Bartleson J D
Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Semin Neurol. 2006 Apr;26(2):163-70. doi: 10.1055/s-2006-939916.
The very common symptom of headache most often has a benign cause and can usually be diagnosed following a thorough history and neurologic and focused general physical examinations. Because the potential etiologies can threaten life and neurological function, headaches provoke understandable concern on the part of the patient and health care provider. Thoughtful testing can exclude the worrisome underlying causes. This article reviews the neurological and general symptoms and signs that should prompt diagnostic testing and the specific diagnostic studies that are recommended. The worrisome factors include recent head or neck injury; a new, worse, worsening, or abrupt-onset headache; headache brought on by exertion or Valsalva maneuver/cough; new headache in the patient over the age of 50; neurological symptoms and/or abnormal signs; systemic symptoms and/or signs; and secondary risk factors such as a history of cancer or human immunodeficiency virus infection. Less worrisome are headaches that wake the patient from sleep at night, side-locked headaches, and prominent effect of change in posture on the pain. The diagnostic investigations include neuroimaging, cerebrospinal fluid examination, and blood testing in specific situations.
非常常见的头痛症状通常由良性原因引起，通常在进行全面的病史询问、神经系统检查和针对性的全身体格检查后即可诊断。由于潜在病因可能危及生命和神经功能，头痛引起患者和医护人员的担忧是可以理解的。经过深思熟虑的检查可以排除令人担忧的潜在病因。本文回顾了应促使进行诊断性检查的神经学和一般症状及体征，以及推荐的具体诊断研究。令人担忧的因素包括近期头部或颈部受伤；新发、加重、恶化或突发的头痛；用力或瓦尔萨尔瓦动作/咳嗽引发的头痛；50岁以上患者的新发头痛；神经症状和/或异常体征；全身症状和/或体征；以及诸如癌症病史或人类免疫缺陷病毒感染等次要危险因素。夜间头痛痛醒、一侧固定性头痛以及姿势改变对疼痛有显著影响的头痛则不太令人担忧。诊断性检查包括神经影像学检查、脑脊液检查以及在特定情况下的血液检查。
