Gaini S M, Fiori L, Cesana C, Vergani F
Neurosurgical Clinic, University of Milano Bicocca, Via Donizetti 106, Monza (MI), Italy.
Neurol Sci. 2004 Oct;25 Suppl 3:S196-201. doi: 10.1007/s10072-004-0285-5.
The headache is a very frequent symptom and represents the 0.36%-2.5% of all reasons of claim to Emergency Department. Even if it is rarely related to high risk diseases, it is mandatory to promptly differentiate life-threatening conditions. In order to establish a correct diagnostic and therapeutic pathway and ask for aimed specialistic consultation, the emergency physician must be familiar with the various categories of headache. It is important to distinguish between essential headache and secondary headache. All patients presenting to the emergency department with the complaint of headache should be interviewed carefully regarding their history. The quality of pain associated with the intensity, location, rate, duration, modality of onset, relieving or worsening conditions, response to drugs, symptoms or signs associated must be investigated as well. Careful neurological examination including the vision of fundus oculi and the evaluation of rigor nucalis can provide further important diagnostic information. Laboratory exams do not usually give significant issues in the majority of patients with headache. However, dosage of inflammation index can be useful when an infective or inflammatory disease is suspected. CT scan can rule-out the suspicion of organic intracranial causes. When the physician suspects meningitis or subarachnoid hemorrhage (SAH) not showed by CT scanning, rachicentesis can turn out diagnostic. The modality of onset, clinical characteristics and differential diagnosis of subarachnoid hemorrhage, intracranial hypertension, colloidal cyst of the third ventricle, trigeminal neuralgia, temporal arteritis and pituitary adenomas and apoplexy will be discussed. These diseases are not only of neurological and neurosurgical interest, but involve also the physician in the Emergency Department.
头痛是一种非常常见的症状，占急诊就诊所有原因的0.36%-2.5%。即使它很少与高危疾病相关，但迅速鉴别危及生命的情况是必要的。为了建立正确的诊断和治疗路径并寻求有针对性的专科会诊，急诊医生必须熟悉各类头痛。区分原发性头痛和继发性头痛很重要。所有因头痛主诉到急诊科就诊的患者都应就其病史进行仔细询问。还必须调查与疼痛强度、部位、频率、持续时间、发作方式、缓解或加重情况、对药物的反应、相关症状或体征相关的疼痛性质。仔细的神经系统检查，包括眼底检查和颈项强直评估，可以提供进一步重要的诊断信息。实验室检查在大多数头痛患者中通常不会给出重要结果。然而，当怀疑有感染性或炎症性疾病时，炎症指标的测定可能会有用。CT扫描可以排除颅内器质性病因的怀疑。当医生怀疑有CT扫描未显示的脑膜炎或蛛网膜下腔出血（SAH）时，腰椎穿刺可能会有诊断价值。将讨论蛛网膜下腔出血、颅内高压、第三脑室胶样囊肿、三叉神经痛、颞动脉炎以及垂体腺瘤和卒中的发作方式、临床特征和鉴别诊断。这些疾病不仅是神经科和神经外科关注的问题，也涉及急诊科医生。
