Nyob rau hauv tsab xov xwm peb yuav txiav txim siab qhov kev faib tawm ntawm kev mob taub hau thiab nws cov tsos mob tseem ceeb.
Ntawm cov mob tshwm sim feem ntau pom hauv kev kho mob, qhov chaw tseem ceeb yog nyob ntawm cephalalgia. Kev mob taub hau tuaj yeem suav hais tias yog qhov mob thiab qhov tsis xis nyob uas nyob hauv lub taub hau, txawm hais tias qee tus kws kho mob tsuas yog txwv rau thaj chaw hauv thaj tsam ntawm pob muag mus rau sab nraub qaum ntawm lub taub hau. Cephalgia tuaj yeem pom nyob rau hauv ntau dua 45 yam kab mob sib txawv. Yog li, kev kuaj mob thiab kev kho mob ntawm qhov tshwm sim pathological no yog ib qho kev sib koom tes, kev kho mob dav dav uas tsim nyog tau txais kev saib xyuas ntawm cov kws kho mob ntawm txhua qhov tshwj xeeb.
hom mob taub hau twg tau qhia hauv ICD-10, peb yuav piav qhia hauv qab no.
Pathogenesis
Tus kab mob ntawm cov tsos mob no tsis to taub zoo. Cephalgia tuaj yeem cuam tshuam nrog kev ua xua ntawm cov txheej txheem rhiab ntawm thaj chaw no los ntawm kev siab, nro, hloov chaw, o thiab ncab. Nrog rau cov hlab ntsha thiabcov hlab ntsha, qee qhov chaw ntawm dura mater, venous sinuses nrog lawv cov tributaries, cov hlab ntsha ntawm lub hauv paus ntawm lub hlwb, cov hlab ntsha loj, nrog rau cov hlab ntsha ntawm lub pob txha taub hau, kuj muaj qhov mob rhiab heev. Lub paj hlwb nws tus kheej, cov ntaub mos mos thiab cov hlab ntsha me tsis muaj qhov rhiab heev.
Kev mob taub hau yog qhov txaus siab rau ntau tus.
Qhov laj thawj tseem ceeb
Cephalgia tuaj yeem tshwm sim vim muaj cov xwm txheej hauv qab no:
- kev txhim kho spasm;
- traction lossis dilatation ntawm cov hlab ntsha;
- kev txav chaw lossis kev sib tw ntawm cov sinuses;
- compression, mob lossis traction ntawm cov hlab ntsha hauv lub cev;
- spasms, o lossis raug mob ntawm cov leeg thiab cov leeg ntawm lub taub hau thiab caj dab;
- khaus ntawm cov meninges thiab nce intracranial siab.
Lub sijhawm thiab qhov hnyav ntawm qhov mob taub hau, nrog rau nws qhov chaw, tuaj yeem muab cov ntaub ntawv tsim nyog rau kev kuaj mob kom raug.
Kev faib tawm
Cia muab kev faib tawm ntawm kev mob taub hau raws li cov txheej txheem ntawm qhov tshwm sim:
- migraine;
- mob taub hau;
- ntau hom cephalgia tsis cuam tshuam nrog cov kab mob organic;
- mob pob thiab mob paroxysmal hemicrania;
- mob vim raug mob taub hau;
- mob txuam nrog vascular mob;
- mob vim tsis muaj kab mob hauv lub pob txha taub hau;
- mob cuam tshuam nrog kev siv lossis tshem tawm qee yam tshuaj;
- pain onkeeb kwm ntawm kis kab mob;
- cephalgia cuam tshuam nrog cov kab mob metabolic;
- cephalgia lossis mob ntawm lub ntsej muag vim qhov txawv txav ntawm pob txha taub hau, qhov muag, caj dab, qhov ntswg, qhov ncauj, hniav, lossis lwm yam cranial lossis lub ntsej muag;
- neuropathy, cranial neuralgia thiab mob deafferentation;
- Unclassifiable cephalalgia.
Hom mob ntau tshaj plaws hauv qhov kev faib tawm ntawm kev mob taub hau yog ob hom: migraine - 39% thiab mob nro - 53%, nrog rau kev mob ntshav qab zib cephalgia.
Migraine
Cov kab mob pathological no yog tshwm sim los ntawm qhov tshwm sim ntawm paroxysmal recurrent mob taub hau ntawm ib tug throbbing xwm, feem ntau ntawm ib sab tes. Nws tshwm sim hauv 2-7% ntawm cov pejxeem, feem ntau yog cov poj niam hnub nyoog 10 txog 35 xyoo.
