Medical University of South Carolina, Charleston, SC, USA. hainerbl@musc. edu
Am Fam Physician. 2013 May 15;87(10):682-7.
Approximately one-half of the adult population worldwide is affected by a headache disorder. The International Headache Society classification and diagnostic criteria can help physicians differentiate primary headaches (e.g., tension, migraine, cluster) from secondary headaches (e.g., those caused by infection or vascular disease). A thorough history and physical examination, and an understanding of the typical features of primary headaches, can reduce the need for neuroimaging, lumbar puncture, or other studies. Some red flag signs and symptoms identified in the history or during a physical examination can indicate serious underlying pathology and will require neuroimaging or other testing to evaluate the cause of headache. Red flag signs and symptoms include focal neurologic signs, papilledema, neck stiffness, an immunocompromised state, sudden onset of the worst headache in the patient's life, personality changes, headache after trauma, and headache that is worse with exercise. If an intracranial hemorrhage is suspected, head computed tomography without contrast media is recommended. For most other dangerous causes of headache, magnetic resonance imaging or computed tomography is acceptable.
全球大约有一半的成年人受到头痛疾病的影响。国际头痛协会的分类和诊断标准可以帮助医生区分原发性头痛（如紧张性头痛、偏头痛、丛集性头痛）和继发性头痛（如由感染或血管疾病引起的头痛）。详细的病史和体格检查，以及对原发性头痛典型特征的了解，可以减少神经影像学、腰椎穿刺或其他检查的需要。病史或体格检查中发现的一些警示症状和体征可能表明存在严重的潜在病理，并需要神经影像学或其他检查来评估头痛的原因。警示症状和体征包括局灶性神经体征、视乳头水肿、颈部僵硬、免疫功能低下、患者一生中最严重的头痛突然发作、性格改变、创伤后头痛和运动后头痛加剧。如果怀疑颅内出血，建议进行头部 CT 平扫而无需造影剂。对于大多数其他危险的头痛原因，磁共振成像或计算机断层扫描是可以接受的。
