国際頭痛分類第3版と発展の私見

■交通事故等「脳脊髄液減少症」

■■国内初の和訳資料『■新「国際頭痛分類第３版（ICHD-III）」基準』

■■■≪英字原文≫直接関連の条文≪その他の関連は別途記載予定≫

■交通事故等「脳脊髄液減少症」■■国内初の和訳必要『■新「国際頭痛分類第３版（ICHD-III）」基準』■≪和訳での注意点≫７件■ICHD-IIIbeta版基準◆英語原文　私が公開も和訳も日本初です

2018/5/6(日) 午前 4:00 https://blogs.yahoo.co.jp/kikitata3/35661760.html#35661760

https://www.ichd-3.org/

Jesオレセン
議長
頭痛分類委員会
国際的頭痛協会

■新「国際頭痛分類第３版（ICHD-III）」基準　英語原文・・・旧基準の次の新たな基準

（■「国際頭痛分類第３版（ICHD-III）beta版」基準　英語原文・・・旧基準となりました。）

上記本文の「third edition of the International Classification of Headache Disorders (ICHD-3). 」を、クイックして下さい。

third edition of the International Classification of Headache Disorders (ICHD-3).

■交通事故等「脳脊髄液減少症」

■■■直接関連の条文≪その他の関連は別途記載予定≫

第３版（ICHD-III）99頁

7. Headache attributed to non-vascular intracranial disorder

7.2 Headache attributed to low cerebrospinal fluid (CSF) pressure

7.2.1 Post-dural puncture headache

7.2.2 Cerebrospinal fluid (CSF) fistula headache

7.2.3 Headache attributed to spontaneous intracranial hypotension

国際頭痛分類第3版beta版（ICHD-3β）では

7．非血管性頭蓋内疾患による頭痛（Headache attributed to　non-vascular intracranial disorder）

7．2 低髄液圧による頭痛（Headache attributed to low　cerebrospinal fluid pressure）

7．2．1 硬膜穿刺後頭痛（Post-dural puncture headache）

7．2．2　脳脊髄液瘻性頭痛（CSF fistula headache）

7.2.3 特発性低脳蓋内圧性頭痛（Headache attributed to spontaneous intracranial　hypotension）

国際頭痛分類第3版beta版（ICHD-3β）では

「国際頭痛学会・国際頭痛分類第3版記載」公式和訳

「7．非血管性頭蓋内疾患による頭痛」の中の「7．2 低髄液圧による頭痛」です。

新旧同じ）、7．非血管性頭蓋内疾患による頭痛（Headache attributed to　non-vascular intracranial disorder）

新旧同じ）、7．2 低髄液圧による頭痛（Headache attributed to low　cerebrospinal fluid pressure）
新旧同じ）、7．2．1 硬膜穿刺後頭痛（Post-dural puncture headache）
旧）、7．2．2 髄液瘻性頭痛（CSF fistula headache）

新）、7．2．2　脳脊髄液瘻性頭痛（CSF fistula headache）新たな公式和訳の変更（原文変更なし）
旧）、7．2．3 特発性低髄液圧性頭痛（Headache attributed　to spontaneous（or idiopathic）low　CSF pressure）

新）、7.2.3 特発性低脳蓋内圧性頭痛（Headache attributed to spontaneous intracranial　hypotension）

「国際頭痛学会・国際頭痛分類第3版記載」公式和訳 beta版

https://www.jhsnet.org/kokusai_new_2015.html

HOME　<<　国際頭痛分類　<<　国際頭痛分類第3版beta版（ICHD-3β）日本語版

7．非血管性頭蓋内疾患による頭痛 84

https://www.jhsnet.org/pdf/ICHD3_up/007_02057_2_9.pdf

①「国際頭痛学会・国際頭痛分類第3版記載」公式和訳

②「国際頭痛学会・国際頭痛分類第3版記載」公式和訳

以上「国際頭痛学会・国際頭痛分類第3版記載」公式和訳 beta版

第３版（ICHD-III）

7. Headache attributed to non-vascular intracranial disorder

General comment
Primary or secondary headache or both? The general rules for attribution to another disorder apply to 7. Headache attributed to non-vascular intracranial disorder.

