Singh Amandeep, Soares William E
Emergency Department, Alameda County Medical Center, Highland Hospital, Oakland, CA, USA.
Emerg Med Pract. 2012 Jun;14(6):1-23; quiz 23-4.
Approximately 2.1 million patients per year present to United States emergency departments with a primary headache disorder. For emergency clinicians, the responsibility is twofold: First, exclude causes of headaches that pose immediate threats to the life and welfare of patients. Second, provide safe, effective, and rapid treatment of symptoms, while facilitating discharge from the emergency department with appropriate follow-up. While emergency management focuses on identification and treatment of life-threatening causes of headache, such as subarachnoid hemorrhage or bacterial meningitis, there is a tendency to misdiagnose specific primary headache disorders and fail to provide consistent, effective treatments in accordance with published guidelines. These mistakes can be avoided by resisting the temptation to label patients with specific primary headache diagnoses and by adopting a consistent, reproducible strategy for treatment of primary headache disorders in the emergency department that is evidence-based and effective.
每年约有210万患有原发性头痛疾病的患者前往美国急诊科就诊。对于急诊临床医生而言，责任有两方面：其一，排除对患者生命和健康构成直接威胁的头痛病因。其二，提供安全、有效且快速的症状治疗，同时促使患者从急诊科顺利出院并进行适当的随访。虽然急诊管理侧重于识别和治疗危及生命的头痛病因，如蛛网膜下腔出血或细菌性脑膜炎，但存在误诊特定原发性头痛疾病以及未能按照已发表指南提供一致、有效治疗的倾向。通过抵制给患者贴上特定原发性头痛诊断标签的诱惑，并在急诊科采用一种基于证据且有效的、一致的、可重复的原发性头痛疾病治疗策略，可以避免这些错误。
