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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=1739674095-aS2WDy40n3emIPynoOrpbXTTxX7HJrTU-0-137cc611f01ff138a459d7366b39d352)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.1_1_6533.jpg?sign=1739674095-0hNtfQJgbYxMBwsHkrxbIciUaSBgPoBm-0-b35f128bf9a97e46af615e4255f5294f)
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=1739674095-xxEc1t2iUD4UZadGtUVZf3MTSh9vXzQ1-0-2ed3ea2ab79e82c872018a5abe1e62c5)
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=1739674095-VaAjU8wCTSNVDaoZ2ToLtTs9OtqIeBas-0-e43c7ab322fe4507cbdb3bba27620688)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.3_1_6599.jpg?sign=1739674095-GBpoq4SNsBTbDGXktSzGhAfHc0JhTeOA-0-9cb0fee143ac3948e9b864310867e12e)
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=1739674095-OvkdvFggdqspWcZJt959CxZ483s7eYJy-0-16f4f2053cb15596a19c42cfffeef071)
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=1739674095-wPWYRBO4JsEcyElrBXN7fcNjCS7WXeWk-0-def0e1058ddb6ff3dd13220dd3474823)
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=1739674095-ysURWNjf6OKfb8Ocbj8mYZUNecYJkCLE-0-14e1224e964d8cb879efa83164d0b2e1)
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=1739674095-rInU9xdfUsBTW4K2EqEXFLtFTk8DqyzA-0-33c653ef2027831861e9d35bc48a041a)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.7_1_59956.jpg?sign=1739674095-v6eWH9uO8K74HAsME4uEeKmogl0A0NTU-0-c1e50a9464eebb9d845bb429975ffdbe)
表8.8 头痛的治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.8_6713.jpg?sign=1739674095-Tbhrvud25GdYA0QJ2z62TIpI0T7xr6RU-0-620ba9153e7a9c46107214eff82cf012)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.8_1_6761.jpg?sign=1739674095-YLKn98EgLfv0YQjD6K941HJW9zz5hvt7-0-adbe3e3178e84dc37a13b28470ab5779)