Becker L, Iverson D C, Reed F M, Calonge N, Miller R S, Freeman W L
Ambulatory Sentinel Practice Network, Denver, Colorado 80202.
J Fam Pract. 1988 Jul;27(1):41-7.
From a consecutive series of 3,847 headache patients, 1,331 patients who made first visits for new headache to 120 primary care physicians were studied for usual care over a 14-month period. Either tension or vascular headache was the initial diagnosis in 23.8 percent and 12.8 percent of patients, respectively. Nearly one half (47.8 percent) were classified as having headaches other than tension or vascular. A total of 15.3 percent of headaches were undiagnosed or were regarded as a mixture of traditional diagnostic designations. At first visit, most patients (76.6 percent) were managed without diagnostic tests. Drugs were prescribed for 73.6 percent, and advice was given for 58.6 percent. Only 2.0 percent of patients had computerized tomographic scanning ordered at first visit, although at least 46 percent met National Institutes of Health criteria, a finding with potential economic consequences of at least $2 billion. These findings suggest the need for reevaluation of diagnostic categories for headache, reevaluation of strategies for headache management, and further investigations of headache in primary care patients.
在连续的3847例头痛患者中，选取了1331例首次因新发头痛前来120名初级保健医生处就诊的患者，对其进行了为期14个月的常规护理研究。紧张性头痛或血管性头痛分别是23.8%和12.8%患者的初始诊断。近一半（47.8%）的患者被归类为患有除紧张性或血管性头痛以外的其他头痛。总计15.3%的头痛未得到诊断或被视为传统诊断名称的混合情况。初诊时，大多数患者（76.6%）未进行诊断性检查。73.6%的患者开具了药物，58.6%的患者得到了建议。初诊时仅2.0%的患者进行了计算机断层扫描，尽管至少46%的患者符合美国国立卫生研究院的标准，这一发现可能带来至少20亿美元的经济后果。这些发现表明需要重新评估头痛的诊断类别、重新评估头痛管理策略，并对初级保健患者的头痛进行进一步调查。
