文档介绍：Copyright ©2006 McGraw-Hill
Tierney, Lawrence M., McPhee, Stephen J., Papadakis, Maxine A.
Current Medical Diagnosis & Treatment, 45th Edition
24
Nervous System
Michael J. Aminoff MD, DSc, FRCP
See
HEADACHE
Headache is such plaint and can occur for so many different reasons that its proper evaluation may be
difficult. Headaches of acute onset are discussed in Chapter 2. Chronic headaches monly due to migraine,
tension, or depression, but they may be related to intracranial lesions, head injury, cervical spondylosis, dental or
ocular disease, temporomandibular joint dysfunction, sinusitis, hypertension, and a wide variety of general medical
disorders. Although underlying structural lesions are not present in most patients presenting with headache, it is
nevertheless important to bear this possibility in mind. About one-third of patients with brain tumors, for example,
present with a plaint of headache.
The intensity, quality, and site of pain—and especially the duration of the headache and the presence of associated
neurologic symptoms—may provide clues to the underlying cause. Migraine or tension headaches are often described
as pulsating or throbbing; a sense of tightness or pressure is mon with tension headache. Sharp lancinating
pain suggests a neuritic cause; ocular or periorbital icepick-like pains occur with migraine or cluster headache; and a
dull or steady headache is typical of an intracranial mass lesion. Ocular or periocular pain suggests an ophthalmologic
disorder; band-like pain mon with tension headaches; and lateralized headache mon with migraine or
cluster headache. In patients with sinusitis, there may be tenderness of overlying skin and bone. With intracranial mass
lesions, headache may be focal or generalized; in patients with trigeminal or glossopharyngeal neuralgia, the pain is
localized to one of the divisions of the trigeminal nerve or to the pharynx and external auditory meatus, respectively.
Inquiry should be made o