1. When a new headache occurs for the ﬁrst time in close temporal relation to a non-vascular intracranial disorder, it is coded as a secondary headache attributed to that disorder. This remains true when the new headache has the characteristics of any of the primary headache disorders classiﬁed in Part One of ICHD-3.

2. When a pre-existing headache with the characteristics of a primary headache disorder becomes chronic, or is made signiﬁcantly worse (usually meaning a twofold or greater increase in frequency and/or severity), in close temporal relation to a non-vascular intracranial disorder, both the initial headache diagnosis and a diagnosis of 7. Headache attributed to non-vascular intracranial disorder (or one of its types or subtypes) should be given, provided that there is good evidence that the disorder can cause headache.

Introduction

In this chapter are the headaches attributed to changes in intracranial pressure. Both increased and decreased cerebrospinal ﬂuid (CSF) pressure can lead to headache. Other causes of headache here are non-infectious inﬂammatory diseases, intracranial neoplasia, seizures, rare conditions such as intrathecal injections and Chiari malformation type I, and other non-vascular intracranial disorders.

Compared to those on primary headaches, there are few epidemiological studies of these headache types. Controlled trials of therapy are almost non-existent.

For headache attributed to any of the non-vascular intracranial disorders listed here, the diagnostic criteria include, whenever possible:

A. Headache fulﬁlling criterion C

B. A non-vascular intracranial disorder known to be able to cause headache has been diagnosed

C. Evidence of causation demonstrated by at least two of the following:

1. headache has developed in temporal relation to the onset of the non-vascular intracranial disorder, or has led to its discovery

2. either or both of the following: a) headache has signiﬁcantly worsened in parallel with worsening of the non-vascular intracranial disorder b) headache has signiﬁcantly improved in parallel with improvement in the non-vascular intracranial disorder

3. headache has characteristics typical for the non-vascular intracranial disorder

4. other evidence exists of causation

D. Not better accounted for by another ICHD-3 diagnosis.

Headache persisting for more than one month after successful treatment or spontaneous resolution of the intracranial disorder usually has other mechanisms. Headache persisting for more than three months after treatment or remission of intracranial disorders is deﬁned in the Appendix for research purposes. Such headache exists but has been poorly studied; Appendix entries are intended to stimulate further research into such headaches and their mechanisms.

7.2 Headache attributed to low cerebrospinal fluid (CSF) pressure

Description: Orthostatic headache caused by low cerebrospinal ﬂuid (CSF) pressure (either spontaneous or secondary), or CSF leakage, usually accompanied by neck pain, tinnitus, changes in hearing, photophophia and/or nausea. It remits after normalization of CSF pressure or successful sealing of the CSF leak.

Diagnostic criteria:
A. Any headache1 fulﬁlling criterion C

B. Either or both of the following: 1. low cerebrospinal ﬂuid (CSF) pressure (<60 mm CSF) 2. evidence of CSF leakage on imaging2

C. Headache has developed in temporal relation to the low CSF pressure or CSF leakage, or led to its discovery3

D. Not better accounted for by another ICHD-3 diagnosis.

Notes:

1. 7.2 Headache attributed to low cerebrospinal ﬂuid (CSF) pressure is usually but not invariably orthostatic. Headache that signiﬁcantly worsens soon after sitting upright or standing and/or improves after lying horizontally is likely to be caused by low CSF pressure, but this cannot be relied upon as a diagnostic criterion.

2. Brain imaging showing brain sagging or pachymeningeal enhancement, or spine imaging (spine MRI, or MRI, CT or digital subtraction myelography) showing extradural CSF.

3. Evidence of causation may depend upon onset in temporal relation to the presumed cause, together with exclusion of other diagnoses.

7.2.1 Post-dural puncture headache
Previously used term: Post-lumbar puncture headache

Description: Headache occurring within ﬁve days of a lumbar puncture, caused by cerebrospinal ﬂuid (CSF) leakage through the dural puncture. It is usually accompanied by neck stiﬀness and/or subjective hearing symptoms. It remits spontaneously within two weeks, or after sealing of the leak with autologous epidural lumbar patch.

