J R Coll Gen Pract. 1987 Sep;37(302):400-3.
Headache is a common symptom in primary care about which surprisingly little is known. Over a 14-month period 3847 patients making 4940 consecutive visits for headache to 38 primary care practices in the USA and Canada were studied. The clinical characteristics of patients, as well as the diagnostic and therapeutic strategies employed by their doctors, were examined. Visits for headache represented 1.5% of all visits during this period. Most patients (72.0%) made only one visit, and nearly half of the headaches reported were new. Only a small number of patients (3.0%) received a computerized tomographic scan; other investigations were used sparingly, as were referrals to consultants (5.0%) and hospitalizations (2.2%). Drugs (75.2%) and advice (64.5%) were commonly employed, although formal psychotherapy was recommended infrequently (4.5%). It is concluded from this large series that most patients with headache visit primary care practitioners only once; their headaches frequently defy usual diagnostic categorization and often change in character from visit to visit. Moreover, headaches in this series were frequently associated with a variety of causes not often included in discussions of headache aetiology. These findings suggest that the strategies which doctors in primary care devise to diagnose, investigate and manage this common symptom, require further study.
头痛是初级保健中一种常见症状，然而令人惊讶的是，人们对此知之甚少。在美国和加拿大的38家初级保健机构中，对3847名患者进行了为期14个月的研究，这些患者因头痛连续就诊4940次。研究了患者的临床特征以及医生采用的诊断和治疗策略。在此期间，因头痛就诊占所有就诊次数的1.5%。大多数患者（72.0%）仅就诊一次，报告的头痛中近一半是新发的。只有少数患者（3.0%）接受了计算机断层扫描；其他检查使用较少，转诊至专科医生（5.0%）和住院治疗（2.2%）的情况也不多见。常用药物（75.2%）和建议（64.5%），不过很少推荐正规心理治疗（4.5%）。从这个大样本系列研究得出的结论是，大多数头痛患者仅就诊一次；他们的头痛常常不符合常规诊断分类，而且每次就诊时性质往往会改变。此外，该系列研究中的头痛常常与头痛病因讨论中不常提及的多种原因相关。这些发现表明，初级保健医生用于诊断、检查和处理这种常见症状的策略需要进一步研究。
