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8. 急性头痛
概 述
头痛是指眉毛以上向后到枕骨粗隆范围的疼痛,一般发病2周以内的称急性头痛。头痛多数是由于致痛因子(物理性或化学性)作用于颅内外疼痛敏感组织内的感受器,经痛觉传导通路至中枢神经系统进行分析、整合而产生的痛觉。以下是急性头痛诊治的临床路径。
表8.1 急性头痛的关键评估
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.1_6479.jpg?sign=1739229741-klCnnNwA9NSyBNlcGnx2Na6w9rtIUHpT-0-a32892cf4ef807720e6219c47f24bbc6)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.1_1_6533.jpg?sign=1739229741-ECSPdAsI94CnMu8Q8sF4aDYd8VUiypOq-0-870369230826191a2927cb73ddfc821e)
注:绝大多数急性头痛的患者都是压力型头痛或偏头痛,少数有威胁生命的病变,如蛛网膜下腔出血或细菌性脑膜炎
表8.2 急性头痛的紧急检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.2_6541.jpg?sign=1739229741-3BidQrXFiQ4IMcZGsG7Rof9zoXi5QDYh-0-a994a39be53144ad5c198c2ceeab397e)
注:ESR,红细胞沉降速率
表8.3 急性头痛合并意识水平减弱、颈部强直或局部神经体征的原因
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.3_6549.jpg?sign=1739229741-Suy97foEg1aWGl0bOa9qK5i9193X18Nv-0-b8c934186a7f0b32818c90902250bf50)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.3_1_6599.jpg?sign=1739229741-HuCqGUQCDONdgecQi9SDeDwpb0XFcK7L-0-3cf43047c5a2a2c5015ba0ab2545db60)
表8.4 合并局部体征急性头痛的原因
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.4_6606.jpg?sign=1739229741-SxMJe6Cp81XG6mzNnwarXwpzqaNxgUQy-0-bb5002684707635338aeae7aa48cfb4e)
表8.5 合并视乳头水肿急性头痛的原因
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.5_6613.jpg?sign=1739229741-l5eUul5AorIoqIal657WhWgMOa2TFp9Z-0-bf4d300796cd16f969b3bc7f053f878e)
表8.6 急性头痛合并发热但无局部神经系统体征的疾病
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.6_6620.jpg?sign=1739229741-MbO5Nw3GbYznz2lQaCHpmuAVQhaPE3gF-0-1bd09a3b11a67574fdd5edf950349b3b)
表8.7 无异常体征的急性头痛
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.7_59955.jpg?sign=1739229741-UDRUATX4ccg0VAXarHqDNGQhQnxMq7z1-0-2574948b2be544414eaa5249b2904ccf)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.7_1_59956.jpg?sign=1739229741-xycWuzFMwFi8GtItQOtWmlR196hvX6RU-0-6a91d3eac23afde952b52568e1e63514)
表8.8 头痛的治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.8_6713.jpg?sign=1739229741-ZlSpVSGf5mrVtAYotyLuTfeHShs54J1o-0-3747afc654d47de90081026301957529)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.8_1_6761.jpg?sign=1739229741-pssD4PrRgDN9YT93xmrWDTW94GwlJInq-0-f07cc71d24f8217e77a0e569c7ab73b3)