醫學知識雙語閱讀：頭痛

下面本站小編爲大家帶來醫學知識雙語閱讀：頭痛，歡迎大家學習!

Headache (cephalalgia) is a common symptom, often associated with disability, but rarely life threatening. Headaches may be a primary disorder (migraine, cluster, or tension headache) or a secondary symptom of such disorders as acute systemic or intracranial infection, intracranial tumor, head injuries, severe hypertension, cerebral hypoxia, and many diseases of the eyes, nose, throat, teeth, ears, and cervical vertebrae. Sometimes no cause is found.　 頭痛是一種常見症狀，常常與功能障礙有關，但很少危及生命。頭痛可能是一種原發性疾病(如偏頭痛，叢集性頭痛或緊張型頭痛)，也可能是某些疾病的繼發症狀，如急性全身性感染或顱內感染、顱內腫瘤、頭外傷、嚴重的高血壓、腦缺氧、及眼、耳、鼻、喉、口腔牙齒和頸椎等多種疾病，有時找不到任何病因。

Headaches may result from stimulation of, traction of, or pressure on any of the pain-sensitive structures of the head: all tissues covering the cranium; the 5th, 9th, and 10th cranial nerves; the upper cervical nerves; the large intracranial venous sinuses; the large arteries at the base of the brain; the large dural arteries; and the dura mater at the skull base. Dilation or contraction of blood vessel walls stimulates nerve endings, causing headache. The cause of most headaches is extracranial rather than intracranial. Stroke, vascular abnormalities, and venous thromboses are uncommon causes of headache.　 對頭部任何疼痛敏感結構的刺激、牽引或壓迫都能引起頭痛，這些結構包括覆蓋頭顱的所有組織;第5、9、10顱神經;上部頸神經;顱內大靜脈竇;顱底大動脈;硬腦膜大動脈以及顱底硬腦膜。血管壁的擴張或收縮刺激神經末梢，引起頭痛。大多數頭痛的病因爲顱外性而非顱內性。因腦卒中、血管畸形與靜脈血栓形成引起的頭痛並不常見。

DiagnosisThe frequency, duration, location, and severity of the headache; the factors that make it better or worse; associated symptoms and signs, such as fever, stiff neck, nausea, and vomiting; and special studies help identify the cause of headache.　 診斷　　診斷內容包括：頭痛的發生頻率、持續時間、部位、嚴重程度;改善或加劇頭痛的因素;相關症狀與體徵(如發熱、頸項強直、噁心與嘔吐);及輔助頭痛病因檢查的特殊檢查。

Secondary headaches may have specific characteristics. An acute whole-cranial, severe headache associated with fever, photophobia, and stiff neck indicates an infectious process, such as meningitis, until proved otherwise. Subarachnoid hemorrhage also causes acute headache with symptoms and signs of meningeal irritation. Space-occupying lesions often cause subacute, progressive headache. New-onset headache in an adult > 40 yr always requires thorough evaluation. With space-occupying lesions, the following may occur: headache on awakening or at night, fluctuation of headache with postural changes, and nausea and vomiting. Additional neurologic complaints, such as seizure, confusion, weakness, or sensory changes, may occur late and are ominous.　 一些繼發性頭痛具有某些特定特徵。急性、劇烈的滿頭痛伴發熱、畏光和頸項強直，提示感染，如腦膜炎，應尋找證據加以排除。蛛網膜下腔出血也能引起急性頭痛，常伴有腦膜刺激的症狀與體徵。佔位性病變常常引起亞急性、漸進性頭痛。40歲以後新發病的頭痛始終需要徹底的評估。.顱內佔位性病變引起的頭痛可出現下列情況：睡醒時或夜間頭痛，體位改變引起頭痛變化，噁心和嘔吐。其他神經性疾病主訴，如驚厥發作、精神錯亂、無力或感覺異常變化等，出現較遲，爲惡性症狀。

