Department of Neurology, Brigham and Womens Faulkner Hospital, John R. Graham Headache Center, Jamaica Plain, MA 02130, USA.
Semin Neurol. 2011 Feb;31(1):5-17. doi: 10.1055/s-0031-1271313. Epub 2011 Feb 14.
Headache is one of the most common complaints among patients presenting to an outpatient neurology practice. The evaluation, diagnosis, and treatment of headache can be rather cumbersome and at times quite challenging for even the most seasoned neurologist. Many complex issues that although not causative, can play an exacerbating role in the genesis of headaches. In this article, the authors review some of the essential elements that are part of headache evaluation including headache-specific history, physical examination, warning signs of secondary headache disorders, and when to consider further studies. They then provide a brief review on the diagnosis of primary headache disorders according to the International Headache Society's International Classification of Headache Disorders, 2nd Edition (ICHD-2), and treatment strategies of the more common primary headache disorders with a focus on migraine, trigeminal autonomic cephalalgias, tension-type headache, and chronic daily headache.
头痛是患者在神经内科门诊就诊时最常见的主诉之一。即使是最有经验的神经科医生,头痛的评估、诊断和治疗也可能相当繁琐,有时颇具挑战性。许多复杂的问题虽然不是病因,但在头痛的发生中可能起到加重作用。本文作者回顾了头痛评估的一些基本要素,包括头痛的特定病史、体格检查、继发性头痛障碍的警告信号,以及何时考虑进一步检查。然后,根据国际头痛协会的《国际头痛疾病分类》第二版(ICHD-2),作者简要回顾了原发性头痛疾病的诊断,并重点介绍了偏头痛、三叉神经自主神经性头痛、紧张型头痛和慢性每日头痛等常见原发性头痛疾病的治疗策略。