常见的原发性头痛.ppt

After the complete history and physical examination, laboratory tests may be ordered. The necessary and sufficient evaluation of the headache and facial pain patient is the matter of some debate. In general, the tests requested should be guided by the history and physical examination findings. In the patient with recent onset headache of moderate to severe intensity and findings on the neurologic examination, EEG may be the test of first choice. EEG is also helpful in the patient with muscle contractions in whom epilepsy is suspected. Radiographic studies (CT and MRI) are useful to evaluate new onset moderate to severe headaches, or to rule out intracranial pathology in patients with long-standing, chronic headache or facial pain. Lab tests directed to rule out autoimmune disease or other systemic disease should be ordered if the history suggests a generalized process. EMG may be useful if a diagnosis of primary muscle disease or neuropathy is suspected. Tenderness of the TMJ may be further evaluated by radiographic imaging of the joint. Postural disorders with muscle pain and trigger points in the neck and shoulder should be evaluated with cervical spine radiographs. ? Psychometric testing may be of benefit in the evaluation and treatment of the patient with headache and facial pain. Many tests have been applied, but probably the most widely used is the Minnesota Multiple Personality Inventory (MMPI). While especially useful in the evaluation of the chronic headache and facial pain patient, a thorough discussion of psychometric testing is beyond the scope of this discussion and mentioned here only for completeness. 走近头痛 丽水市人民医院神经内科 汤亚男 我们一生，都有“头痛”的经历 每人描述一下自己经历的头痛 什么是头痛？ 头痛是指头颅上半部（眉弓、耳廓上部、枕外隆突连线以上）的疼痛。 医学上头痛分类 主诉: 头痛 头痛警惕症状 病史和体检—恶性头痛的证据 原发性头痛 继发性头痛 NO YES 常见的原发性头痛 偏头痛 紧张型头痛 丛集性头痛 药物过量性头痛 继发性头痛原因 头和（或）颈部外伤所致的头痛 头和（或）颈部血管所致的头痛 非血管性颅内疾病引起的头痛 某些物质或某种物质戒断所致的头 感染所致的头痛 代谢疾病所致的头痛 头颅、颈部、眼、耳、鼻、鼻窦、牙齿、口腔或其他头面部结构疾患所致的头痛 精神疾患所致的头痛 脑神经痛和中枢疾患有关的头痛 其他原因 我们需要向