Sporns P B, Hälker L, Heindel W, Niederstadt T, Allkemper T, Dziewas R, Schwindt W
Institute of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Deutschland.
Department of Neurology, University Hospital Muenster, Münster, Deutschland.
Radiologe. 2018 Sep;58(9):850-854. doi: 10.1007/s00117-018-0421-5.
Headaches are a very common symptom and imaging is important to rule out symptomatic causes. For clinical differentiation between primary and secondary headaches an exact anamnesis and neurological examination are important. The aim of this study is therefore to identify anamnestic and neurological information that is associated with secondary headaches. Moreover, this study gives an overview of the causes and differential diagnoses of secondary headaches.
We performed a retrospective analysis of 239 patients ≥18 years with headaches who had undergone computed tomography or magnetic resonance imaging. The impact of basic characteristics such as age and gender as well as anamnestic (pain intensity, thromboembolic risk profile) and clinical information (neurological deficit, papilledema, reduced vigilance) was tested by χ test at the significance level p < 0.05.
In all, 27 of the included patients (11.3%) showed intracranial pathologies that required treatment. The most frequent pathologies were intracranial hypertension (9 patients), cerebral mass lesions (7 patients) and thrombosis of the cranial sinus/veins (3 patients). There was a significant association of a pathologic imaging finding and neurological deficits (p = 0.001) and a papilledema (p < 0.001). Reduced vigilance, pain intensity and thromboembolic risk factors as well as age and gender showed no significant association.
A neurological deficit and especially papilledema are hints towards secondary headaches and should result in computed tomography or magnetic resonance imaging. Other factors such as reduced vigilance, pain intensity, age and gender have no relevant impact on the occurrence of intracranial pathologies.
头痛是一种非常常见的症状，影像学检查对于排除症状性病因很重要。对于原发性头痛和继发性头痛的临床鉴别，准确的病史采集和神经系统检查很重要。因此，本研究的目的是确定与继发性头痛相关的病史和神经系统信息。此外，本研究概述了继发性头痛的病因和鉴别诊断。
我们对239例年龄≥18岁的头痛患者进行了回顾性分析，这些患者均接受过计算机断层扫描或磁共振成像检查。通过χ检验在显著性水平p<0.05下测试年龄、性别等基本特征以及病史（疼痛强度、血栓栓塞风险概况）和临床信息（神经功能缺损、视乳头水肿、警觉性降低）的影响。
总共，纳入的患者中有27例（11.3%）显示出需要治疗的颅内病变。最常见的病变是颅内高压（9例）、脑实质病变（7例）和颅窦/静脉血栓形成（3例）。病理影像学表现与神经功能缺损（p=0.001）和视乳头水肿（p<0.001）之间存在显著关联。警觉性降低、疼痛强度和血栓栓塞危险因素以及年龄和性别均未显示出显著关联。
神经功能缺损，尤其是视乳头水肿，提示继发性头痛，应进行计算机断层扫描或磁共振成像检查。其他因素，如警觉性降低、疼痛强度、年龄和性别，对颅内病变的发生没有相关影响。
