小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 长期头痛
- 恶心
- 机能下降
- 活动时头痛加重
- 对光敏感
- 对噪声敏感
- 先兆
其他诊断因素
- 呕吐
- 单侧耳鸣
- 搏动感
危险因素
- 偏头痛的家族史
- 女性
- 肥胖
- 应激性生活事件
- 过度用药
- 睡眠障碍
- 社会经济地位低
- 过敏或哮喘
- 甲状腺功能减退
诊断性检查
首要检查
- 临床诊断
需考虑的检查
- 红细胞沉降率 (ESR)
- 腰椎穿刺术 (LP)
- 脑脊液 (CSF) 培养
- 颅脑 MRI 扫描
- 头颅 CT
- 血管造影术
治疗流程
因持续性偏头痛至急诊室就诊的患者
轻中度症状：非妊娠
严重症状：未妊娠
妊娠
频繁复发的严重/失能性症状：未妊娠
频繁复发的严重/失能性症状：已妊娠
撰稿人
作者
Timothy A. Collins, MD
Associate Professor of Neurology
Chief
Headache Division
Department of Neurology
Duke University Medical Center
Durham
NC
利益声明
TAC served as a paid consultant for Alphasights (a global healthcare consulting organization) in 2017 and 2018 regarding migraine headache diagnosis and treatment. He provides expert testimony for legal cases regarding headache disorders and treatment (approximately one case per year). TAC is an author of several references cited in this topic.
鸣谢
Dr Timothy Collins would like to gratefully acknowledge Dr Ann Donnelly, the previous contributor to this topic.
利益声明
AD declares that she has no competing interests.
同行评议者
Anne Walling, MD
Professor
Family and Community Medicine
University of Kansas School of Medicine
Wichita
KS
利益声明
AW declares that she has no competing interests.
Marc S. Husid, MD
Director
Walton Headache Center
Augusta
GA
利益声明
MSH declares that he has no competing interests.
鉴别诊断
- 头痛，紧张型
- 头痛，丛集性
- 药物过度使用性头痛
更多 鉴别诊断指南
- 12 岁以上患者的头痛：诊断和管理
- 偏头痛的神经影像学检查：美国头痛学会系统评价和循证指南
更多 指南患者教育信息
偏头痛
偏头痛：询问医生
更多 患者教育信息Videos
成人诊断性腰椎穿刺的动画演示
外周静脉置管的动画演示
更多 videos
Log in or subscribe to access all of BMJ Best Practice
内容使用需遵循免责声明