颅骨缺损患者头痛的患病率及临床特征：一项单中心回顾性研究
Prevalence and clinical characterization of headache in patients with cranial bone defects: a single-center retrospective study.
文献信息
| PMID | 42726452 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Helbert de Oliveira Manduca Palmiero |
| 作者单位 | Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil. helbertpalmiero@gmail.com. |
| 期刊 | Acta neurologica Belgica |
| SCI 分区 | Q3 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景与目的： 头痛是残余颅骨缺损患者中一种特征尚不明确的症状。本研究旨在描述等待颅骨成形术的队列中头痛的患病率和临床特征，包括强度、性质、体位调节、伴随症状及缓解因素。
方法： 在三级神经外科转诊中心开展了一项回顾性横断面研究（2016年1月至2026年5月）。因开颅术后存在残余颅骨缺损的成人在专门的头痛门诊接受评估。使用视觉模拟量表（VAS）评估头痛，使用DN4问卷评估神经病理性特征，并系统记录缓解因素。进行了描述性统计和组间比较（卡方检验、Fisher精确检验和独立样本t检验）。
结果： 在182例患者中（平均年龄45.4±13.0岁；60.4%为男性），112例（61.5%）报告头痛。平均VAS为5.7±2.2，84.0%的患者至少为中度强度。头痛主要局限于缺损部位（85.7%），以压迫感/沉重感（68.8%）和紧箍感（66.9%）为主要疼痛性质。6.2%存在神经病理性特征。伴随症状——包括眩晕（42.0%）、畏光（24.1%）和畏声（23.2%）——仅在头痛组出现或更频繁出现（所有p<0.01）。67.0%的患者确定了缓解因素，最常见的是安乃近（50.0%）和卧位（10.7%）。
结论： 头痛影响大多数颅骨缺损患者，表现为中度至重度、以缺损部位为主的综合征，具有压力介导的特征和丰富的神经系统伴随症状。在颅骨成形术之前，该人群有必要进行系统的头痛评估和循证镇痛方案。
英文摘要
BACKGROUND AND OBJECTIVES: Headache is a poorly characterized symptom in patients with residual cranial bone defects. This study aimed to describe the prevalence and clinical features of headache-including intensity, quality, postural modulation, associated symptoms, and relief factors-in a cohort awaiting cranioplasty.
METHODS: A retrospective, cross-sectional study was conducted at a tertiary neurosurgical referral center (January 2016 - May 2026). Adults with residual cranial bone defects following craniotomy were evaluated at a specialized headache clinic. Headache was assessed using the Visual Analogue Scale (VAS), neuropathic features with the DN4 questionnaire, and relief factors were systematically recorded. Descriptive statistics and between-group comparisons (chi-squared, Fisher's exact, and independent-samples t-tests) were conducted.
RESULTS: Of 182 patients (mean age 45.4 ± 13.0 years; 60.4% male), 112 (61.5%) reported headache. Mean VAS was 5.7 ± 2.2, and 84.0% had at least moderate intensity. Headache was predominantly localized to the defect site (85.7%), with pressure/heaviness (68.8%) and tightness (66.9%) as the leading pain qualities. Neuropathic features were present in 6.2%. Associated symptoms-including vertigo (42.0%), photophobia (24.1%), and phonophobia (23.2%)-occurred exclusively or more frequently in the headache group (all p < 0.01). Relief factors were identified in 67.0% of patients, most commonly dipyrone (50.0%) and recumbency (10.7%).
CONCLUSION: Headache affects most patients with cranial bone defects, presenting as a moderate-to-severe, defect-site-predominant syndrome with pressure-mediated features and a rich neurological accompaniment. Systematic headache assessment and evidence-based analgesic protocols are warranted in this population pending cranioplasty.