Filler Levi, Akhter Murtaza, Nimlos Perrin
Department of Emergency Medicine, Maricopa Medical Center, Phoenix, Arizona.
Department of Emergency Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.
Semin Neurol. 2019 Feb;39(1):20-26. doi: 10.1055/s-0038-1677023. Epub 2019 Feb 11.
The acute headache in the emergency department (ED) poses a diagnostic dilemma that may overwhelm providers attempting to weigh the cost of advanced workups against the risk of missing serious pathology. While the majority of headache concerns are benign primary headache disorders, identifying life-threatening secondary causes of headache-which may be broadly categorized into structural, infectious, and vascular causes-is the primary focus of evaluation in the ED. Secondary headaches are associated with a high morbidity and mortality, and require strict scrutiny of the history and physical examination to adequately risk-stratify patients. Innovative and emerging technologies may further assist providers in the diagnosis of headache, and challenge previous gold-standard diagnostic evaluations. Herein, we present a general overview of the workup and management of headaches in the ED, with a special section for diagnostic considerations in evaluating for acute meningitis, subarachnoid hemorrhage, and acute angle-closure glaucoma.
急诊科的急性头痛带来了诊断难题，这可能会让试图权衡高级检查成本与漏诊严重病变风险的医护人员不堪重负。虽然大多数头痛问题是良性原发性头痛疾病，但识别危及生命的继发性头痛原因（可大致分为结构性、感染性和血管性原因）是急诊科评估的主要重点。继发性头痛与高发病率和死亡率相关，需要对病史和体格检查进行严格审查，以便对患者进行充分的风险分层。创新和新兴技术可能会进一步帮助医护人员诊断头痛，并对以前的金标准诊断评估提出挑战。在此，我们概述了急诊科头痛的检查和管理，并特别介绍了评估急性脑膜炎、蛛网膜下腔出血和急性闭角型青光眼时的诊断注意事项。