Tension headache tends to be chronic or continuous and commonly originates in the occipital or bifrontal region, then spreads over the entire head. It is usually described as a pressure sensation or a viselike constriction of the skull. Febrile illnesses, arterial hypertension, and migraine usually cause throbbing pain that can occur in any part of the head.　 緊張型頭痛往往表現爲慢性或持續性，通常始於枕部或雙額部，然後擴散到整個頭部，常被病人描述爲受壓感或顱緊箍感。發熱性疾病、動脈性高血壓以及偏頭痛通常引起搏動性頭痛，可出現在頭部任何部位。

Useful tests include CBC, STS, serum chemistry profile, ESR, CSF examination, and, for specific symptoms, ocular tests (acuity, visual fields, refraction, intraocular pressure) or sinus x-rays. If the cause of recent, persistent, recurrent, or increasing headache remains in doubt, MRI and/or CT is appropriate, especially if abnormal neurologic signs are present.　 有用的檢查包括血常規、梅毒血清試驗、血生化分析、血沉與腦脊液檢查，如有特殊症狀，應進行視覺檢查(視敏度、視野、屈光、眼內壓)或鼻竇X線檢查。如對最近發生的持續、反覆、或程度加重的頭痛，無法查明其原因的，就應作MRI和/或CT檢查，特別是出現異常神經體徵時。

Treatment Many headaches are of short duration and require no treatment other than mild analgesics (eg, aspirin, acetaminophen) and rest.　 治療　　很多頭痛都是短期的，除服用一些輕鎮痛劑(如阿司匹林或撲熱息痛)及休息外，無需其他治療。

Treatment of primary headaches is discussed under the specific disorders, below. Alternative approaches, such as biofeedback, acupuncture, dietary manipulations, and some less conventional modes, have been advocated for these disorders. None of these treatments has shown clear-cut benefits in rigorous studies. However, to the extent that an alternative treatment poses little risk, it may be tried, with the idea that effective headache management is multidimensional.　 原發性頭痛的治療將在下文討論。有人主張採用不同的治療措施，如生物反饋、鍼灸、飲食調控及某些較少使用的治療方式。這些治療措施都未能在嚴格的檢驗中證明其明確的療效。不過，既然這些另類治療措施幾乎沒什麼風險，試一下倒也不妨，因爲有效的頭痛治療本來也是多種多樣的。

Treatment of secondary headaches depends on treatment of the underlying disorder. For meningitis, prompt antibiotic therapy is critical. Subsequently, symptoms can be relieved with analgesics, including acetaminophen, NSAIDs, or opioid narcotics. Certain disorders require more specific treatment; eg, temporal arteritis is treated with corticosteroids, and headache due to benign intracranial hypertension is treated with acetazolamide or diuretics and weight loss. Subdural hematomas or brain tumors may be treated surgically.　 繼發性頭痛的治療取決於潛在疾病的治療。對腦膜炎而言，即時的抗生素治療至關重要。以後，鎮痛劑，包括撲熱息痛、非類固醇抗炎藥或阿片類麻醉劑，都可用於緩解頭痛症狀。有些疾病則需要更專門的治療。如，顳動脈炎需用腎上腺皮質激素治療，由良性顱內壓增高引導的頭痛則可用乙酰唑胺或利尿劑，並配合減輕體重。硬膜下血腫或腦腫瘤則需進行外科手術。

Stress management taught by a psychologist often reduces the incidence of headaches. However, most patients are helped by an understanding physician who accepts the pain as real, sees the patient regularly, and encourages discussion of emotional difficulties, whether they are the cause or the result of chronic headaches. The physician can reassure the patient that no organic lesion is present and recommend environmental readjustments and the removal of irritants and stresses. For particularly difficult problems, a team composed of a physician, psychotherapist, and physiotherapist is most effective in managing chronic headache.　 心理醫生的減壓療法常常可以減少頭痛的發病率。不過，大多數病人還是要由懂行的醫生來治療，定期隨訪，鼓勵討論一些情感問題，不管這些習慢性頭痛是否由這些因素引起或是頭痛導致這些問題，醫生的這些措施對病人都是有幫助的。醫生可以安慰病人，告訴他並不存在器質性病變，並量出一些環境適應方面的建議及消除刺激與壓力方法。對一些特別難處理的病情，則應交給由臨牀醫生、心理治療醫生和理療師組成的醫療小組來處理，他們在治療慢性頭痛方面是最爲有效的。

