一病例報告：以非藥物方式治療老年人慢性每日頭痛

A Case Report of Chronic Daily Headache Treated Non-medically

老年人慢性每日頭痛中以慢性偏頭痛與慢性緊縮型頭痛最多，在診療時須先設法排除器質性的病變。一78歲男性，苦於前額部位持續性的鈍痛感已經半年，只要戴上帽子，症狀就會減輕。理學檢查均無異常發現，醒覺腦波圖無異常發現，T1、T2權重及磁振液體訊號減弱逆轉回復影像顯示無腦部器質性病變，但是擴散加權顯影呈現中腦不規則顯影。顱外頸部動脈超音波檢查顯示整體腦血流量為553 mL/min。分析其1個月頭痛日記後診斷為慢性緊縮型頭痛，建議保守治療。由於口服藥物無法減輕症狀，遂建議不妨戴上帽子以減輕不適感。5個月後，症狀居然自然緩解，擴散加權顯影呈現中腦處顯影又發生了變化，顱外頸部動脈超音波檢查顯示整體腦血流量為549 mL/min。因此，本個案可能為中腦病變所致之三叉神經感覺症狀，並非腦血流減少所致。結論：老年人慢性每日頭痛不一定得用藥物治療，徹底了解頭痛型態及患者反應，或許，簡單的生活調整即可治療病症。

Although chronic migraine and chronic tension-type headaches are the most common geriatric chronic daily headaches, an organic lesion is possible. A 78-year-old male presented with dull frontal pain for 6 months. Wearing a cap alleviated the symptom. Physical examinations were unremarkable. A waking electroencephalogram was normal. T1, T2 and a fluid attenuated inversion recovery magnetic resonance image were unremarkable, but a diffusion weighted image revealed irregular intensity of the midbrain. An extra-cranial neck color-coded duplex sonogram showed that the total cerebral blood flow was 553 mL/min. The patient's one-month headache diary was characteristic of a chronic tension-type headache, so conservative treatment was recommended. Medication failed to relieve his symptom, so wearing a cap was recommended. Five months later, the symptom subsided spontaneously. The diffusion weighted image revealed that the midbrain had changed intensity. The extra-cranial neck color-coded duplex sonogram now showed that the total cerebral blood flow was 549 mL/min. The symptom might have been due to trigeminal sensation secondary to a midbrain lesion, but not to a cerebral hemodynamic decrease. In conclusion, medication is not necessarily recommended for geriatric chronic daily headache. After determining the headache pattern and the patient's response, a simple life-style accommodation may treat the symptom. Few such cases have been reported in the literature, and we encourage other experts' opinions.