網站 : 頭痛電子報第 162 期發行人 : 台灣頭痛學會發刊日期 : 民國 107 年 03 月本期內容咳嗽頭痛運動頭痛與性行為相關之頭痛的鑑別診斷 - 周品吟醫師 p 2 IHS FELLOWSHIP AWARD 201

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1 網站 : 發行人 : 發刊日期 : 民國 107 年 03 月本期內容咳嗽頭痛運動頭痛與性行為相關之頭痛的鑑別診斷 - 周品吟醫師 p 2 IHS FELLOWSHIP AWARD 2018 p 6 3/25 南區頭痛研討會議 p 15 4/01 中區頭痛研討會議 p 16 4/15 北區頭痛研討會議 p 17 各位頭痛學會的會員大家好 : 咳嗽頭痛運動頭痛與性行為相關之頭痛等, 雖然在臨床上不是那麼常見, 但對第一線的醫師來說, 確是很大的考驗, 是要當作良性的頭痛處理呢? 還是應該當作頭痛急症立即住院作詳盡的影像檢查呢? 那些治療對病患是有效的呢? 這些問題常令臨床醫師困惑與左右為難以下由高雄醫學大學神經科周品吟醫師, 為大家介紹與整理咳嗽頭痛運動頭痛與性行為相關之頭痛的鑑別診斷與臨床應注意的事項, 相信經過周醫師簡潔但詳盡的說明後, 大家日後遇到這類病患時, 在處理與治療上會更有把握電子報主編施景森醫師

2 秘書處報告 1. 咳嗽頭痛運動頭痛與性行為相關之頭痛的鑑別診斷 p 2 2. IHS FELLOWSHIP AWARD 2018 p /25 南區頭痛研討會議 p /01 中區頭痛研討會議 p /15 北區頭痛研討會議 p 17 敬啟咳嗽頭痛運動頭痛與性行為相關之頭痛的鑑別診斷周品吟醫師高醫神經內科在國際頭痛疾病分類第三版 (ICHD-3) 中的其他原發性頭痛疾病 (Other primary headache disorders) 這個大傘下, 包含了許多臨床表現非常不同的頭痛其中活動相關的頭痛 (activity-related headaches) 中包含了在短時間出力後 ( 例如 Valsalva maneuvers) 誘發的咳嗽頭痛 (cough headache), 需較持久運動才能誘發的運動頭痛 (exercise headache), 及性興奮誘發的性行為相關之頭痛 (sexual headache) 1 這幾大類的頭痛在診斷上是很有挑戰性的, 因為有可能是原發性或次發性的, 而其預後隨著病因的不同是差很多的因此本文整理出一些臨床的線索, 在面臨這些活動相關的頭痛時, 可以幫忙臨床醫師作鑑別診斷, 挑出哪些可能是次發性頭痛的患者以進一步詳查在門診裏這三大類頭痛中最常遇到的是咳嗽頭痛, 咳嗽頭痛也是臨床特徵最不同的反之, 運動頭痛和性行為相關之頭痛則有許多共同點, 甚至常會遇到病人同時都有這兩種頭痛的病史 2-4 事實上, 性行為也可被視作一種較持久的運動, 而有些性行為相關之頭痛的患者之所以沒有運動頭痛, 是因為他們沒有從事其他運動! 以下分別介紹這三大類頭痛以及可以幫忙鑑別診斷的臨床線索咳嗽頭痛 4.1 原發性咳嗽頭痛 Primary cough headache(ichd-3) 舊稱 : 原發性運動頭痛 (Primary exertional headache), 良性運動頭痛 (Benign exertional headache) 說明 : 在沒有任何顱內疾患且沒有過長時間的運動下, 頭痛因咳嗽或其他 Valsalva 氏操作 ( 用力 ) 而引起 2

