Silberstein S D
Comprehensive Headache Center, Germantown Hospital and Medical Center, Philadelphia, PA 19144.
Headache. 1992 Sep;32(8):396-407. doi: 10.1111/j.1526-4610.1992.hed3208396.x.
Headache is a common complaint in patients presenting to the emergency department. Most such headaches are benign, but some have a more severe organic cause. Occasionally, patients present with a chronic headache disorder with which they can no longer cope. The new International Headache Society Classification of Headache is reviewed along with the differential diagnosis of benign headache disorders. Headache diagnosis by history is examined in detail followed by a discussion of the emergency presentation of headache patients. Causes for concern are presented, along with a detailed discussion of differential diagnosis, including subarachnoid hemorrhage, meningitis, sinusitis, glaucoma, internal carotid artery dissection, and cerebro-vascular disease. Also discussed are medications used for the symptomatic treatment of headache, including analgesics, NSAIDs, narcotics, and ergotamine preparations. Approaches to the treatment of the severe, persistent headache in the emergency department are outlined and treatment options suggested. Headache medication overuse is discussed and guidelines are presented to recognize the condition and prevent its recurrence.
头痛是急诊科患者的常见主诉。大多数此类头痛是良性的，但有些有更严重的器质性病因。偶尔，患者会出现慢性头痛疾病且无法再应对。本文回顾了新的国际头痛协会头痛分类以及良性头痛疾病的鉴别诊断。详细探讨了通过病史进行头痛诊断，随后讨论了头痛患者的急诊表现。列出了需要关注的病因，并详细讨论了鉴别诊断，包括蛛网膜下腔出血、脑膜炎、鼻窦炎、青光眼、颈内动脉夹层和脑血管疾病。还讨论了用于头痛症状治疗的药物，包括镇痛药、非甾体抗炎药、麻醉药和麦角胺制剂。概述了急诊科治疗严重持续性头痛的方法并提出了治疗选择。讨论了头痛药物过度使用的问题，并给出了识别该病症并预防其复发的指南。