Nyob rau hauv pathogenesis ntawm migraine (ICD-10 code code G43), hereditary impairment ntawm vasomotor kev tswj ntawm intra- thiab extracranial hlab ntsha yog ib qho tseem ceeb heev. Thaum muaj kev tawm tsam, 4 theem ntawm vasomotor mob ua raws ib leeg:
- spasm ntawm retinal thiab intracerebral hlab ntsha;
- dilatation of extracerebral hlab ntsha;
- edema ntawm phab ntsa vascular;
- reverse development of cov kev hloov no.
Thaum thawj theem, qhov aura tuaj yeem tshwm sim, thaum lub sijhawm thib ob, mob taub hau. Hauv qhov no, tej zaum yuav muaj kev ua txhaum ntawm cov metabolism ntawm serotonin, nrog rau lwm yam tshuaj lom neeg (histamine, tyramine, prostaglandins, glutamate, thiab lwm yam), thiab cov kev hloov pauv neurophysiological suav tias yog qhov ua rau muaj kev tawm tsam.
Raws li kev faib tawm thoob ntiaj teb ntawm lub taub haumob, migraine muab faib ua 2 hom: migraine nrog aura thiab tsis muaj aura. Cov tsos mob ntawm cov menyuam yaus tuaj yeem yog qhov ua ntej ntawm tus mob no: mob plab migraine nrog rau qhov mob hauv plab, paroxysmal kiv taub hau, ntuav ntuav, nyiam ua rau muaj mob tsis xis nyob, hloov pauv ntawm ceg ceg.
Nyob zoo ib tsoom niam txiv kwv tij neej tsa phooj ywg sawv daws.
Tseeb migraine (tsis muaj aura) - unilateral throbbing cephalalgia. Feem ntau, nws tsis npog tag nrho sab ntawm lub taub hau, tab sis thaj tsam parieto-occipital lossis fronto-temporal. Qee zaum nws yog ob sab lossis muaj kev hloov pauv ntawm ob sab ntawm kev txhim kho ntawm qhov mob. Qhov kev siv ntawm cephalgia yog nruab nrab los yog pronounced, thaum kawg ntawm kev tawm tsam qhov mob yuav dull. Thaum lub sij hawm tawm tsam, muaj kev hyperesthesia, intolerance rau lub suab muaj zog, lub teeb. Rau cov neeg feem coob, qhov kev tawm tsam yog nrog ntuav thiab xeev siab.
Los ntawm 4 mus rau 72 teev - qhov no yog, qhov no, lub sijhawm mob taub hau.
Migraine nrog aura kuj tseem ceeb hauv kev faib tawm.
Migraine nrog aura
Neurological focal tsos mob ua ntej mob taub hau uas tshwm sim tam sim tom qab cov tsos mob tau tas los yog tom qab lub sijhawm luv luv. Feem ntau, qhov pom kev aura tshwm sim, uas tshwm sim los ntawm qhov muag tsis pom kev, atrial scotoma, zigzag kab ntawm qhov muag pom. Nws kav ntev txog 20 feeb, tom qab ntawd qhov kev tawm tsam ntawm cephalgia tshwm sim. Nyob rau hauv ob qhov chaw nyob rau hauv zaus yog lub aura nyob rau hauv daim ntawv ntawm paresthesia. Thaum pib, nws tshwm sim nyob rau hauv tus ntiv tes ntawm tes, ces nws nce raws caj npab thiab tuaj yeem kis mus rau lub ntsej muag, qhov ncauj. Rau qhov tsis tshua muajAura ntau yam muaj xws li hemiparesis, ophthalmoparesis, lub cev muaj zog aphasia. Migraine nrog aura nyob rau hauv daim ntawv ntawm ib tug neurological teeb meem siv los hu ua txuam. Tsis tshua muaj, feem ntau hauv cov txiv neej laus, tsis muaj mob taub hau tom qab aura, thiab tom qab ntawd qhov tshwm sim no hu ua ischemia hauv zos.
Peb tseem xav txog qhov kev faib tawm ntawm kev mob taub hau.
Tension Pain
hom mob taub hau no feem ntau tshwm sim. Nws cuam tshuam txog 6% ntawm cov neeg. Nws etiology yog txuam nrog autonomic dysfunction, hereditary yam, psychology yam ntxwv (kev ntxhov siab vim), kev nyuaj siab, ntev kev nyuaj siab (lub cev, psycho-emotional).
Tension mob taub hau hauv kev faib ua tus thawj coj. ICD-10 code - G44.
