木）或语言障碍。
• 这些症状通常持续5至60分钟，随后是持续4至72小时的头痛。

3. 无先兆偏头痛：
• 这是更常见的偏头痛类型，不涉及先兆症状。
• 头痛通常持续4至72小时，通常表现为单侧位置，跳动性质，中到重度强度，并且会因日常体力活动而加剧。同时伴有恶心和/或对光和声音敏感。

鉴别诊断重点依赖于患者详细的头痛病史，特别是头痛天数的频率、先兆的存在与类型以及头痛的特点。

Migraine is a neurological condition characterized by intense, often debilitating headaches. The pain is typically described as throbbing or pulsing and is usually on one side of the head. Migraines are often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. They can last for hours to days, and the pain can be so severe that it interferes with daily activities.

There are several types of migraines, including:
1. Migraine with aura (Classic migraine): This type involves visual disturbances and other neurological symptoms that appear about 10 to 60 minutes before the actual headache begins. Symptoms might include visual phenomena, such as seeing various shapes, bright spots, or flashes of light; sensory disturbances, like pins and needles sensations; or speech or language problems.
2. Migraine without aura (Common migraine): This is the more frequent type, which does not have the early symptoms (aura) that the classic migraine has.
3. Chronic migraine: This type occurs when a person has a migraine for 15 or more days per month for more than three months. Chronic migraines affect daily life more significantly due to their frequency.
4. Hemiplegic migraine: This rare type of migraine can mimic a stroke, as it causes temporary paralysis (hemiplegia) or neurological or sensory changes on one side of the body. The symptoms can be quite severe and frightening, though they are usually reversible.
5. Retinal migraine: Another rare form, involving temporary, partial, or complete loss of vision in one eye, accompanied by a migraine headache.

Migraine treatments involve managing symptoms and preventing additional attacks. Options include over-the-counter or prescription drugs, lifestyle adjustments, and sometimes alternative therapies.

Migraine is primarily diagnosed based on clinical history, symptoms, physical examinations, and sometimes diagnostic tests to rule out other conditions. Here are the details:

Symptoms:
• Severe, recurring, and often unilateral (one-sided) headaches.
• Pulsating or throbbing pain.
• Sensitivity to light, sounds, and sometimes smells.
• Nausea and/or vomiting.
• Aura (visual disturbances, such as flashes of light, zigzag lines, or temporary loss of vision) preceding the headache in some cases.

Medical History:
• Frequency and duration of attacks.
• Description of symptoms.
• Family history of migraines.
• Response to any previous treatments.

Physical Examination:
• Neurological examination to rule out other causes of headaches.
• Checking for signs of sinus issues, infection, or neurological deficits.

Diagnostic Tests: While there are no specific tests to confirm migraine, certain tests might be conducted to exclude other causes:
• MRI or CT scan to rule out tumors, strokes, or structural brain issues.
• Blood tests to check for infection or other medical conditions that might cause similar symptoms.
• Lumbar puncture in rare cases if there’s a suspicion of central nervous system infections or bleeding.

In the differential diagnosis of migraine, several conditions should be considered to rule out other potential causes of headache. These include:
1. Tension-type headaches - Typically presenting with a mild to moderate band-like pain around the head.
2. Cluster headaches - Known for severe, piercing pain around one eye or temple, occurring in groups or "clusters."
3. Sinus headaches - Often associated with sinus infection symptoms like facial pain, nasal congestion, and fever.
4. Brain tumors - Although rare, headaches can sometimes be a symptom of a brain tumor.
5. Subarachnoid hemorrhage - A sudden, severe headache often described as the "worst headache" ever experienced, can indicate bleeding in the space around the brain.
6. Temporal arteritis - This involves inflammation of the arteries in the temples and can cause pain in the head, jaw claudication, and vision problems.
7. Medication-overuse headaches - These are caused by the chronic overuse of headache medications.

By evaluating these conditions, healthcare providers can more accurately diagnose migraine and its type, ensuring appropriate management and treatment.

