Department of Neurology, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Semin Neurol. 2010 Feb;30(1):74-81. doi: 10.1055/s-0029-1245000. Epub 2010 Feb 1.
Distinguishing primary headache from secondary headache is the first objective of every new clinical encounter with a patient complaining of headache. The history is king in headache medicine-90% of patients presenting with headache have a primary headache disorder and the examination is normal. The history must be elicited because patients will not always volunteer seminal information. A standard series of questions must be asked of each patient to guide an appropriate diagnostic evaluation and ensure that secondary causes are not overlooked. The second objective, of course, is making the correct diagnosis of the primary headache disorder. Although at first glance this appears obvious and almost patronizing, making the correct diagnosis is often not a priority, nor is it a process that is emphasized in undergraduate and postgraduate training programs. Knowing some simple rules and standard questions will make the process almost fail proof.
从继发性头痛中鉴别原发性头痛是每位以头痛为主要症状的新患者临床诊疗的首要目标。在头痛医学中，病史至关重要——90%的头痛患者都存在原发性头痛障碍，且体格检查正常。必须采集病史，因为患者不会主动提供关键信息。必须向每位患者询问一系列标准问题，以指导适当的诊断评估并确保不会忽视继发性病因。当然，第二个目标是正确诊断原发性头痛障碍。虽然乍一看这似乎显而易见，甚至有些自以为是，但正确的诊断通常不是首要任务，也不是本科和研究生培训课程中强调的过程。了解一些简单的规则和标准问题将使诊断过程几乎万无一失。
