Headache 头痛概述 Headache（cephalalgia）isacommonsymptom,oftenassociatedwithdisability,butrarelylifethreatening.Headachesmaybeaprimarydisorder（migraine,cluster,ortensionheadache）orasecondarysymptomofsuchdisordersasacutesystemicorintracranialinfection,intracranialtumor,headinjuries,severehypertension,cerebralhypoxia,andmanydiseasesoftheeyes,nose,throat,teeth,ears,andcervicalvertebrae.Sometimesnocauseisfound. 头痛是一种常见症状，常常与功能障碍有关，但很少危及生命。头痛可能是一种原发性疾病（如偏头痛，丛集性头痛或紧张型头痛），也可能是某些疾病的继发症状，如急性全身性感染或颅内感染、颅内肿瘤、头外伤、严重的高血压、脑缺氧、及眼、耳、鼻、喉、口腔牙齿和颈椎等多种疾病，有时找不到任何病因。 Headachesmayresultfromstimulationof,tractionof,orpressureonanyofthepain-sensitivestructuresofthehead:alltissuescoveringthecranium;the5th,9th,and10thcranialnerves;theuppercervicalnerves;thelargeintracranialvenoussinuses;thelargearteriesatthebaseofthebrain;thelargeduralarteries;andtheduramaterattheskullbase.Dilationorcontractionofbloodvesselwallsstimulatesnerveendings,causingheadache.Thecauseofmostheadachesisextracranialratherthanintracranial.Stroke,vascularabnormalities,andvenousthrombosesareuncommoncausesofheadache. 对头部任何疼痛敏感结构的刺激、牵引或压迫都能引起头痛，这些结构包括覆盖头颅的所有组织；第5、9、10颅神经；上部颈神经；颅内大静脉窦；颅底大动脉；硬脑膜大动脉以及颅底硬脑膜。血管壁的扩张或收缩刺激神经末梢，引起头痛。大多数头痛的病因为颅外性而非颅内性。因脑卒中、血管畸形与静脉血栓形成引起的头痛并不常见。 DiagnosisThefrequency,duration,location,andseverityoftheheadache;thefactorsthatmakeitbetterorworse;associatedsymptomsandsigns,suchasfever,stiffneck,nausea,andvomiting;andspecialstudieshelpidentifythecauseofheadache. 诊断 诊断内容包括：头痛的发生频率、持续时间、部位、严重程度；改善或加剧头痛的因素；相关症状与体征（如发热、颈项强直、恶心与呕吐）；及辅助头痛病因检查的特殊检查。 Secondaryheadachesmayhavespecificcharacteristics.Anacutewhole-cranial,severeheadacheassociatedwithfever,photophobia,andstiffneckindicatesaninfectiousprocess,suchasmeningitis,untilprovedotherwise.Subarachnoidhemorrhagealsocausesacuteheadachewithsymptomsandsignsofmeningealirritation.Space-occupyinglesionsoftencausesubacute,progressiveheadache.New-onsetheadacheinanadult>40yralwaysrequiresthoroughevaluation.Withspace-occupyinglesions,thefollowingmayoccur:headacheonawakeningoratnight,fluctuationofheadachewithposturalchanges,andnauseaandvomiting.Additionalneurologiccomplaints,suchasseizure,confusion,weakness,orsensorychanges,mayoccurlateandareominous. 一些继发性头痛具有某些特定特征。急性、剧烈的满头痛伴发热、畏光和颈项强直，提示感染，如脑膜炎，应寻找证据加以排除。蛛网膜下腔出血也能引起急性头痛，常伴有脑膜刺激的症状与体征。占位性病变常常引起亚急性、渐进性头痛。40岁以后新发病的头痛始终需要彻底的评估。.颅内占位性病变引起的头痛可出现下列情况：睡醒时或夜间头痛，体位改变引起头痛变化，恶心和呕吐。其他神经性疾病主诉，如惊厥发作、精神错乱、无力或感觉异常变化等，出现较迟，为恶性症状。 Tensionheadachetendstobechronicorcontinuousandcommonlyoriginatesintheoccipitalorbifrontalregion,thenspreadsovertheentirehead.Itisusuallydescribedasapressuresensationoraviselikeconstrictionoftheskull.Febrileillnesses,arterialhypertension,andmigraineusuallycausethrobbingpainthatcanoccurinanypartofthehead. 