Schoen Jessica C, Campbell Ronna L, Sadosty Annie T
Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island.
Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
West J Emerg Med. 2015 Mar;16(2):291-301. doi: 10.5811/westjem.2015.1.23688. Epub 2015 Feb 25.
Headache is a common presenting complaint in the emergency department. The differential diagnosis is broad and includes benign primary causes as well as ominous secondary causes. The diagnosis and management of headache in the pregnant patient presents several challenges. There are important unique considerations regarding the differential diagnosis, imaging options, and medical management. Physiologic changes induced by pregnancy increase the risk of cerebral venous thrombosis, dissection, and pituitary apoplexy. Preeclampsia, a serious condition unique to pregnancy, must also be considered. A high index of suspicion for carbon monoxide toxicity should be maintained. Primary headaches should be a diagnosis of exclusion. When advanced imaging is indicated, magnetic resonance imaging (MRI) should be used, if available, to reduce radiation exposure. Contrast agents should be avoided unless absolutely necessary. Medical therapy should be selected with careful consideration of adverse fetal effects. Herein, we present a review of the literature and discuss an approach to the evaluation and management of headache in pregnancy.
头痛是急诊科常见的就诊主诉。鉴别诊断范围广泛，包括良性原发性病因以及凶险的继发性病因。妊娠患者头痛的诊断和管理存在诸多挑战。在鉴别诊断、影像学检查选择和药物治疗方面有一些重要的独特考量。妊娠引起的生理变化会增加脑静脉血栓形成、动脉夹层和垂体卒中的风险。子痫前期是妊娠特有的严重病症，也必须予以考虑。应高度怀疑一氧化碳中毒。原发性头痛应作为排除性诊断。如需进行高级影像学检查，如有条件应使用磁共振成像（MRI）以减少辐射暴露。除非绝对必要，应避免使用造影剂。选择药物治疗时应仔细考虑对胎儿的不良影响。在此，我们对文献进行综述，并讨论妊娠头痛的评估和管理方法。