3 診斷基準 : A. 至少 2 次頭痛符合基準 B-D B. 因咳嗽閉氣用力及 / 或 Valsalva 氏操作引發的頭痛, 且只發生在上述情況 C. 突然發生 D. 持續 1 秒到 2 小時 E. 沒有其他更合適的 ICHD-3 診斷咳嗽頭痛是最常見的活動相關頭痛, 而且有將近 4 成的咳嗽頭痛是次發性的! 因此建議如果疑似次發性咳嗽頭痛的病患, 最好接受頭頸部磁振造影 (craniocervical MRI) 檢查而次發性咳嗽頭痛最常見的病因是後顱窩的病灶, 其中又以 Chiari type I malformation 最常見原發性咳嗽頭痛很少發生在 40 歲之前, 其平均發生年齡是 67 歲 ( 從 44 到 81 歲都有 ); 而次發性咳嗽頭痛平均會提早 20 年發生以下是兩者簡單的鑑別診斷幫忙鑑別診斷原發與次發性咳嗽頭痛的臨床線索 ( 翻譯自參考資料 5) 原發性咳嗽頭痛年紀 >50 歲近期才開始的頭痛咳嗽是誘發頭痛之一頭痛位置不在枕區 (Occipital area) 痛持續幾秒無其他症狀對 indomethacin 有反應次發性咳嗽頭痛年紀 <50 歲頭痛已超過一年咳嗽不會誘發頭痛頭痛位置在枕區痛超過一分鐘合併其他神經學症狀對 indomethacin 無反應運動頭痛 4.2 原發性運動頭痛 Primary exercise headache(ichd-3) 舊稱 : 原發性運動頭痛 (Primary exertional headache) 說明 : 在沒有顱內疾患的狀況下, 任何形式運動所引發之頭痛診斷基準 : A. 至少 2 次頭痛符合基準 B 及 C B. 因激烈運動引發, 且只發生在運動時或運動後 C. 持續 <48 小時 D. 沒有其他更合適的 ICHD-3 診斷原發性運動頭痛有許多偏頭痛的特徵, 好發於年輕人 (10-50 歲 ) 及男性, 有 60% 是雙側的, 平均發作時間為 3-4 小時 (10 分鐘 ~3 天 ) 其預後大多良好, 多半只持續 2 ~6 個月原發性運動頭痛特別好發在在天氣熱時或高海拔處, 缺水低血糖酒精咖啡因也會加劇原發性運動頭痛 7 和原發性咳嗽頭痛不同, 原發性運動頭痛是需要持續出力的運動才能誘發, 而原發性咳嗽頭痛則是短時間的出力 ( 例如 Valsalva-like 3

4 maneuver) 即可誘發原發性運動頭痛的機轉不明, 但大多認為跟血管相關第一次遇到運動頭痛時, 須排除蜘蛛膜下腔出血 (subarachnoid hemorrhage, SAH), 動脈剝離, 或可逆性腦血管收縮症候群 (reversible cerebral vasoconstriction syndrome, RCVS) 等 1 原發性運動頭痛的治療 : 避免會引起頭痛的運動一段時間, 大多可以緩解或根治原發性運動頭痛藥物治療可以在運動前服用非類固醇消炎藥 (NSAID), 尤其是 indomethacin ( mg), 或傳統的偏頭痛預防藥物例如 propranolol ( 可以規律服用或運動前服用 ) 6 適度的暖身, 充足的休息和補充水分也都有幫助性行為相關之頭痛 4.3 原發性性行為相關之頭痛 Primary headache associated with sexual activity(ichd-3) 說明 : 在沒有任何顱內疾患的狀況下, 因性行為引起的頭痛, 通常在性興奮增加時開始頭部兩側鈍痛, 並在高潮時突然變為劇烈疼痛診斷基準 : A. 至少 2 次在頭部以及 / 或頸部的疼痛, 且符合基準 B-D B. 因性行為引發, 且只發生在性行為時 C. 符合下列 1 項或 2 項 : 1. 隨著性興奮而頭痛程度增強 2. 在性高潮前或當中突發嚴重 ( 爆炸般 ) 頭痛 D. 嚴重頭痛持續 1 分鐘到 24 小時, 及 / 或輕微頭痛可長達 72 小時 E. 沒有其他更合適的 ICHD-3 診斷原發與次發性運動 / 性行為頭痛的鑑別診斷運動頭痛和性行為相關之頭痛有 80% 是原發性的, 這兩類頭痛有許多共同點, 都好發於年輕人, 多是雙側搏動性, 很多病患過去有過偏頭痛的病史或家族史, 也都對 β-blocker 有效對這類疑似次發性因素的病人, 電腦斷層加 CTA 甚至 MRI+ MRA 是必要的,, 有些病人甚至還要考慮腰椎穿刺以下的參考可以幫忙鑑別診斷原發與次發性運動 / 性行為頭痛 5 幫忙鑑別診斷原發與次發性運動 / 性行為頭痛的臨床線索 ( 翻譯自參考資料 5) 原發性運動 / 性行為頭痛年紀 <40 歲發生過不只一次男性痛 <24 小時無其他症狀次發性運動 / 性行為頭痛年紀 >40 歲只發生過一次女性痛 >24 小時合併其他神經學症狀 4

