Nye Barbara L, Ward Thomas N
Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA.
Headache. 2015 Oct;55(9):1301-8. doi: 10.1111/head.12648. Epub 2015 Sep 30.
Evaluation of the headache patient in the outpatient clinic and emergency department (ED) has different focuses and goals. The focus of this paper is to review the evaluation of patients in both settings with mention of evaluation in the pediatric and pregnant patient population. The patient's history should drive the practitioner's decision and evaluation choices. We review recommendations made by the American Board of Internal Medicine and American Headache Society through the Choosing Wisely Campaign, which has an emphasis on choosing the right imaging modality for the clinical situation and elimination/prevention of medication overuse headache, as well as the US Headache Consortium guidelines for migraine headache. We will also review focusing on ED evaluation of the pediatric patient and pregnant patient presenting with headache.
At the end of the review we hope to have provided you with a framework to think about the headache patient and what is the appropriate test in the given clinical setting in order to ensure that the patient gets the right diagnosis and is set on a path to the appropriate management plan.
门诊和急诊科对头痛患者的评估有不同的重点和目标。本文的重点是回顾这两种情况下对患者的评估，并提及儿科和孕妇人群的评估。患者的病史应指导从业者的决策和评估选择。我们回顾了美国内科医学委员会和美国头痛协会通过明智选择运动提出的建议，该运动强调为临床情况选择正确的成像方式以及消除/预防药物过度使用性头痛，以及美国头痛联盟关于偏头痛的指南。我们还将回顾重点关注儿科患者和因头痛就诊的孕妇在急诊科的评估。
在回顾结束时，我们希望为您提供一个思考头痛患者的框架，以及在特定临床环境中进行何种适当检查，以确保患者得到正确诊断并走上适当的管理计划之路。
