Arroyo H A
Servicio de Neurología, Hospital de Pediatría Prof Dr JP Garrahan, Buenos Aires, Argentina.
Rev Neurol. 2003;37(4):364-70.
Headache is one of the most frequent reasons for presenting to Neuropaediatric units. Although in most cases the patient is not suffering from any serious disease, the parents and even the paediatrician do tend to fear that this is indeed the case. Evaluating a patient with headache requires a detailed interview, as well as a careful clinico-neurological examination. From these elements it is basically possible to sort headaches into four large groups: acute, acute-recurrent, chronic non-progressive and chronic progressive. Acute headaches are an emergency and it is therefore necessary to have an algorithm available which can be used regardless of the degree of complexity of the clinical environment in which the patient is being treated. Invasive studies such as a spinal tap and/or neuroradiological studies are often needed. The International Headache Society criteria have been adapted to the juvenile population for the diagnosis of patients suffering from acute-recurrent headaches (migraine). Chronic non-progressive headaches are a group in which prevalence increases with age and is the most frequently observed form of headache in adolescents. Emotional factors, situations involving family and/or social conflict, either alone or in combination, are usually predisposing or triggering factors in this type of headache. Chronic progressive headache is a consequence of some organic disorder. In the search for and treatment of headache we must not forget to calm the pain experienced by the patient.
头痛是前往神经儿科就诊最常见的原因之一。尽管在大多数情况下患者并无严重疾病，但家长甚至儿科医生往往会担心情况确实如此。评估头痛患者需要进行详细的问诊以及仔细的临床神经学检查。基于这些要素，基本上可以将头痛分为四大类：急性、急性复发性、慢性非进行性和慢性进行性。急性头痛属于急症，因此有必要具备一种算法，无论患者所处临床环境的复杂程度如何，均可使用。通常需要进行诸如腰椎穿刺和/或神经放射学检查等侵入性研究。国际头痛协会的标准已针对青少年群体进行了调整，用于诊断患有急性复发性头痛（偏头痛）的患者。慢性非进行性头痛是一类患病率随年龄增长而增加的头痛类型，也是青少年中最常见的头痛形式。情绪因素、涉及家庭和/或社会冲突的情况，单独或共同作用，通常是这类头痛的诱发或触发因素。慢性进行性头痛是某些器质性疾病的结果。在寻找和治疗头痛时，我们绝不能忘记缓解患者所经历的疼痛。
