![急诊临床路径](https://wfqqreader-1252317822.image.myqcloud.com/cover/11/36535011/b_36535011.jpg)
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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=1739496625-hX1QYsnNgUQ1BtMN7NM7FD7fnkDCAaiX-0-0a5a0161bc8b3203be8f20029e0f480d)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.1_1_6533.jpg?sign=1739496625-kqK6PJpuUmzDut98PKVqod5IhEeBxbDw-0-60786cd81bd2206ae2929a022e49318c)
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=1739496625-VbOYyWqiBD8Fm8nwRehlZR1EWvy1Pbqq-0-72f133b3d232e2df4863b568de47a6bc)
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=1739496625-DjtVA55A0g3f3MyuEQKgqfM2cWEWbLoG-0-6b3ffb17d5366c447941dfcdd7f88bfd)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.3_1_6599.jpg?sign=1739496625-ScvrgPjDpR88h5uB3d3MDsCnarWUxpWd-0-c440e046275e34ce2cff53bce964a26c)
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=1739496625-bQ8l437w4tELuQgOsxZgVR64WCS7bT4V-0-2228dd15919dbbd7a5de3d3ccdab26f3)
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=1739496625-SxMF2xHR3ybyP2eABgst5lOxisX53uw4-0-5e5ef3ed4cda4d9b623baa9d26b32531)
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=1739496625-OnI3i2hPeuD7z8vRPCdP6AIZoVMoOAd2-0-de04b561a077d1711654a3755da6b45a)
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=1739496625-KThnT5p8wIkFSjoqtX9CCNcU1txGFhUC-0-5c5360a210149b4a6f209db8a7d60c9b)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.7_1_59956.jpg?sign=1739496625-ifbvNfvr1mgLMiHHHrrFwOMKk8tyFfeP-0-0783aa473e762823590fae7aa4857b40)
表8.8 头痛的治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.8_6713.jpg?sign=1739496625-Ymperj257aklq0KKEDTIrzl5oQw249FH-0-f58810ec3237c8551804a574cba96d86)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T8.8_1_6761.jpg?sign=1739496625-J2tXAdtS42Igq7TcsVDZeqHsGxqxszgn-0-2ec16b5f09f50714ff0be023bb105f9f)