Lewis D W, Qureshi F
Department of Pediatrics, Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, USA.
Headache. 2000 Mar;40(3):200-3. doi: 10.1046/j.1526-4610.2000.00029.x.
Our goals were (1) to investigate the causes of acute headache in childhood from the emergency department perspective and (2) to search for clinical clues that might distinguish headache associated with serious underlying disease.
The clinical presentation of headache in children and adolescents can be separated into 5 temporal patterns: acute, acute-recurrent, chronic progressive, chronic nonprogressive, and mixed. Few data exist regarding acute headache in children.
Consecutive children who presented to our emergency department with the abrupt onset of severe headache were prospectively evaluated. The headache character, location, severity, and associated symptoms, as well as underlying causes, were recorded using a standardized survey.
One hundred fifty children, aged from 2 to 18 years, 87 boys and 63 girls, were enrolled over a 10-month period. Upper respiratory tract infection with fever (viral upper respiratory tract infection 39%, sinusitis 9%, streptococcal pharyngitis 9%) was the most frequently identified cause of acute headache (57%). Other causes included migraine (18%), viral meningitis (9%), posterior fossa tumors (2.6%), ventriculoperitoneal shunt malfunction (2%), epileptic seizure (postictal headache) (1.3%), concussion (postconcussive headache) (1. 3%), intracranial hemorrhage (1.3%), and undetermined (7%). Two clinical features were found to have statistically significant associations with serious underlying disease: occipital location of headache and an inability of the patient to describe the quality of the head pain. All children with surgically remediable conditions had clear and objective neurological signs.
In children and adolescents, the abrupt onset of severe headache is most frequently caused by upper respiratory tract infection with fever, sinusitis, or migraine. Special attention is warranted if the acute headache is occipital in location and if the affected patient is unable to describe the quality of the pain. Serious underlying processes such as brain tumor or intracranial hemorrhage are uncommon and, when present, are accompanied by multiple neurological signs (ataxia, hemiparesis, papilledema).
我们的目标是（1）从急诊科的角度调查儿童急性头痛的病因，以及（2）寻找可能区分与严重潜在疾病相关的头痛的临床线索。
儿童和青少年头痛的临床表现可分为5种时间模式：急性、急性复发性、慢性进行性、慢性非进行性和混合型。关于儿童急性头痛的数据很少。
对连续到我们急诊科就诊且突然出现严重头痛的儿童进行前瞻性评估。使用标准化调查问卷记录头痛的特征、部位、严重程度、相关症状以及潜在病因。
在10个月的时间里，共纳入了150名年龄在2至18岁之间的儿童，其中87名男孩和63名女孩。伴有发热的上呼吸道感染（病毒性上呼吸道感染39%，鼻窦炎9%，链球菌性咽炎9%）是急性头痛最常见的病因（57%）。其他病因包括偏头痛（18%）、病毒性脑膜炎（9%）、后颅窝肿瘤（2.6%）、脑室腹腔分流管故障（2%）、癫痫发作（发作后头痛）（1.3%）、脑震荡（脑震荡后头痛）（1.3%）、颅内出血（1.3%）以及病因不明（7%）。发现两个临床特征与严重潜在疾病有统计学上的显著关联：头痛位于枕部以及患者无法描述头痛的性质。所有患有可手术治疗疾病的儿童都有明确且客观的神经系统体征。
在儿童和青少年中，严重头痛的突然发作最常见的原因是伴有发热的上呼吸道感染、鼻窦炎或偏头痛。如果急性头痛位于枕部且受影响的患者无法描述疼痛的性质，则需要特别关注。严重的潜在疾病过程，如脑肿瘤或颅内出血并不常见，一旦出现，会伴有多种神经系统体征（共济失调、偏瘫、视乳头水肿）。
