Department of Neurology, 725 Albany Street, Suite 7B, Boston, MA 02118, USA.
Department of Ophthalmology and Neurology, 85 East Concord Street 8th Floor, Boston, MA 02118, USA.
Neurol Clin. 2021 May;39(2):355-372. doi: 10.1016/j.ncl.2021.01.003.
Headache is a common reason for seeking medical attention. Most cases are benign primary headache disorders; however, there is significant overlap between symptoms of these disorders and secondary headaches. Differentiating these clinical scenarios requires a careful history with attention to red flag symptoms and a neurologic examination. These details can identify dangerous disorders: subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, elevated intracranial pressure, hydrocephalus, cerebral venous sinus thrombosis, arterial dissection, central nervous system infection, and inflammatory vasculitis. Older, pregnant, or immunocompromised patients have a higher risk for secondary disorders; clinicians should have a different threshold to conduct evaluations in such patients.
头痛是寻求医疗关注的常见原因。大多数病例为良性原发性头痛障碍;然而,这些障碍的症状与继发性头痛有显著重叠。区分这些临床情况需要仔细询问病史,注意危险症状和神经系统检查。这些细节可以识别出危险的疾病:蛛网膜下腔出血、可逆性脑血管收缩综合征、颅内压升高、脑积水、脑静脉窦血栓形成、动脉夹层、中枢神经系统感染和炎症性血管炎。老年、孕妇或免疫功能低下的患者发生继发性疾病的风险更高;对于这些患者,临床医生应设定不同的门槛来进行评估。