Ryan C W
Johnson City Family Care Center, New York, USA.
Am Fam Physician. 1996 Sep 1;54(3):1051-7.
Most chronic headache syndromes can be identified by conducting a careful interview that yields a thorough understanding of the patient's headache experience. The interview should explore the PQRST of the pain: provocation, quality, region, strength and time course, with the last element being the most helpful. Associated symptoms, such as nausea and vomiting in migraine, can be clues to the etiology. A list of all current medicines and the frequency of use should be obtained, since overuse of various analgesics can convert paroxysmal migraine into chronic daily headache. Psychosocial issues should be addressed, since depression can manifest as chronic headache. Changes in mood, energy, appetite, sleep, libido, enjoyments and suicidal ideation (represented by the acronym MEASLES) can indicate depression. A neurologic examination is important, and any focal findings warrant tomographic imaging of the brain. Findings on physical examination, however, are usually normal in patients with chronic headache. Laboratory and imaging studies are of most value when targeted to elucidate potential diagnoses raised by the detailed interview.
大多数慢性头痛综合征可通过仔细询问病史来确诊，这有助于全面了解患者的头痛经历。问诊应探究疼痛的PQRST：诱因、性质、部位、程度和病程，其中最后一项最为重要。相关症状，如偏头痛时的恶心和呕吐，可能提示病因。应获取患者目前所有正在服用药物的清单及其服用频率，因为过度使用各种镇痛药可使阵发性偏头痛转变为慢性每日头痛。还应关注心理社会问题，因为抑郁症可能表现为慢性头痛。情绪、精力、食欲、睡眠、性欲、乐趣和自杀观念的变化（由首字母缩写词MEASLES表示）可能提示抑郁症。神经系统检查很重要，任何局灶性体征都需要进行脑部断层扫描。然而，慢性头痛患者的体格检查结果通常正常。实验室检查和影像学检查在针对详细问诊中提出的潜在诊断进行排查时最有价值。
