对患者的头痛的医疗方法Approach to a patient with headache【国外优秀ppt精品】.pptVIP

Temporal Arteritis Rare before age 50 Temporal artery tenderness, swelling, redness, nodularity Visual disturbance Visual loss in 7-60% if untreated Jaw claudication Systemic symptoms fever, wt loss, anorexia, malaise Polymyalgia rheumatica (prox muscle pain/tend./stiffness) ESR usually 50 (mm/hr) Temporal artery biopsy multinucleated giant cells / inflammation Therapy: High dose steroids Overall Approach Chief Complaint: Headache Headache Alarms Evidence of serious headache disorder by history or physical exam Diagnosis of Primary Headache Disorder Work-up to identify/exclude secondary headache etiology Treat Primary Headache NO YES YES NO Consider work-up for secondary headache * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Approach to a patient with headache Dr. Abdul Mottalib Sarker Medicine unit 2 RMCH , A headache or cephalagia is pain anywhere in the region of head or neck. It can be a symptom of a number of different conditions of head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of pain sensitive structures around the head and neck. Pain Sensitivity of Cranial Structures Cranial venous sinuses with afferent veins Arteries at base of brain and their major branches Arteries of the dura Dura near base of brain and large arteries Dural, Cranial and extracranial nerves All extracranial structures Brain parenchyma Ependyma Choroid Pia Arachnoid Dura over convexity Skull Pain-Sensitive Pain-Insensitive Overall Approach Chief Complaint: Headache Headache Alarms Evidence of serious headache disorder by history or physical exam Diagnosis of Primary Headache Disorder Work-up to identify/exclude secondary headache etiology Treat Primary Headache NO YES YES NO Consider work-up for secondary headache General Mechanisms of Headache Traction on major intracranial vessels Distention, dilation of in