| Headache | 頭痛概述 |
| Headache （cephalalgia） is a common symptom, often associated with disability, but rarely life threatening. Headaches may be a primary disorder （migraine, cluster, or tension headache） or a secondary symptom of such disorders as acute systemic or intracranial infection, intracranial tumor, head injuries, severe hypertension, cerebral hypoxia, and many diseases of the eyes, nose, throat, teeth, ears, and cervical vertebrae. Sometimes no cause is found. | 頭痛是一種常見癥狀，常常與功能障礙有關(guān)，但很少危及生命。頭痛可能是一種原發(fā)性疾病（如偏頭痛，叢集性頭痛或緊張型頭痛），也可能是某些疾病的繼發(fā)癥狀，如急性全身性感染或顱內(nèi)感染、顱內(nèi)腫瘤、頭外傷、嚴重的高血壓、腦缺氧、及眼、耳、鼻、喉、口腔牙齒和頸椎等多種疾病，有時找不到任何病因。 |
| Headaches may result from stimulation of, traction of, or pressure on any of the pain-sensitive structures of the head: all tissues covering the cranium; the 5th, 9th, and 10th cranial nerves; the upper cervical nerves; the large intracranial venous sinuses; the large arteries at the base of the brain; the large dural arteries; and the dura mater at the skull base. Dilation or contraction of blood vessel walls stimulates nerve endings, causing headache. The cause of most headaches is extracranial rather than intracranial. Stroke, vascular abnormalities, and venous thromboses are uncommon causes of headache. | 對頭部任何疼痛敏感結(jié)構(gòu)的刺激、牽引或壓迫都能引起頭痛，這些結(jié)構(gòu)包括覆蓋頭顱的所有組織；第5、9、10顱神經(jīng)；上部頸神經(jīng)；顱內(nèi)大靜脈竇；顱底大動脈；硬腦膜大動脈以及顱底硬腦膜。血管壁的擴張或收縮刺激神經(jīng)末梢，引起頭痛。大多數(shù)頭痛的病因為顱外性而非顱內(nèi)性。因腦卒中、血管畸形與靜脈血栓形成引起的頭痛并不常見?！?/td> |
| DiagnosisThe frequency, duration, location, and severity of the headache; the factors that make it better or worse; associated symptoms and signs, such as fever, stiff neck, nausea, and vomiting; and special studies help identify the cause of headache. | 診斷 診斷內(nèi)容包括：頭痛的發(fā)生頻率、持續(xù)時間、部位、嚴重程度；改善或加劇頭痛的因素；相關(guān)癥狀與體征（如發(fā)熱、頸項強直、惡心與嘔吐）；及輔助頭痛病因檢查的特殊檢查?！?/td> |
| Secondary headaches may have specific characteristics. An acute whole-cranial, severe headache associated with fever, photophobia, and stiff neck indicates an infectious process, such as meningitis, until proved otherwise. Subarachnoid hemorrhage also causes acute headache with symptoms and signs of meningeal irritation. Space-occupying lesions often cause subacute, progressive headache. New-onset headache in an adult > 40 yr always requires thorough evaluation. With space-occupying lesions, the following may occur: headache on awakening or at night, fluctuation of headache with postural changes, and nausea and vomiting. Additional neurologic complaints, such as seizure, confusion, weakness, or sensory changes, may occur late and are ominous. | 一些繼發(fā)性頭痛具有某些特定特征。急性、劇烈的滿頭痛伴發(fā)熱、畏光和頸項強直，提示感染，如腦膜炎，應(yīng)尋找證據(jù)加以排除。蛛網(wǎng)膜下腔出血也能引起急性頭痛，常伴有腦膜刺激的癥狀與體征。占位性病變常常引起亞急性、漸進性頭痛。40歲以后新發(fā)病的頭痛始終需要徹底的評估。.顱內(nèi)占位性病變引起的頭痛可出現(xiàn)下列情況：睡醒時或夜間頭痛，體位改變引起頭痛變化，惡心和嘔吐。其他神經(jīng)性疾病主訴，如驚厥發(fā)作、精神錯亂、無力或感覺異常變化等，出現(xiàn)較遲，為惡性癥狀。 |
| Tension headache tends to be chronic or continuous and commonly originates in the occipital or bifrontal region, then spreads over the entire head. It is usually described as a pressure sensation or a viselike constriction of the skull. Febrile illnesses, arterial hypertension, and migraine usually cause throbbing pain that can occur in any part of the head. | 緊張型頭痛往往表現(xiàn)為慢性或持續(xù)性，通常始于枕部或雙額部，然后擴散到整個頭部，常被病人描述為受壓感或顱緊箍感。發(fā)熱性疾病、動脈性高血壓以及偏頭痛通常引起搏動性頭痛，可出現(xiàn)在頭部任何部位。 |
