Diagnosticandtherapeuticerrorsintrigeminalautonomiccephalalgiasandhemicraniacontinua:asystematicreviewMicheleViana1*,CristinaTassorelli1,2,MartaAllena1,GiuseppeNappi1,OttarSjaastad3andFabioAntonaci1,2Vianaetal.TheJournalofHeadacheandPain2013,14:14CHwasmostfrequentlymisdiagnosedas:migraine,sinusitis,tooth/jawproblems,andtrigeminalneuralgia.1与migraine鉴别Migraineseemstobeaparticularlyfrequentmisdiagnosis.ThedifferenttemporalpatternsofmigraineandCHattacksshouldmakeitpossibletodistinguishbetweenthesetwoconditionsinthetypicalcase,butifthisaspectisnotreportedbythepatientorthoroughlyinvestigatedbythephysician,confusionmayarise,giventhatmanyotherfeaturesoftheseheadachescanoverlap.Migrainepainisfrequentlysevereinintensityandunilateralin2/3ofpatients[28].Inabout56%ofmigrainepatientsatleastoneCAS(i.e.lacrimationorconjunctivalinjection)ispresentduringattacks[29].28.SjaastadO(1992)Clusterheadachesyndrome.W.B.Saunders,London29.LaiTH,FuhJL,WangSJ(2009)Cranialautonomicsymptomsinmigraine:characteristicsandcomparisonwithclusterheadache.JNeurolNeurosurgPsychiatry80(10):1116–1119Moreover,typicalmigrainefeaturesareoftenassociatedwithCHattacks.AstudyofalargecohortofGermanCHpatientsfoundthatCHattackswereassociatedwithphotophobiaorphonophobiain61.2%andwithnauseaandvomitingin27.8%,whilemigraineauraprecededCHattacksinalmostaquarterofthepatients[17].SchurksM,KurthT,deJesusJ,JonjicM,RosskopfD,DienerHC(2006).Clusterheadache:clinicalpresentation,lifestylefeatures,andmedicaltreatment.Headache46(8):1246–1254Unfortunately,theICHD-IIfailstomention(eitherinthediagnosticcriteriaorinthedefinitionsandcomments)thatCASmaybepresentinmigraineandthatnausea,vomiting,andphoto/phonophobiamaybepresentinCH.临床鉴别点：Forclinicians,itishelpfultonotethatphoto-andphonophobiatendtobeunilateralinTACsandHCwhiletheyarebilateralinmigraine[28,30],30.IrimiaP,CittadiniE,PaemeleireK,CohenAS,GoadsbyPJ(2008)Unilateralphotophobiaorphonophobiainmigrainecomparedwithtrigeminalautonomiccephalalgias.Cephalalgia28(6):626–630moreovernauseaandvomitingaregenerallymorefrequentinmigrainethaninCH(especiallyiftheyoccurtogether)[31].31.EkbomK(1970)Aclinicalcomparisonofclusterheadacheandmigraine.ActaNeurolScand48(Suppl41):1–48AnotherfeaturethatmightincreasetheriskofmisdiagnosingCHasmigraineisthepossibilityofthepainswitchingsidesbetweenattacksorclusterperiods[18].18.vanVlietJA,EekersPJ,HaanJ,FerrariMD,DutchRSG(2003)Featuresinvolvedinthediagnosticdelayofclusterheadache.JNeurolNeurosurgPsychiatry74(8):1123–1125Manyphysicians,evenheadachespecialists,arenotawarethatthiscanhappeninCH.Indeed,accordingtothediagnosticcriteriaforCH(ICHD-II,code3.1)thepainisunilateral;furthermore,thedescriptionparagraphstatesthatitis“strictlyunilateral”whilethecommentssectionspecifiesthatthe“painalmostinvariablyrecursonthesamesideduringanindividualclusterperiod”[1].Yet,upto14%ofCHpatientsmayexperienceasideshiftofpainduringaclusterperiod,and18%mayhavesideshiftsfromoneclusterperiodtothenext[32].2.与牙痛/下颌痛的鉴别（部位相似，CH单侧、CAS、自发缓解、周期）Apreviousdiagnosisoftooth/jawproblemsislikelytobefoundinthehistoryofCHpatients,as37%to50%ofthemreportedthatthepainradiatedtothelowerjaw,upperjaworcheek[6,18,32].ThiscomesfromthefactthatpatientswithCHoftendescribethepainasemanatingfromthemidfacialregion,whichmightbeinterpretedaspainoriginatingfromtheteeth,jawsortem...
