В первичном звене медико-санитарной помощи наблюдается основная часть пациентов с первичными головными болями – ГБ (цефалгиями). Оптимальный диагностический алгоритм подразумевает исключение потенциально опасных причин ГБ и вторичных цефалгий, требующих специфического лечения. Верификация формы первичной ГБ осуществляется клинически, не требует дополнительных методов диагностики и основывается на использовании критериев Международной классификации ГБ. Среди всех цефалгий в общей клинической практике подавляющее большинство случаев представлено четырьмя формами: мигрень, ГБ напряжения, кластерная ГБ и лекарственно-индуцированная ГБ. Комплексное применение современных методов фармакологического и нефармакологического лечения с использованием профилактических стратегий обеспечивает высокую эффективность ведения пациентов с ГБ.
The bulk of patients with primary headaches – HA (cephalalgias) are observed in primary care. The optimal diagnostic algorithm implies the exclusion of potentially dangerous causes of HA and secondary cephalalgias requiring specific treatment. Verification of the form of primary HA is carried out clinically, does not require additional diagnostic methods and is based on the use of the criteria of the International Classification of Headache Disorders. Among all cephalalgias in general clinical practice, the vast majority of cases are represented by four forms: migraine, tension type headache, cluster headache, and medication overuse headache. The complex application of modern methods of pharmacological and non-pharmacological treatment with the use of preventive strategies ensures high efficiency in the management of patients with HA.
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2. GBD 2019 Diseases and Injuries Collaborators. Global burden of
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3. Martelletti P, Luciani M, Spuntarelli V, Bentivegna E. Deprescribing in migraine. Expert Opin Drug Saf. 2021;20(6):623-5. DOI:10.1080/14740338.2021.1907342
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12. Fejes E, Feher G, Gurdan Z, et al. Characteristics of Patients Referred To A Specialized Headache Clinic. Sci Rep. 2020;10(1):1146. DOI:10.1038/s41598-020-58234-w
13. Smitherman TA, Burch R, Sheikh H, Loder E. The prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from national surveillance studies. Headache. 2013;53(3):427-36. DOI:10.1111/head.12074
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16. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. Cephalalgia. 2018;38(1):1-211. DOI:10.1177/0333102417738202
17. Steiner TJ, Jensen R, Katsarava Z, et al. Aids to management of headache disorders in primary care (2nd edition). J Headache Pain. 2019;20:57.
DOI:10.1186/s10194-018-0899-2
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24. Lipton RB, Diamond S, Reed M, et al. Migraine diagnosis and treatment: results from the American Migraine Study II. Headache. 2001;41(7):638-45.
DOI:10.1046/j.1526-4610.2001.041007638.x
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27. Tepper SJ, Dahlöf CG, Dowson A, et al. Prevalence and diagnosis of migraine in patients consulting their physician with a complaint of headache: data from the Landmark Study. Headache. 2004;44(9):856-64. DOI:10.1111/j.1526-4610.2004.04167.x
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35. Остроумова Т.М., Остроумова О.Д., Парфенов В.А. Ранние признаки поражения головного мозга как органа-мишени при артериальной гипертензии. Неврология, нейропсихиатрия, психосоматика. 2019;11(3S):32-7 [Ostroumova TM, Ostroumova OD, Parfenov VA. Early signs of damage to the brain as a target organ in hypertension. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3S):32-7 (in Russian)]. DOI:10.14412/2074-2711-2019-3S-32-37
36. Dodick DW. Pearls: headache. Semin Neurol. 2010;30(1):74-81.DOI:10.1055/s-0029-1245000
37. Gago-Veiga AB, Camiña Muñiz J, García-Azorín D, et al. Headache: What to ask, how to examine, and which scales to use. Recommendations of the Spanish Society of Neurology's Headache Study Group. Neurologia (Engl Ed). 2019;S0213-4853(19)30024-6. DOI:10.1016/j.nrl.2018.12.006
38. Simon C, Everitt H, Kendrick T. Assessment of headache. In: Oxford Handbook of General Practice. 3rd ed. Oxford, GB: Oxford University Press, 2010; p. 560.
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40. Jordan JE, Flanders AE. Headache and Neuroimaging: Why We Continue to Do It. AJNR Am J Neuroradiol. 2020;41(7):1149-55. DOI:10.3174/ajnr.A6591
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________________________________________________
1. Atlas of headache disorders and resources in the world. A collaborative project of World Health Organization and Lifting The Burden. World Health Organization, 2011.