5 以上介紹這幾種頭痛是臨床較少見的疾病且大部分是原發性頭痛, 但初次發作時仍必須注意是否有次發性原因的可能, 例如 SAH 血管痙攣動脈剝離, 或 RCVS 等病患遇到這樣的情形建議應及早就醫, 尋求頭痛醫師的協助對於臨床醫師而言, 神經理學檢查是必要的, 如果懷疑有其他病症仍建議做詳盡的影像學檢查, 如電腦斷層磁振造影或磁振造影血管攝影病患是原發性的頭痛, 通常對藥物治療反應良好, 症狀也可能會自然緩解對於這些疾病的病生理機轉或預防治療目前雖已有一些大型而有系統性的研究, 但結論仍莫衷一是, 需要更多的研究與努力, 讓我們繼續努力來進一步了解它的全貌參考資料 1. Headache Classification Committee of the International Headache Society. The international classification of headache disorders-3rd edition. Cephalalgia. 2013;33: Silbert PL, Edis RH, Stewart-Wynne EG, Gubbay SS. Benign vascular sexual headache and exertional headache: Interrelationships and long term prognosis. J Neurol Neurosurg Psychiatry. 1991; 54: Pascual J, Iglesias F, Oterino A, Vázquez-Barquero A, Berciano J. Cough, exertional, and sexual headaches. An analysis of 72 benign and symptomatic cases. Neurology. 1996;46: Pascual J, González-Mandly A, Martín R, Oterino A. Headaches precipitated by cough, prolonged exercise or sexual activity: A prospective etiological and clinical study. J Headache Pain. 2008;9: Alvarez R, Ramón C, Pascual J. Clues in the Differential Diagnosis of Primary vs Secondary Cough, Exercise, and Sexual Headaches. Headache Oct;54(9): Review 6. Allena M, Rossi P, Tassorelli C, et al. Focus on therapy of the chapter IV headaches provoked by exertional factors: primary cough headache, primary exertional headache and primary headache associated with sexual activity. J Headache Pain 2010;11: Simpson M. Weightlifter s headache. Pract Neurol 2016;16: doi: /practneurol

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IHS FELLOWSHIP AWARD 2018 INFORMATION AND APPLICATION FORM Information for Applicants The IHS fellowship award aims to support innovative and impactful research from young investigators, promote the

7 IHS FELLOWSHIP AWARD 2018 INFORMATION AND APPLICATION FORM Information for Applicants The IHS fellowship award aims to support innovative and impactful research from young investigators, promote the career of young investigators in the field of headache, and increase the knowledge base of headache disorders. Applications for basic or clinical headache research, or a combination of basic and clinical research, will be considered. The deadline for applications is 20 April 2018; applicants will be notified within 2 months of the deadline. The fellowship should commence within 6 months of acceptance. Applications received by the IHS Administrative Office will be evaluated to ensure they fulfil all the required eligibility criteria. Incomplete or incorrect applications will not be considered further. Complete and accurate applications will be submitted for evaluation to the IHS Fellowship Review Committee. Applicants will be informed of a definitive decision by as soon as practical. Length of tenure: Funding is provided for 1- and 2-year fellowships Value: The award is designed to provide funding to cover the fellow s salary costs based on the local economic context of where the fellowship is taking place. The maximum amount of the total yearly grant is GBP 50,000 (12 months). Awards are to be received by the host institution no administrative expenses should be deducted from the grant award. In exceptional circumstances (such as in the case that the host institutions will withhold administrative expenses) awards may be paid directly to the fellow in portions depending on progress reports approved by the mentor. Funding transparency: The applicant must declare in advance to IHS if he/she will benefit from any other source of financing to complete the fellowship. Essential criteria: Applicants must meet the following criteria to be considered for a fellowship award: The applicant and mentor must be members of IHS 7

8 The applicant and mentor must be professionally involved in the treatment, research or management of headache disorders The applicant should be within 7 years of completing training (MD, PhD, specialty training, whatever was last) not including non-professional periods The applicant should not have previously received an IHS fellowship award The hosting institution must be different from the home institution and preferably, but not necessarily, in another country. The applicant should not currently be working with the future mentor. In special cases applications on this basis will be accepted if the current working period has been for less than 12 months No geographical restriction on the host institution shall be applied Application: Each application must include: Updated curriculum vitae of the applicant (to include personal data, qualifications, language ability, academic training, clinical experience, research experience, honours achieved, full bibliography and any other material thought to be appropriate) Fellowship proposal following the template in the Aims and plan section Two reference letters (other than the fellowship mentor) Updated short curriculum vitae of the fellowship mentor Confirmation letter of support and acceptance from the host institution or fellowship mentor (to include where appropriate a description of the clinical programme, hours of work, type of work, time in the office/hospital, level of patient care). Host organisation: The host organisation must ensure that the award holder is made aware of his/her responsibilities during the fellowship. Failure to comply with these conditions may lead to termination of the award and the society reserves the right to recover the fund in part or fully. Data protection: To meet the society s obligations for member s accountability, some details of Awards will be made available on the society s website, reports, documents or mailing lists. Protection of any intellectual property will be fully respected. Nevertheless, and with the consent of the award holder, the society may share the findings from the research fellowship with its members via its website or owned publications. Reporting: The award holder must submit an interim report on the completion of the first half of the fellowship, and a final report within 6 months following the end of the fellowship period. All reports must be signed and approved by the mentor. All payments may be recovered if the report is not received within the 6 months of the end of the fellowship period. Data presentation: The award holder must present the results of his/her research at the next IHS congress (IHC) following completion of the fellowship (unless the congress is held less than 1 month following submission). IHS contribution: The society s contribution to the accomplishment of the fellowship should be acknowledged in all publications or presentations related to the research. Insurance: Any insurance-related matters for the duration of the fellowship will be the entire responsibility of the award holder. 8