Diagnostic criteria:

A. Headache fulﬁlling criteria for 7.2 Headache attributed to low cerebrospinal ﬂuid (CSF) pressure, and criterion C below

B. Dural puncture has been performed

C. Headache has developed within ﬁve days of the dural puncture

D. Not better accounted for by another ICHD-3 diagnosis.

Comment: Independent risk factors for 7.2.1 Post-dural puncture headache have recently been demonstrated: female gender, age between 31 and 50 years, a previous history of 7.2.1 Post-dural puncture headache and orientation of the needle bevel perpendicular to the long axis of the spinal column at the time of the dural puncture.

7.2.2 Cerebrospinal fluid (CSF) fistula headache

Description: Orthostatic headache occurring after a procedure or trauma causing a persistent cerebrospinal ﬂuid (CSF) leakage resulting in low intracranial pressure. It remits after successful sealing of the CSF leak.

Diagnostic criteria:

A. Headache fulﬁlling criteria for 7.2 Headache attributed to low cerebrospinal ﬂuid (CSF) pressure, and criterion C below

B. A procedure has been performed, or trauma has occurred, known sometimes to cause persistent CSF leakage (CSF ﬁstula)

C. Headache has developed in temporal relation to the procedure or trauma

D. Not better accounted for by another ICHD-3 diagnosis.

7.2.3 Headache attributed to spontaneous intracranial hypotension

Previouslyusedterms: Headacheattributedtospontaneous low CSF pressure or primary intracranial hypotension; low CSF-volume headache; hypoliquorrhoeic headache.

Description: Orthostatic headache caused by low cerebrospinal ﬂuid (CSF) pressure of spontaneous origin. It is usually accompanied by neck stiﬀness and subjective hearing symptoms. It remits after normalization of CSF pressure.

Diagnostic criteria:

A. Headache fulﬁlling criteria for 7.2 Headache attributed to low cerebrospinal ﬂuid (CSF) pressure, and criterion C below

B. Absence of a procedure or trauma known to be able to cause CSF leakage1

C. Headache has developed in temporal relation to occurrence of low CSF pressure or CSF leakage, or has led to its discovery2

D. Not better accounted for by another ICHD-3 diagnosis.

Notes:

1. 7.2.3 Headache attributed to spontaneous intracranial hypotension cannot be diagnosed in a patient who has had a dural puncture within the prior month.

2. Dural puncture to measure CSF pressure directly is not necessary in patients with positive MRI signs of leakage such as dural enhancement with contrast.

Comments: Spontaneous cerebrospinal ﬂuid (CSF) leak has been associated with heritable connective tissue disorders. Patients with CSF leaks should be screened for connective tissue and vascular abnormalities.

While there is a clear postural component in most cases of 7.2.3 Headache attributed to spontaneous intracranial hypotension, it may not be as dramatic or immediate as in 7.2.1 Post-dural puncture headache. Thus, 7.2.3 Headache attributed to spontaneous intracranial hypotension may occur immediately or within seconds of assuming an upright position and resolve quickly (within one minute) after lying horizontally, resembling 7.2.1 Post-dural puncture headache, or it may show delayed response to postural change, worsening after minutes or hours of being upright and improving, but not necessarily resolving, after minutes or hours of being horizontal. The orthostatic nature of the headache at its onset should be sought when eliciting a history, as this feature may become much less obvious over time.

In patients with typical orthostatic headache and no apparent cause, and after exclusion of postural orthostatic tachycardia syndrome (POTS), it is reasonable in clinical practice to provide autologous lumbar epidural blood patch (EBP). While EBPs are frequently eﬀective in sealing CSF leaks, the response to a single EBP may not be permanent, and complete relief of symptoms may not be achieved until two or more EBPs have been performed. However, some degree of sustained improvement, beyond a few days, is generally expected. In some cases, sustained improvement cannot be achieved with targeted (to the site of the leak) and/or non-targeted lumbar EBPs, and surgical intervention may be required.

It is not clear that all patients with 7.2.3 Headache attributed to spontaneous intracranial hypotension have an active CSF leak, despite a compelling history or brain imaging signs compatible with CSF leakage. The underlying disorder may be low CSF volume. A history of a trivial increase in intracranial pressure (e.g. on vigorous coughing) is sometimes elicited.

Postural headache has been reported after coitus: such headache should be coded as 7.2.3 Headache attributed to spontaneous intracranial hypotension because it is most probably due to CSF leakage.