Night sweats are drenching sweats that require a change of bedding. 盜汗爲淋透性出汗，需換牀單。

I. Approach. The first priority is to exclude night sweats caused by fever. Sweating associated with fever is a separate evaluation. Before the 20th century, night sweats implied infection with tuberculosis. Now, many other ailments are associated with this symptom. Night sweats are often the mark of a known condition such as diabetes (especially with nocturnal hypoglycemia), cancer, head trauma, and rheumatologic disorders. Night sweats can also be a symptom of a new disorder. The investigation of a patient reporting night sweats requires a review of past illnesses and new symptoms. I. 診斷。首先要排除發燒引起的出汗。發燒性出汗應另行診斷。20世紀前，盜汗通常提示有結核菌感染。現在，其他很多不適都與此症狀相關。盜汗通常是某已知病症的標誌，如糖尿病(特別是伴夜間低血糖者)、癌症、頭外傷和各種風溼病。盜汗也可能是新的疾病的一種症狀，在給盜汗報告病人進行檢查時，需檢查既往病史及新的症狀。

II. History. Night sweats can be characterized by determining onset, frequency, exacerbations, and remissions of symptoms. Question patients about the current state of known disorders. Excessive sweating is associated with poor nocturnal glycemic control. Flares of rheumatologic disorders (rheumatoid arthritis, lupus, juvenile rheumatoid arthritis, and temporal arteritis) cause sweating too. Pregnancy temporarily changes the intrinsic thermostat in many women who perspire excessively. Patients who are immuno-compromised are at increased risk for infections, especially with atypical agents. Patients with a history of substance abuse need to be asked about needle use and contaminants. II. 病史。盜汗可通過確認發作時間、次數、加劇及症狀消退加以確定。詢問病人已知疾病。多汗也與夜間血糖控制不良有關。風溼性疾病(如類風溼關節炎、狼瘡、幼兒性類風溼性關節炎、顳關節炎等)也導致出汗，婦娠也會暫時的改變很多婦女的體溫狀況，導致出汗過多。免疫代償病人感染風險增加，特別是非典型性病原體感染。有藥物濫用史病人需詢問其針頭使用及其他接觸狀況。

A. Review of systems. Other symptoms that can accompany night sweats include flushing (carcinoid syndrome, pheochromocytoma), joint pain, sleep apnea, menstrual irregularities, reflux, cough, headache, dysuria, dyspnea, rashes, fatigue, palpitations, and weight and bowel habit changes. A. 系統檢查。伴隨盜汗的其他症狀包括潮紅(類癌綜合症、嗜鉻細胞瘤)、關節痛、睡眠性呼吸暫停、月經不調、反流、咳嗽、頭痛、排尿困難、睡眠困難、皮疹、疲乏、心悸及體重與排便習慣改變。

B. Exposure factors. Inquire about recent immunizations or new medicines such as antidepressants, cholinergics, meperidine, estrogen inhibitors, gonadotropin inhibitors, niacin, steroids, stimulants, over-the-counter preparations, antipyretics, and naturopathic therapies. Question patients about exposure to sexually transmitted diseases (STDs), human immuno-deficiency virus (HIV), hepatitis, tuberculosis, or occupational and travel-related exposures. Also ask about increases in general changes in the ambient night temperature. B. 暴露因素。詢問最近免疫及新藥使用情況，如抗抑鬱劑、膽鹼能藥、哌替定、雌激素抑制劑、促性腺激素抑制劑、煙酸、類固醇、興奮劑、非處方製劑、解熱劑和自然療法。詢問病人有無接觸性傳染病(STD)、HIV、肝炎、結核病，有否職業性及旅遊相關性接觸。也應詢問周圍夜間體溫總體變化增多情況。

C. Psychological factors. Anxiety, nightmares, and psychoactive preparations can precipitate night sweats in healthy individuals. C. 精神因素。焦慮、噩夢及興奮劑可導致健康個體盜汗。

D. Family history. Patients who report a family history of hereditary disorders and possible malignancies should have appropriate screening. D. 家庭史。有遺傳疾病及可能的惡性腫瘤家庭史病人應進行適當的篩檢。

