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=1739561688-3DHgZvkNb8PD7sDTk3EOdvlowpCV0VaP-0-95d20f9a15ef4225ef7c4f5ef6936ff5)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.1_1_6533.jpg?sign=1739561688-CmE6uve7sgTuqvrpMbMTRPhsQ2z8lsVQ-0-97643932a7279cc37b41369fc08a3265)
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=1739561688-Bl2IHP1w7V3KaX9kdcZz4mPnIRovjqQZ-0-677157fb7a980002aff15ff18c622e5d)
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=1739561688-LDwiAF0qiZvLHp6GzFGBQkYQgRG182Gb-0-170317ac084801ff78f3dd0a89af3de5)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.3_1_6599.jpg?sign=1739561688-TlL4yJrQ52i0JWfxMeUufQeLU0QpKtrD-0-d821aa239b95223629e9993c64695f1f)
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=1739561688-ZnHKMLbSsK2iuEyiHWf1igmkdF7vMtzX-0-c12411283451b6d0c0890b2fa5895aca)
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=1739561688-m79RUqmsx5v9ZGf3pNcU69UU5tnStIcq-0-152f962024f700918997daad2b620f18)
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=1739561688-W1cW9ryWWmUnUqbjw18eMOoNN3b78XfS-0-2084230c77062321dd18fd5097061504)
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=1739561688-IWnkPmGtVVhuMULdE5G3TLcbUMqyrL1l-0-1962182f0bfe62ba2eca4265d26b7857)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.7_1_59956.jpg?sign=1739561688-cbd52GTdTCngb8txgxJpAxZJmJWEqDWv-0-1252c60e82178b857e77c1a8c363bd51)
表8.8 头痛的治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.8_6713.jpg?sign=1739561688-Ehku8wfhOjGaSahFQa5wstyyrup6fNBo-0-ad8c3f9eeb56c902787a71637f19ad36)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.8_1_6761.jpg?sign=1739561688-I3s61LH7YTPa7KBoXakojEwImOlfvwmB-0-8c34f7be59776ec4c941b733a7969d75)