2. GBD 2019 Diseases and Injuries Collaborators. Global burden of
369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-22. DOI:10.1016/S0140-6736(20)30925-9
3. Martelletti P, Luciani M, Spuntarelli V, Bentivegna E. Deprescribing in migraine. Expert Opin Drug Saf. 2021;20(6):623-5. DOI:10.1080/14740338.2021.1907342
4. GBD 2016 Headache Collaborators. Global, Regional, and National Burden of Migraine and Tension-Type Headache, 1990–2016: A Systematic Analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17(11):954-76. DOI:10.1016/S1474-4422(18)30322-3
5. Steiner TJ, Stovner LJ, Jensen R, et al. Migraine remains second among the world’s causes of disability, and first among young women: findings from GBD2019. J Headache Pain. 2020;21(1):137. DOI:10.1186/s10194-020-01208-0
6. Latinovic R, Gulliford M, Ridsdale L. Headache and migraine in primary care: consultation, prescription, and referral rates in a large population. J Neurol Neurosurg Psychiatry. 2006;77(3):385-7. DOI:10.1136/jnnp.2005.073221
7. Lebedeva ER, Kobzeva NR, Gilev DV, Olesen E. Analysis of the quality of diagnosis and treatment of primary headache in different social groups of the Ural Region. Neurology, Neuropsychiatry, Psychosomatics. 2015;1:19-26 (in Russian). DOI:10.14412/2074-2711-2015-1-19-26
8. Stovner L, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27:193-210. DOI:10.1111/j.1468-2982.2007.01288.x
9. Lucas C, Geraud G, Valade D, et al. Recognition and therapeutic management of migraine in 2004, in France: results of FRAMIG 3, a French Nationwide Population-Based Survey. Headache. 2006;46:715-25. DOI:10.1111/j.1526-4610.2006.00430.x
10. Kovalchuk NA, Kiryanova EA, Tabeeva GR. Medication adherence in migraine patients (data of an online survey). Neurology, Neuropsychiatry, Psychosomatics. 2021;13(4):81-7 (in Russian).DOI:10.14412/2074- 2711-2021-4-81-87
11. McNeil M. Headaches in Adults in Primary Care: Evaluation, Diagnosis, and Treatment. Med Clin North Am. 2021;105(1):39-53. DOI:10.1016/j.mcna.2020.09.005
12. Fejes E, Feher G, Gurdan Z, et al. Characteristics of Patients Referred To A Specialized Headache Clinic. Sci Rep. 2020;10(1):1146. DOI:10.1038/s41598-020-58234-w
13. Smitherman TA, Burch R, Sheikh H, Loder E. The prevalence, impact, and treatment of migraine and severe headaches in the United States: a review of statistics from national surveillance studies. Headache. 2013;53(3):427-36. DOI:10.1111/head.12074
14. Green LA, Phillips RL, Fryer GE. The nature of primary medical care. In: Oxford Textbook of Primary Medical Care. Oxford University Press, Oxford, UK, 2005.
15. BeckerL A, Iverson DC, Reed FM, et al. Study of Headache in North America in primary care. J R Coll Gen Pract. 1987;37:400-3.
16. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd ed. Cephalalgia. 2018;38(1):1-211. DOI:10.1177/0333102417738202
17. Steiner TJ, Jensen R, Katsarava Z, et al. Aids to management of headache disorders in primary care (2nd edition). J Headache Pain. 2019;20:57.
DOI:10.1186/s10194-018-0899-2
18. Steiner TJ, Paemeleire K, Jensen R, et al. European principles of management of common headache disorders in primary care. J Headache Pain. 2007;8(Suppl. 1).
19. Becker WJ, Findlay T, Moga C, et al. Guideline for primary care management of headache in adults. Can Fam Physician. 2015;61(8):670-9. PMID: 26273080; PMCID: PMC4541429
20. Kernick D, Stapley S, Hamilton W. GPs' classification of headache: is primary headache underdiagnosed? Br J Gen Pract. 2008;58(547):102-4. DOI:10.3399/bjgp08X264072
21. Hamilton W, Kernick D. Clinical features of primary brain tumours: a case-control study using electronic primary care records. Br J Gen Pract. 2007;57(542):695-9. PMID: 17761056; PMCID: PMC2151783
22. Kernick D, Stapley S, Goadsby PJ, Hamilton W. What happens to new-onset headache presented to primary care? A case-cohort study using electronic primary care records. Cephalalgia. 2008;28(11):1188-95. DOI:10.1111/j.1468-2982.2008.01674.x
23. O'Flynn N, Ridsdale L. Headache in primary care: how important is diagnosis to management? Br J Gen Pract. 2002;52(480):569-73. PMID: 12120731; PMCID: PMC1314361
24. Lipton RB, Diamond S, Reed M, et al. Migraine diagnosis and treatment: results from the American Migraine Study II. Headache. 2001;41(7):638-45.
