对头痛患者进行病史采集的技巧。
The art of history-taking in a headache patient.
作者信息
Ravishankar K
机构信息
Department of Neurology, Consultant in Charge, The Headache and Migraine Clinics, Jaslok Hospital and Research Centre, Lilavati Hospital and Research Centre, Mumbai, India.
出版信息
Ann Indian Acad Neurol. 2012 Aug;15(Suppl 1):S7-S14. doi: 10.4103/0972-2327.99989.
Headache is a common complaint that makes up for approximately 25% of any neurologists outpatient practice. Yet, it is often underdiagnosed and undertreated. Ninety percent of headaches seen in practice are due to a primary headache disorder where there are no confirmatory tests, and neuroimaging studies, if done, are normal. In this situation, a good headache history allows the physician to recognize a pattern that in turn leads to the correct diagnosis. A comprehensive history needs time, interest, focus and establishment of rapport with the patient. When to ask what question to elicit which information, is an art that is acquired by practice and improves with experience. This review discusses the art of history-taking in headache patients across different settings. The nuances of headache history-taking are discussed in detail, particularly the questions related to the time, severity, location and frequency of the headache syndrome in general and the episode in particular. An emphasis is made on the recognition of red flags that help in the identification of secondary headaches.
头痛是一种常见的主诉，约占任何神经科门诊业务的25%。然而，它常常被漏诊和治疗不足。在实际临床中见到的头痛，90%是由原发性头痛疾病引起的，这类疾病没有确诊性检查，而且神经影像学检查（如果进行的话）结果正常。在这种情况下，一份详尽的头痛病史能让医生识别出一种模式，进而得出正确的诊断。一份全面的病史需要时间、兴趣、专注以及与患者建立融洽的关系。何时询问何种问题以获取哪方面信息，这是一门通过实践习得并随经验而提高的艺术。本综述讨论了在不同情况下对头痛患者进行病史采集的技巧。详细讨论了头痛病史采集的细微差别，特别是与头痛综合征总体及具体发作的时间、严重程度、部位和频率相关的问题。重点强调了识别有助于鉴别继发性头痛的警示信号。
Zotero 插件