頭痛・めまい

Headache and Vertigo

頭痛は，日常臨床において遭遇する機会の非常に多い症状の1つである。頭痛の分類と診断は国際頭痛学会より出版されている国際頭痛分類（ICHD）に基づいて行われ，現在は2018年に出版されたICHD-3が用いられている。ICHD-3における第1部「一次性頭痛」は慢性頭痛とも呼ばれ，片頭痛，緊張型頭痛および群発頭痛などを含んでいるが，その診断に有用なバイオマーカーは現時点では存在しない。このため問診で，診断基準項目の一部の確認を逃してしまうと診断を誤ることがある。本論では，45歳男性例をもとに頭痛診療のピットフォールを示す。

Abstract

Headache is one of the most common symptoms in clinical practice. Classification and diagnosis of headache are based on the International Classification of Headache Disorders (ICHD) published by the International Headache Society. Currently, the third edition of the International Headache Classification (ICHD-3) —published in 2018— is used for headache medical treatment. In the ICHD-3, headaches are classified as part 1 “the primary headaches,” part 2 “the secondary headaches,” or part 3 “painful cranial neuropathies, other facial pain and other headaches.” Primary headaches, also called chronic headaches, include migraines, tension-type headaches, and cluster headaches. There are no useful biomarkers for the diagnosis of primary headaches. Failing to confirm certain diagnostic criteria during the patient interview may result in headache misdiagnosis. A 45-year-old male presented with what was initially considered a tension headache. He exhibited a bilateral and non-pulsating headache, but was later diagnosed with a migraine headache. We will review this case in order to better illustrate pitfalls for the medical treatment of headache.