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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=1739513775-HpvB1ZFN4qWraJuiY5r0WuWFhI4CzSkW-0-90809983f205edc860dcb4cfea7d0313)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.1_1_6533.jpg?sign=1739513775-VTGkeVIAQUvq5hoDEa48eTFK6WNhCkVs-0-0e38867926ba45445cb5102d4f36b379)
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=1739513775-fLYC6ZUckxjZm3whv9d3idHlrMnYvvbg-0-2c38197dd3cdd402b5bbb7ff7101c97a)
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=1739513775-nE3Wiiq2HVr7xVU9cTrs6lqstEHTtHdL-0-2af3d890ac6e930b090419de95fb2851)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.3_1_6599.jpg?sign=1739513775-kWFYxASueycTQqomdYZS8MV6nKH5A1VE-0-9f35a88e8e13099f9c46fc7e71efc8b4)
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=1739513775-wv8FHrfyIQ1Wkgu5YxRitUVxJxc7lJKu-0-a50976f4da677e23077a029cbf1dc352)
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=1739513775-v2YPn3sPgwqO1WVRDckWaYrX5oZGmbaQ-0-547cdff389bddcab25d150686200d1e3)
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=1739513775-gNq1XzL9096m1jiUVenLm2Ms13yehiPt-0-2a9c958c05f7dcd12fd0131e396e52d0)
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=1739513775-WpJXi591iU5NwHF1oNUo1NzO2KW55dK4-0-80ee1152e6742350fc2bd5be65858d42)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.7_1_59956.jpg?sign=1739513775-ydOzFwHi57k4kCmFK9Sn0FQiRhHy4cpT-0-9fab12ca3e2a5283f4b5caa56bc715ea)
表8.8 头痛的治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.8_6713.jpg?sign=1739513775-KBdlektIhK9SvHUVRjUl8dXadEwmjJOb-0-b8bcd015d2c0118a2df35708b024f079)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.8_1_6761.jpg?sign=1739513775-jgDDD1QAZk3BIebxqZuT2LdlLmmfWbfd-0-c143d31671d58e864524ee8d9e3aeeb7)