Coutin I B, Glass S F
Kaiser Permanente Medical Center, Fontana, California, USA.
Am Fam Physician. 1996 Nov 15;54(7):2247-52.
Uncommon headache syndromes can be classified into two broad categories: (1) urgent conditions, including subarachnoid hemorrhage, giant cell arteritis and bacterial meningitis, and (2) special syndromes, such as cluster headache, migraine with aura and headache caused by benign intracranial hypertension. In this article, uncommon headaches are differentiated from the common migraine and the tension headache, which fall into a third category. If a neurologic abnormality is detected during the physical examination, aggressive medical diagnostic intervention is required. Because of its cost, neuroimaging should be reserved for specific situations that herald life-threatening or acutely reversible conditions; it should not be used in the work-up of nonspecific headache. The diagnosis of common headaches can be simplified by considering tension and common migraine syndromes to exist at different points on a headache spectrum.
（1）紧急情况，包括蛛网膜下腔出血、巨细胞动脉炎和细菌性脑膜炎；（2）特殊综合征，如丛集性头痛、伴有先兆的偏头痛和良性颅内高压引起的头痛。在本文中，罕见头痛与普通偏头痛和紧张性头痛相区分，后两者属于第三类。如果在体格检查中发现神经系统异常，则需要积极进行医学诊断干预。由于其成本，神经影像学检查应仅用于预示危及生命或急性可逆情况的特定情形；不应将其用于非特异性头痛的检查。通过将紧张性头痛和普通偏头痛综合征视为头痛谱上不同点的存在，可以简化普通头痛的诊断。