| Useful tests include CBC, STS, serum chemistry profile, ESR, CSF examination, and, for specific symptoms, ocular tests （acuity, visual fields, refraction, intraocular pressure） or sinus x-rays. If the cause of recent, persistent, recurrent, or increasing headache remains in doubt, MRI and/or CT is appropriate, especially if abnormal neurologic signs are present. | 有用的檢查包括血常規(guī)、梅毒血清試驗、血生化分析、血沉與腦脊液檢查，如有特殊癥狀，應(yīng)進行視覺檢查（視敏度、視野、屈光、眼內(nèi)壓）或鼻竇X線檢查。如對最近發(fā)生的持續(xù)、反復(fù)、或程度加重的頭痛，無法查明其原因的，就應(yīng)作MRI和/或CT檢查，特別是出現(xiàn)異常神經(jīng)體征時。 |
| Treatment Many headaches are of short duration and require no treatment other than mild analgesics （eg, aspirin, acetaminophen） and rest. | 治療 很多頭痛都是短期的，除服用一些輕鎮(zhèn)痛劑（如阿司匹林或撲熱息痛）及休息外，無需其他治療。 |
| Treatment of primary headaches is discussed under the specific disorders, below. Alternative approaches, such as biofeedback, acupuncture, dietary manipulations, and some less conventional modes, have been advocated for these disorders. None of these treatments has shown clear-cut benefits in rigorous studies. However, to the extent that an alternative treatment poses little risk, it may be tried, with the idea that effective headache management is multidimensional. | 原發(fā)性頭痛的治療將在下文討論。有人主張采用不同的治療措施，如生物反饋、針灸、飲食調(diào)控及某些較少使用的治療方式。這些治療措施都未能在嚴格的檢驗中證明其明確的療效。不過，既然這些另類治療措施幾乎沒什么風(fēng)險，試一下倒也不妨，因為有效的頭痛治療本來也是多種多樣的。 |
| Treatment of secondary headaches depends on treatment of the underlying disorder. For meningitis, prompt antibiotic therapy is critical. Subsequently, symptoms can be relieved with analgesics, including acetaminophen, NSAIDs, or opioid narcotics. Certain disorders require more specific treatment; eg, temporal arteritis is treated with corticosteroids, and headache due to benign intracranial hypertension is treated with acetazolamide or diuretics and weight loss. Subdural hematomas or brain tumors may be treated surgically. | 繼發(fā)性頭痛的治療取決于潛在疾病的治療。對腦膜炎而言，即時的抗生素治療至關(guān)重要。以后，鎮(zhèn)痛劑，包括撲熱息痛、非類固醇抗炎藥或阿片類麻醉劑，都可用于緩解頭痛癥狀。有些疾病則需要更專門的治療。如，顳動脈炎需用腎上腺皮質(zhì)激素治療，由良性顱內(nèi)壓增高引導(dǎo)的頭痛則可用乙酰唑胺或利尿劑，并配合減輕體重。硬膜下血腫或腦腫瘤則需進行外科手術(shù)?！?/td> |
| Stress management taught by a psychologist often reduces the incidence of headaches. However, most patients are helped by an understanding physician who accepts the pain as real, sees the patient regularly, and encourages discussion of emotional difficulties, whether they are the cause or the result of chronic headaches. The physician can reassure the patient that no organic lesion is present and recommend environmental readjustments and the removal of irritants and stresses. For particularly difficult problems, a team composed of a physician, psychotherapist, and physiotherapist is most effective in managing chronic headache. | 心理醫(yī)生的減壓療法常常可以減少頭痛的發(fā)病率。不過，大多數(shù)病人還是要由懂行的醫(yī)生來治療，定期隨訪，鼓勵討論一些情感問題，不管這些習(xí)慢性頭痛是否由這些因素引起或是頭痛導(dǎo)致這些問題，醫(yī)生的這些措施對病人都是有幫助的。醫(yī)生可以安慰病人，告訴他并不存在器質(zhì)性病變，并量出一些環(huán)境適應(yīng)方面的建議及消除刺激與壓力方法。對一些特別難處理的病情，則應(yīng)交給由臨床醫(yī)生、心理治療醫(yī)生和理療師組成的醫(yī)療小組來處理，他們在治療慢性頭痛方面是最為有效的。 |
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