For a patient with migraine, the results from medical history taking, physical examinations, and diagnostic tests are focused on ruling out other causes of headache and confirming the diagnosis based on symptomatology and patterns of attacks. Here’s a breakdown:

Medical History Taking:
• Symptoms: The patient often describes recurrent episodes of moderate to severe headache characterized by a pulsating or throbbing pain. The headache is typically unilateral (one-sided) but can be bilateral.
• Duration: Attacks generally last between 4 and 72 hours.
• Associated Features: Commonly reported associated symptoms include nausea, vomiting, and sensitivity to light (photophobia) and sound (phonophobia).
• Triggers: Patients might report specific triggers such as stress, certain foods, hormonal changes, weather changes, sleep disturbances, or strong smells.
• Family History: There may be a significant family history of migraine, which supports the diagnosis.

Physical Examination:
• General Examination: Usually normal. The examination is more to exclude other neurological abnormalities.
• Neurological Examination: Typically normal in patients with migraine. The doctor checks for any signs of focal neurological deficits, which are not expected in migraine and would prompt further investigation.

Diagnostic Tests:
• Diagnostic tests are not typically used to diagnose migraines directly but are employed to rule out other causes of headaches.
• Imaging Tests: Such as MRI or CT scans may be used to exclude serious conditions like brain tumors, strokes, or aneurysms.
• Blood Tests: Might be performed to rule out infections, thyroid problems, or electrolyte imbalances that could contribute to headache symptoms.

Example Medical Record in English

Patient Details:
Name: John Doe
Age: 32
Gender: Male
Date of Visit: April 30, 2024

Symptoms:
• Recurrent headaches occurring 2-3 times per month, primarily on one side of the head.
• Pain described as throbbing and severe.
• Episodes often accompanied by nausea, sensitivity to light and sound.
• Duration of headaches varies from 4 hours to 3 days.

Medical History:
• Migraines diagnosed at age 25.
• Family history of migraines (mother and sister).
• No significant other medical issues reported.

Physical Examination:
• General: Well-nourished, well-developed, no acute distress.
• Neurological Examination: Cranial nerves intact, no focal neurological deficits observed.
• ENT: Normal exam.
• Cardiovascular: Regular rate and rhythm, no murmurs.

Diagnostic Tests Required:
• Blood tests to rule out metabolic causes like anemia or thyroid dysfunction.
• MRI of the brain to exclude structural abnormalities.
• Possibly lumbar puncture if there is a suspicion of meningitis or other central nervous system infections.

A 32-year-old woman presents to the clinic with a history of recurrent headaches that have worsened over the past year. She describes the headaches as a throbbing pain on one side of her head, often accompanied by nausea and sensitivity to light and sound. The episodes typically last for several hours and sometimes up to a few days. She notes that stress and lack of sleep seem to trigger her headaches. Her family history reveals that her mother also suffered from migraines. Upon examination, no neurological deficits are found, and a diagnosis of migraine without aura is made. The patient is advised to monitor her triggers and is prescribed a triptan medication to use at the onset of her headaches, along with advice on stress management and sleep hygiene.

Chronic migraine, migraine with aura, and migraine without aura are differentiated based on the frequency of headache days, the presence of aura, and the characteristics of the headache.

1. Chronic Migraine:
• Defined as headaches on 15 or more days per month for more than three months, with at least eight of those headache days meeting criteria for migraine.
• The headaches may or may not include aura.

2. Migraine with Aura:
• Involves neurological symptoms known as aura that typically precede the headache phase. Aura symptoms may include visual disturbances (like flashing lights or blind spots), sensory changes (such as tingling or numbness), or speech disturbances.
• These symptoms usually last between 5 and 60 minutes and are followed by a headache that lasts 4 to 72 hours.

3. Migraine without Aura:
• This is the more common type of migraine and does not involve aura symptoms.
• The headache typically lasts between 4 and 72 hours and is usually characterized by unilateral location, pulsating quality, moderate to severe intensity, and is aggravated by routine physical activity. It is also associated with nausea and/or sensitivity to light and sound.

Differential diagnosis relies heavily on the patient’s detailed headache history, focusing on the frequency of headache days, the presence and type of aura symptoms, and the characteristics of the headaches.