Walker David M, Teach Stephen J
Division of Emergency Medicine, Children's National Medical Center, Washington, DC 20010, USA.
Curr Opin Pediatr. 2008 Jun;20(3):248-54. doi: 10.1097/MOP.0b013e3282ff6308.
Headaches in children and adolescents are common presenting complaints in emergency departments. There is wide variation among acute treatments. We sought to review options for acute emergency department management and the recent evidence supporting their use.
Currently accepted diagnosis of pediatric headache is based on the International Classification of Headache Disorders-II classification system, which remains incomplete with regard to pediatric patients. In general, there is a paucity of studies evaluating acute treatment for pediatric headache, especially in the emergency department setting. Most studies use previously diagnosed patients with migraines as their subjects. Recent additions to the literature are mostly reviews in nature or pertain to the evaluation of triptan use in adolescents. No articles evaluate treatment of tension-type headaches.
Further research is needed on therapies targeted toward children and adolescents with headache subtypes other than migraine, including those without a previous diagnosis. While little evidence exists, most authors agree with an initial trial of ibuprofen followed by sumatriptan nasal spray for children over 12 years of age for those with persistent symptoms. Antiemetics remain an option for those with nausea and/or vomiting as a prominent feature of their illness. Other treatments such as ketorolac are still being investigated in children.
儿童和青少年头痛是急诊科常见的就诊主诉。急性治疗方法差异很大。我们试图回顾急诊科急性处理的选择以及支持其使用的最新证据。
目前公认的儿童头痛诊断基于《国际头痛疾病分类第二版》分类系统，但该系统在儿科患者方面仍不完整。总体而言，评估儿童头痛急性治疗的研究较少，尤其是在急诊科环境中。大多数研究以先前诊断为偏头痛的患者为研究对象。近期文献新增内容大多是综述性质的，或与青少年使用曲坦类药物的评估有关。没有文章评估紧张型头痛的治疗。
对于患有除偏头痛以外头痛亚型的儿童和青少年，包括那些未先前诊断的患者，需要进一步研究针对他们的治疗方法。虽然证据很少，但大多数作者同意，对于有持续症状的12岁以上儿童，可先试用布洛芬，然后使用舒马曲坦鼻喷雾剂。对于以恶心和/或呕吐为突出症状的患者，止吐药仍是一种选择。其他治疗方法，如酮咯酸，仍在儿童中进行研究。