9 APPLICATION FORM This form must be fully completed with the required documentation in order to be eligible for the fellowship award. The full application in electronic form must be sent to IHS by to Application deadline: 20 April 2018 Receipt of your application will be acknowledged. Notification will be sent to you by 1 June Required information 1. General Name Nationality Date of birth Full contact address Current working address Current status (training in headache, if no longer training, when training ended) address Telephone 2. Fellowship Length of the fellowship Proposed dates (to commence before January 2019) Proposed location Institution name Institution address Mentor name * Mentor contact details Title of proposed study 9

10 * The applicant should not be currently working with the mentorfinancial information Amount requested For remuneration & related costs: For travel: For subsistence (based on no. of days): For other expenses (justify in full): Total amount: Would you be granted paid leave of absence to take up this fellowship? YES/ NO If YES please state the amount 3. Research details Reasons for choosing the host institution and mentor 10

11 Aims and plan of the project Please structure following the given template Title: Abstract: (<½ page) Hypothesis and objectives: (< ½ page) Background: (< 1 page) Methods and statistical plan: (< 1 page) Relevance: (< ½ page) Potential future impact of project on the headache field 11

12 What do you expect to gain from the fellowship? Future impact of fellowship and project on your career 12

13 4. Required documentation (check list) Updated curriculum vitae of the applicant (including Academic record (degree, subject, institution, year, etc.) A clear fellowship proposal (documentation above) Two reference letters (other than the fellowship mentor) Updated curriculum vitae of the fellowship mentor Completed mentor section (please see the last page of this document) Confirmation letter of the fellowship acceptance from the host institution and mentor 5. Acceptance I have carefully read and completed the above application form and attached all the requested documentation. If my application is successful I agree to abide by the rules and regulations for this award. Signature: Date: MENTOR SECTION This section must be completed by the fellowship mentor IN CONFIDENCE AND MUST BE SENT INDEPENDENTLY from the remaiing full application and related documentation by to carol.taylor@i-h-s.org by 20 April 2018 Applicant s name Title of proposed study Mentor s name Institution s name Mentor s contact details Address: Tel: Fax: 13

14 Applicant s scientific ability and suitability for this fellowship Why is your institution appropriate to hold this specific fellowship? Signature: Date: 14

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18 本電子報以電子郵件方式寄發內容包括的會員通知事項, 及頭痛相關文章本園地公開, 竭誠歡迎所有頭痛相關醫學著述病例討論文獻推介研討會講座等投稿, 稿酬從優敬請不吝指教, 感謝您的支持! 聯絡人 : 秘書李瑞琦會址 : 台南市永康區中華路 901 號 - 全人醫療科辦公室 TEL: 轉或 FAX: taiwan.head@msa.hinet.net 學會網頁 : 18

入學考試網上報名指南

入學考試網上報名指南入學考試網上報名指南 On-line Application Guide for Admission Examination 16/01/2015 University of Macau Table of Contents Table of Contents... 1 A. 新申請網上登記帳戶 /Register for New Account... 2 B. 填

網站 : 頭痛電子報第 162 期 發行人 : 台灣頭痛學會 發刊日期 : 民國 107 年 03 月 本期內容 咳嗽頭痛 運動頭痛與性行為相關之頭痛的鑑別診斷 - 周品吟醫師 p 2 IHS FELLOWSHIP AWARD 201

網站 : 頭痛電子報第 162 期發行人 : 台灣頭痛學會發刊日期 : 民國 107 年 03 月本期內容咳嗽頭痛運動頭痛與性行為相關之頭痛的鑑別診斷 - 周品吟醫師 p 2 IHS FELLOWSHIP AWARD 201