Nyob rau hauv pathogenesis ntawm qhov mob, kev ua txhaum ntawm "qhov rooj tswj qhov system" los ntawm Phab ntsa thiab Melzak (noci-anti-nociceptive system), biochemical, vascular, neurogenic yam raug txiav txim siab. Qhov mob hnyav yog qhov nyuaj ntawm cov kab mob pathological xws li mob me me mus rau kev sib tw txhua hnub nyob rau txhua hnub. Muab faib ua ntu zus thiab ntu ntu ntu cephalgia. Ib txoj cai ciam teb yog tsim los ntawm cov xeev no: 180 lossis ntau hnub hauv ib xyoos - hauv daim ntawv ntev thiab tsawg dua qhov no - hauv daim ntawv episodic. Cov yam tseem ceeb ntawm no yog rhiab heev ntawm cov hlab ntsha tom qab ntawm tus txha caj qaum, yog tias qhov mob yog mob ntev, thiab myofascial mob hauv cov leeg nqaij pericranial,uas tuaj yeem lees paub siv txoj hauv kev EMG, txawm li cas los xij, cov kev ua txhaum cai no tsis suav tias yog yuav tsum tau ua.
Ib hom mob nro tuaj yeem yog mob hlwb uas tsis nrog los ntawm kev hloov pauv ntawm myofascial (qhov mob nro yam tsis muaj kev ua haujlwm tsis zoo ntawm cov leeg pericranial).
Tus kab mob no tau pom los ntawm cov neeg mob raws li kev nyem lub taub hau, qhov kev xav ntawm hnyav. Kev ntxhov siab yog nyob rau hauv lub hauv pliaj feem ntau nyob rau hauv lub hauv pliaj, calvaria, ob lub qhov muag, thiab nyob rau hauv tej rooj plaub tej zaum yuav tawg mus rau lub tuam tsev, caj dab, lub xub pwg nyom. Cov mob taub hau no feem ntau nrog rau kev puas siab puas ntsws: tsis qab los noj mov, ua tsis taus pa, xeev siab, tsaug zog ntxhov siab, ib qho kev xav ntawm "pob hauv caj pas", nce qaug zog (lub hlwb thiab lub cev), kev xav tsis zoo.
mob qhov mob hnyav feem ntau yog paroxysmal thiab tuaj yeem tshwm sim ntawm ntau lub sijhawm ntawm hnub. Lub sijhawm ntawm kev tawm tsam yog los ntawm 30 feeb mus rau 7 hnub. Hauv qhov no, tus neeg mob pheej hnov mob.
Tsis zoo li tus mob migraine, lub zog ntawm qhov mob taub hau yog me me lossis nruab nrab, qhov kev xav tau nias (tsis yog lub zog), qhov chaw yog ob sab, nws tsis nce nrog kev tawm dag zog lub cev. Qhov mob ntawm qhov tsis sib haum xeeb tsis nrog xeev siab, phonophobia, thiab thaum lub sijhawm tawm tsam nws xyaum tsis ua rau tus neeg muaj peev xwm ua haujlwm.
Nyob rau hauv kev faib cov mob taub hau hauv neurology, qhov mob ntev yog qhov txawv.
mob hnyav hnyav zoo ib yam li qhov xwm txheej, tab sis tshwm sim txhua hnublos yog ntau zaus tawm tsam.
Qhov tsis muaj cov tsos mob ntawm cov tsos mob ntawm qhov mob hnyav, uas txawv ntawm migraine, ua rau nws nyuaj rau kev kuaj mob. Yuav luag ib nrab ntawm cov neeg mob tau kuaj pom muaj cov tsos mob cephalgia cuam tshuam nrog cov kab mob hauv lub hlwb.
Mob taub hau tuaj yeem ua ke nrog migraines. Hauv kwv yees li 10-50% ntawm cov neeg mob, mob hnyav lossis mob hnyav tau sau tseg hauv lub sijhawm interictal. Feem ntau lawv tau koom nrog peb daim ntawv - abuza, uas yog txuam nrog kev tsim txom ntawm cov tshuaj uas tshem tawm cephalalgia.
Cluster cephalgia yog qhia nyob rau hauv kev faib thoob ntiaj teb kev mob taub hau.
Cluster cephalgia
Qhov mob no tseem hu ua pob mob, Harris ciliary migraine neuralgia, Horton histamine cephalgia, thiab lwm yam. Qhov mob no sib xyaw ua ke ntau hom kev sib cais: ciliary neuralgia, migraine thiab pterygopalatine neuralgia. Hauv kev faib tawm thoob ntiaj teb, peb hom kev mob sib txawv nyob ntawm qhov zaus ntawm lawv qhov tshwm sim: nrog rau qhov tsis paub meej, ntev thiab ntu ntu. Ua ke nrog lawv, paroxysmal chronic hemicrania kuj suav nrog.
Tsis yog txhua tus paub tias mob taub hau yog dab tsi.
Cluster cephalgia (raws li ICD-10 R51) yog qhov tsawg heev, cov txiv neej raug kev txom nyem los ntawm nws ntau zaus ntau dua li cov poj niam, qhov pib ntawm tus kab mob no tau sau tseg hauv 20-50 xyoo. Lub etiopathogenesis ntawm hom mob taub hau no tsis paub, txawm li cas los xij, cov kws tshawb fawb qhia tias nws yog raws li kev ua txhaum ntawm qee yam vascular mechanisms.