DOI:10.1046/j.1526-4610.2001.041007638.x
25. Kernick D, Matharu MS, Goadsby PJ. Cluster headache in primary care: unmissable, underdiagnosed and undertreated. Br J Gen Pract. 2006;56(528):486-7. PMID: 16834873; PMCID: PMC1872057
26. Schreiber CP, Hutchinson S, Webster CJ, et al. Prevalence of migraine in patients with a history of self-reported or physician-diagnosed “sinus” headache. Arch Intern Med. 2004;164(16):1769-72. DOI:10.1001/archinte.164.16.1769
27. Tepper SJ, Dahlöf CG, Dowson A, et al. Prevalence and diagnosis of migraine in patients consulting their physician with a complaint of headache: data from the Landmark Study. Headache. 2004;44(9):856-64. DOI:10.1111/j.1526-4610.2004.04167.x
28. Ridsdale L, Clark LV, Dowson AJ, et al. How do patients referred to neurologists for headache differ from those managed in primary care? Br J Gen Pract. 2007;57(538):388-95. PMID: 17504590; PMCID: PMC2047014
29. Parfenov VA, Neverovsky DV. Outpatient management of patients with dyscirculatory encephalopathy. Neurology, Neuropsychiatry, Psychosomatics. 2015;1:37-42 (in Russian). DOI:10.14412/2074-2711-2015-1-37-42
30. Parfenov VA. Vascular cognitive impairment and chronic cerebral ischemia (dyscirculatory encephalopathy). Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3S):61-7 (in Russian). DOI:10.14412/2074-2711-2019-3S-61-67
31. Golovacheva VA, Parfenov VA. Chronic daily headaches clinically simulating dyscirculatory encephalopathy. Medical Council. 2015;2:72-7 (in Russian). DOI:10.21518/2079-701X-2015-2-72-77
32. Manoylov AE, Lost criteria. Neurology, Neuropsychiatry, Psychosomatics. 2010;2(4):62-4 (in Russian). DOI:10.14412/2074-2711-2010-119
33. Parfenov VA, Ostroumova TM, Ostroumova OD. Hypertensionand Headache: the Effect of Antihypertensive Drugs. Rational Pharmacotherapy in Cardiology. 2019;15(3):416-23 (in Russian). DOI:10.20996/1819-6446-2019-15-3-416-423
34. Tabeeva GR, Muranov AV, Kostrygina EN, Sergeev AV. Migraine and hypertension. Neurology, Neuropsychiatry, Psychosomatics. 2015;7(4):4-10 (in Russian).
DOI:10.14412/2074-2711-2015-4-4-10
35. Ostroumova TM, Ostroumova OD, Parfenov VA. Early signs of damage to the brain as a target organ in hypertension. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3S):32-7 (in Russian). DOI:10.14412/2074-2711-2019-3S-32-37
36. Dodick DW. Pearls: headache. Semin Neurol. 2010;30(1):74-81.DOI:10.1055/s-0029-1245000
37. Gago-Veiga AB, Camiña Muñiz J, García-Azorín D, et al. Headache: What to ask, how to examine, and which scales to use. Recommendations of the Spanish Society of Neurology's Headache Study Group. Neurologia (Engl Ed). 2019;S0213-4853(19)30024-6. DOI:10.1016/j.nrl.2018.12.006
38. Simon C, Everitt H, Kendrick T. Assessment of headache. In: Oxford Handbook of General Practice. 3rd ed. Oxford, GB: Oxford University Press, 2010; p. 560.
39. Toward Optimized Practice (TOP) Headache Working Group. Primary care management of headache in adults: clinical practice guideline. 2016. Available at: http://www.topalbertadoctors.org/cpgs/10065. Accessed: 31.11.2017.
40. Jordan JE, Flanders AE. Headache and Neuroimaging: Why We Continue to Do It. AJNR Am J Neuroradiol. 2020;41(7):1149-55. DOI:10.3174/ajnr.A6591
41. Expert Panel on Neurologic Imaging; Whitehead MT, Cardenas AM, Corey AS, et al. ACR Appropriateness Criteria® Headache. J Am Coll Radiol. 2019;16(11S):S364-77. DOI:10.1016/j.jacr.2019.05.030
42. Shagbazyan AE, Kovalchuk NA, Tabeeva GR. Role of educational programs in management of patients with medication-overuse headache. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(3):27-33 (in Russian). DOI:10.14412/2074-2711-2021-3-27-33
43. Golovacheva VA, Golovacheva AA, Parfenov VA, et al. Cognitive behavioral therapy in the treatment of chronic migraine: a clinical case report. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(1):74-80 (in Russian). DOI:10.14412/2074-2711-2021-1-74-80
44. McNeil M. Headaches in Adults in Primary Care: Evaluation, Diagnosis, and Treatment. Med Clin North Am. 2021;105(1):39-53. DOI:10.1016/j.mcna.2020.09.005
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DOI:10.17116/jnevro201811861124
Авторы
Г.Р. Табеева*
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*grtabeeva@gmail.com
________________________________________________
Gyuzyal R. Tabeeva*
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*grtabeeva@gmail.com