Elkind A H
New York Medical College, Valhalla.
Otolaryngol Clin North Am. 1989 Dec;22(6):1251-71.
Head injury frequently results in headache and at times facial pain. Controversy concerns the relationship of injury in the head and neck area to chronic headache, particularly when no apparent structural traumatic lesion is demonstrable. Neuropathological studies suggest with concussion there is neuronal injury without gross pathology. Closed head injury of seemingly minor degrees may lead to chronic symptoms, often stereotypic, similar to those following concussion, and they have been described by the term post head trauma syndrome or postconcussional syndrome. Headache after head injury in an individual warrants careful medical, neurological, and neuroimaging assessment. The use of neuroimaging has greatly enhanced diagnosis in head-injured patients but has not satisfactorily clarified post head trauma symptoms in the less severely traumatized. Differential diagnosis is critical to avoid missing disabling, progressive, and life-threatening entities. In patients with head trauma neck injury should be sought. The headache may be nonspecific or mimic common nontraumatic headache disorders such as tension, migraine, and cluster. Recovery may include headache, psychological symptoms, and cognitive impairment. Neuropsychological assessment can be helpful in demonstrating deficiencies in mildly impaired individuals and explain the poor response to headache therapy in some patients suggesting more widespread injury. Therapy of head and facial pain follows the careful diagnosis and, if needed, assessment of the psychological status. Surgery, drug therapy, physical modalities, and at times a comprehensive neuropsychological rehabilitation program are necessary. Simple analgesics such as nonsteroidal antiinflammatory agents for short-term treatment and tricyclic antidepressants for chronic pain are most often effective in patients without structural damage. More complex medication regimens may include beta adrenergic blockers and monamine oxidase inhibitors. Since many injuries result from motor vehicle accidents, work-related factors, and other instances in which litigation may result, legal elements may be involved. Most often the prognosis is favorable for resolution of symptoms but a small percentage of patients will have persistent symptoms after three years. The notion that litigation prolongs the duration of the illness is not valid. In the past two decades great advances have been made in neurodiagnosis, and parallel therapeutic advances are expected in the near future.
头部损伤常导致头痛，有时还会引起面部疼痛。关于头部和颈部损伤与慢性头痛之间的关系存在争议，尤其是在没有明显结构性创伤病变的情况下。神经病理学研究表明，脑震荡会导致神经元损伤，但无明显病理改变。看似轻微的闭合性头部损伤可能会导致慢性症状，通常具有刻板性，类似于脑震荡后的症状，这些症状被称为头部创伤后综合征或脑震荡后综合征。个体头部受伤后的头痛需要进行仔细的医学、神经学和神经影像学评估。神经影像学的应用极大地提高了对头部受伤患者的诊断能力，但对于创伤较轻的患者，尚未令人满意地阐明头部创伤后的症状。鉴别诊断对于避免漏诊致残性、进行性和危及生命的疾病至关重要。对于头部外伤患者，应检查是否存在颈部损伤。头痛可能是非特异性的，或类似于常见的非创伤性头痛疾病，如紧张性头痛、偏头痛和丛集性头痛。恢复过程可能包括头痛、心理症状和认知障碍。神经心理学评估有助于发现轻度受损个体的缺陷，并解释一些患者对头痛治疗反应不佳的原因，提示存在更广泛的损伤。头部和面部疼痛的治疗需要在仔细诊断后进行，如有必要，还需评估心理状态。手术、药物治疗、物理治疗方法，有时还需要一个全面的神经心理学康复计划。对于没有结构损伤的患者，简单的镇痛药如非甾体类抗炎药用于短期治疗，三环类抗抑郁药用于慢性疼痛，通常最为有效。更复杂的药物治疗方案可能包括β肾上腺素能阻滞剂和单胺氧化酶抑制剂。由于许多损伤是由机动车事故、与工作相关的因素以及其他可能导致诉讼的情况引起的，因此可能涉及法律因素。大多数情况下，症状缓解的预后良好，但一小部分患者在三年后仍会有持续症状。诉讼会延长疾病持续时间的观点是不正确的。在过去二十年中，神经诊断取得了巨大进展，预计在不久的将来治疗方面也会有相应进展。
