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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=1739290434-C7q7ApDQQ0zBNrgS1g6S95WU9leRgOLO-0-dd20da099f6ade964240b347f8885a4f)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.1_1_6533.jpg?sign=1739290434-hRuYiIAhA25xEIoppHFrjjDVYN7N57UZ-0-e7e7720acf164ac84c95317830f7793e)
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=1739290434-Dan4333aCPDqaVgamUcOYVMiF9ijBFrs-0-7f61738306c367b042626fb28ade5090)
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=1739290434-sfNnwD8mZJQpZCrZP9eSOnVs84NqGm00-0-139b6e13da59e4af7d8c972d98710f17)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.3_1_6599.jpg?sign=1739290434-ZVPLIjdyiHRfoSjvH9PDe1qHSeGRyXUN-0-ad1174b01f1162302a7b91e78a4fe774)
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=1739290434-gwTMtq973O11d0bRyqvSFZMZGhAaF7Nc-0-235eb40d67234bc718b497c100625a4e)
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=1739290434-dRLNcxZASg7thKSYQ3B7TxBELdHsBYC8-0-60c0a4e54b8110f966a1886a9886aace)
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=1739290434-mrFpeW781KIv5UpZP1ys9omfBcLwPvCK-0-113c1182fd7f9f6098ddaf23979ca472)
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=1739290434-pgJsIf2OOO1uZhbGizoVwXfg0wrnNN0r-0-7052767a56980a58bf95fd92d228d961)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.7_1_59956.jpg?sign=1739290434-AhjlSx8X9NWO3hMs6zOxBTAF5ZE9ZPKt-0-24471fabfac0c5fa8abeba9322a0cc55)
表8.8 头痛的治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.8_6713.jpg?sign=1739290434-EiqTYkQrgFKp7VwHe6v7gSzWPvLJr6d1-0-0fef4fed850fd58335c506a4595d4234)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.8_1_6761.jpg?sign=1739290434-P4xxxk0JX1lmB2SdZbB5agxYkoCz8Z8d-0-08306a5a12206361cdbc478b19960b3c)