Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, (PGIMER), Chandigarh 160012, India.
Indian J Pediatr. 2012 Mar;79(3):376-80. doi: 10.1007/s12098-011-0570-2. Epub 2011 Oct 20.
Headache remains a frequently encountered neurological symptom in Emergency department. Secondary causes of headache outnumber the primary entities such as migraine. Most of the secondary headaches have benign etiologies. The goal of emergent evaluation is to detect those with serious or life threatening causes. Identifying the pattern of headache helps in narrowing down the possible etiological diagnosis. A single episode of acute headache usually results from an acute infection ranging from viral URI to acute meningitis. Acute recurrent headaches are typically a feature of migraine. Chronic progressive headaches often indicate a serious underlying pathology such as a brain tumor and warrant a detailed neurological examination for signs of raised intracranial pressure (ICP) and focal deficits. Children with abnormal neurological findings require a neuroimaging. CT scan usually detects most of the abnormalities. Initial stabilization and management of raised ICP takes precedence in sick children. While simple analgesics like paracetamol and ibuprofen are used for symptomatic therapy, identification and appropriate treatment of underlying conditions is necessary for complete resolution of headache.
头痛仍然是急诊科常见的神经科症状。头痛的继发性病因比原发性头痛（如偏头痛）更为常见。大多数继发性头痛的病因是良性的。紧急评估的目的是发现那些有严重或危及生命的病因。识别头痛模式有助于缩小可能的病因诊断。单次急性头痛发作通常是由急性感染引起的，从病毒上呼吸道感染到急性脑膜炎不等。急性复发性头痛通常是偏头痛的特征。慢性进行性头痛常提示严重的潜在病理，如脑肿瘤，并需要进行详细的神经系统检查，以发现颅内压升高（ICP）和局灶性缺陷的迹象。有异常神经学发现的儿童需要进行神经影像学检查。CT 扫描通常可以检测到大多数异常。在患病儿童中，首先要进行颅内压升高的初始稳定和管理。虽然简单的镇痛药，如对乙酰氨基酚和布洛芬，可用于对症治疗，但需要识别和适当治疗潜在疾病，以完全解决头痛。