紧张型头痛往往表现为慢性或持续性，通常始于枕部或双额部，然后扩散到整个头部，常被病人描述为受压感或颅紧箍感。发热性疾病、动脉性高血压以及偏头痛通常引起搏动性头痛，可出现在头部任何部位。 UsefultestsincludeCBC,STS,serumchemistryprofile,ESR,CSFexamination,and,forspecificsymptoms,oculartests（acuity,visualfields,refraction,intraocularpressure）orsinusx-rays.Ifthecauseofrecent,persistent,recurrent,orincreasingheadacheremainsindoubt,MRIand/orCTisappropriate,especiallyifabnormalneurologicsignsarepresent. 有用的检查包括血常规、梅毒血清试验、血生化分析、血沉与脑脊液检查，如有特殊症状，应进行视觉检查（视敏度、视野、屈光、眼内压）或鼻窦X线检查。如对最近发生的持续、反复、或程度加重的头痛，无法查明其原因的，就应作MRI和/或CT检查，特别是出现异常神经体征时。 TreatmentManyheadachesareofshortdurationandrequirenotreatmentotherthanmildanalgesics（eg,aspirin,acetaminophen）andrest. 治疗 很多头痛都是短期的，除服用一些轻镇痛剂（如阿司匹林或扑热息痛）及休息外，无需其他治疗。 Treatmentofprimaryheadachesisdiscussedunderthespecificdisorders,below.Alternativeapproaches,suchasbiofeedback,acupuncture,dietarymanipulations,andsomelessconventionalmodes,havebeenadvocatedforthesedisorders.Noneofthesetreatmentshasshownclear-cutbenefitsinrigorousstudies.However,totheextentthatanalternativetreatmentposeslittlerisk,itmaybetried,withtheideathateffectiveheadachemanagementismultidimensional. 原发性头痛的治疗将在下文讨论。有人主张采用不同的治疗措施，如生物反馈、针灸、饮食调控及某些较少使用的治疗方式。这些治疗措施都未能在严格的检验中证明其明确的疗效。不过，既然这些另类治疗措施几乎没什么风险，试一下倒也不妨，因为有效的头痛治疗本来也是多种多样的。 Treatmentofsecondaryheadachesdependsontreatmentoftheunderlyingdisorder.Formeningitis,promptantibiotictherapyiscritical.Subsequently,symptomscanberelievedwithanalgesics,includingacetaminophen,NSAIDs,oropioidnarcotics.Certaindisordersrequiremorespecifictreatment;eg,temporalarteritisistreatedwithcorticosteroids,andheadacheduetobenignintracranialhypertensionistreatedwithacetazolamideordiureticsandweightloss.Subduralhematomasorbraintumorsmaybetreatedsurgically. 继发性头痛的治疗取决于潜在疾病的治疗。对脑膜炎而言，即时的抗生素治疗至关重要。以后，镇痛剂，包括扑热息痛、非类固醇抗炎药或阿片类麻醉剂，都可用于缓解头痛症状。有些疾病则需要更专门的治疗。如，颞动脉炎需用肾上腺皮质激素治疗，由良性颅内压增高引导的头痛则可用乙酰唑胺或利尿剂，并配合减轻体重。硬膜下血肿或脑肿瘤则需进行外科手术。 Stressmanagementtaughtbyapsychologistoftenreducestheincidenceofheadaches.However,mostpatientsarehelpedbyanunderstandingphysicianwhoacceptsthepainasreal,seesthepatientregularly,andencouragesdiscussionofemotionaldifficulties,whethertheyarethecauseortheresultofchronicheadaches.Thephysiciancanreassurethepatientthatnoorganiclesionispresentandrecommendenvironmentalreadjustmentsandtheremovalofirritantsandstresses.Forparticularlydifficultproblems,ateamcomposedofaphysician,psychotherapist,andphysiotherapistismosteffectiveinmanagingchronicheadache. 心理医生的减压疗法常常可以减少头痛的发病率。不过，大多数病人还是要由懂行的医生来治疗，定期随访，鼓励讨论一些情感问题，不管这些习慢性头痛是否由这些因素引起或是头痛导致这些问题，医生的这些措施对病人都是有帮助的。医生可以安慰病人，告诉他并不存在器质性病变，并量出一些环境适应方面的建议及消除刺激与压力方法。对一些特别难处理的病情，则应交给由临床医生、心理治疗医生和理疗师组成的医疗小组来处理，他们在治疗慢性头痛方面是最为有效的。