Beamcephalgia yog tus cwj pwm los ntawm kev tawm tsam ntawm ntse, excruciating unilateral mob nyob rau hauv lub taub hau, rov ua dua txhua hnub rau lub sij hawm ntev, ua raws li tib lub sij hawm ntev. Qhov kev siv thiab lub sijhawm ntawm qhov mob sib txawv thaum lub sij hawm ua pawg los ntawm qhov mob me thiab luv mus rau qhov hnyav thiab ntev. Mob tshwm sim sai sai, tsis muaj precursors, thiab pom nyob rau hauv lub qhov muag cheeb tsam, lub tuam tsev, nyob rau hauv lub periorbital cheeb tsam, irradiation rau lub caj dab, pob ntseg, thiab caj npab yog ua tau. Qhov xwm txheej ntawm qhov mob no yog qhov tho txawv, kub hnyiab, thiab lub zog loj heev uas nws tuaj yeem ua rau cov neeg mob tsaug zog. Thaum pib, kev tawm tsam tshwm sim thaum hmo ntuj, tib lub sijhawm. Thaum lub sij hawm lawv, psychomotor agitation thiab pronounced vegetative teeb meem, liab thiab tearing ntawm lub qhov muag, o ntawm daim tawv muag, qhov ntswg congestion.
Yuav mob taub hau dab tsi?
Chronic paroxysmal hemicrania
mob taub hau no yog hom tsis tshua muaj ntawm paroxysmal unilateral cephalgia, uas yog nyob rau hauv thaj tsam oculo-frontal-temporal thiab muaj cov lus hais siv zog thiab tho txawv. Kev tawm tsam ntev txog 30 feeb, rov ua dua ntau zaus hauv ib hnub thiab nrog rau kev tsis txaus ntseeg ntawm lub qhov muag thiab qhov ntswg. Dab tsi ua rau lawv txawv ntawm pawg mob cephalgia yog qhov mob zoo li no hauv cov poj niam.
Neuralgia
Yog lwm hom mob taub hau uas cuam tshuam rau tib neeg tsis hais poj niam txiv neej. Lub sijhawm ntawm kev tawm tsam - los ntawm ob peb vib nas this mus rau ob peb feeb, lawv rov qab nrogQee lub sij hawm thiab muaj cov yam ntxwv ntawm qhov sib txawv ntawm kev siv zog (los ntawm nruab nrab mus rau qhov muaj zog). Ua rau neuralgia irritation ntawm ib qho ntawm cov hlab ntsha.
Kev mob ntsig txog mob taub hau
Nyob rau hauv neurology, muaj ib tug nyiam ua rau mob cephalgia nrog mob hlwb raug mob. Hauv kev faib tawm thoob ntiaj teb, ntau hom mob taub hau yog qhov txawv, uas yog, ob hom kev mob ntshav qab zib cephalalgia: mob thiab mob ntev. Thiab rau txhua hom, muaj ob hom subspecies, suav nrog qhov hnyav ntawm qhov raug mob:
- tseem ceeb, nrog cov tsos mob ntawm lub paj hlwb,
- me me, tsis muaj.
Mob mob tom qab mob tshwm sim thaum lub sijhawm raug mob lossis tom qab ob lub lis piam. Qhov sib txawv luminous yuav tsum tau kuaj xyuas kom tsis suav nrog subdural hematomas thiab lwm yam teeb meem ntawm kev raug mob.
Mob mob tom qab mob yog tus yam ntxwv los ntawm cov tsos mob zoo ib yam, tab sis kav ntev heev. Nyob rau hauv txoj kev loj hlob ntawm cov mob tom qab raug mob hauv lub taub hau, kev puas hlwb ntawm lub hlwb, ib qho kev tsis sib haum xeeb ntawm nws cov kev ua ub ua no, kev puas siab puas ntsws, kev puas siab puas ntsws ntawm tus neeg mob, cov yam ntxwv ntawm psychogenic, thiab cov cwj pwm xauj tsev tseem ceeb. Qhov mob taub hau zoo li no yog tshwm sim los ntawm kev sib cuam tshuam ntawm kev puas siab puas ntsws thiab cov organic uas ua rau muaj kev raug mob me me, thaum cov organic hloov pauv hauv qhov hnyav.
mob taub hau thib ob
Lawv yog tshwm sim los ntawm tag nrho cov tswv ntawm ntau yam. Yog li, xws li mob hauv lub taub hau tshwm sim los ntawm-rau:
- mob taub hau thiab caj dab;
- kab mob sib kis;
- tshuaj tiv thaiv tus kheej;
- cawv thiab tshuaj yeeb;
- hlwb hlav.
Zaj lus tham txog kev faib cov mob taub hau.