III. Physical examination. The physical examination should address the pertinent positives noted in the patient's medical history. Note the patient's weight and temperature. Examination of the head, eyes, ears, nose, and throat (HEENT) should focus on common types of infection: sinusitis, pharyngitis, and otitis. A thorough examination of lymph nodes is helpful to identify infection or lymphatic abnormalities. The cardiopulmonary examination can also signal infection, valvular disease, and stimulant use. Patients should be examined for abscesses, skin ulcers, septic joints, phlebitis, and osteomyelitis. III. 身體檢查。身體檢查應針對病人醫療史中的相關陽性記錄。注意病人體重體溫。頭、眼、耳、鼻及喉檢查的重點是普通類型的感染：鼻竇炎、喉炎和耳炎。淋巴結徹底檢查有助於確認感染及淋巴病變。心肺檢查也可提示感染、辨膜疾病及興奮劑使用情況。應檢查病人是否有膿腫、皮膚潰瘍、關節膿腫、靜膜炎和骨髓炎。

IV. Testing

IV. 檢驗。

A. Clinical laboratory testing. For patients with a known condition, testing for exacerbations is appropriate: erythrocyte sedimentation rate (infection, osteomyelitis, and temporal arteritis), C-reactive protein (rheumatologic disorders), and hemoglobin AiC (diabetes mellitus). Depending on the patient's symptoms or exposures, other appropriate tests can include purified protein derivative skin test for tuberculosis, free T4 level to rule out thyrotoxicosis, complete blood count with differential (infection), and follicle-stimulating hormone to investigate the possibility of menopause. Special tests may be required of patients with travel-related or STD exposures. A. 臨牀實驗室檢查。對有已知病症病人，應檢測病症是否加劇：血沉(感染、骨髓炎和顳關節炎)、C反應蛋白(風溼性疾病)和血紅蛋白AIC(糖尿病)。根據病人症狀及暴露情況決定是否進行其他檢查，包括結合病純蛋白衍生物皮膚測試、排除甲狀腺機能亢進的遊離T4水平檢驗、全血計數及分類(感染)、促卵泡激素檢查停經可能性。有旅遊相關及STD接觸病人可能需要進行特種檢驗。

B. Imaging. Chest x-ray studies are useful in the evaluation of night sweats in patients with a smoking history, industrial exposure, or a cough. These patients need to be screened for occult malignancy. Computed tomography scans are generally not appropriate unless other signs or symptoms dictate further evaluation. B. 影像檢查。胸部X線檢查對評估有下列情況病人的盜汗很有用：吸菸史、工業性接觸或咳嗽。這些病人需要進行潛在惡性腫瘤篩檢。CT掃描通常並不合適，除非其他症狀或體徵提示要作進一步檢查。

V. Diagnostic assessment. Night sweating as a single entity is not worrisome. V. 診斷評估。盜汗作爲單一徵狀並不令人擔心。

Explore the likelihood of exacerbation of known conditions or the onset of a new disease process. The history is the most helpful part of the patient encounter. A new medication, with perspiration as a side effect, is the culprit. Patients may need cessation of the medication as well as a washout period. Night sweats might be an early symptom of a developing illness so watchful waiting is useful. Patients need to be instructed to watch for weight changes, fevers, and sleep and mood changes. Patients can complete a symptom diary, which is very helpful to the clinician in determining the need for additional evaluation. Consider illnesses that tend to be present in the patient's age group. Screening for common malignancies through mammograms, pap smears, and fecal occult blood testing is appropriate health maintenance as well as often being a part of the evaluation of the presenting complaint of night sweats. 檢查已知疾病加劇可能性或所得疾病過程的發作情況。病史在病人疾病中最有幫助。有出汗副作用的新藥常常是盜汗的魁首。病人可能需要停藥及給予一段藥物清除時間。盜汗也可能是某種疾病發展的早期症狀，因此觀察等待是有用的。應指導病人留意體重變化、發燒及睡眠和情緒變化。病人可填寫一份症狀日誌，它對臨牀醫師確定是否作進一步檢查很有幫助。考慮該病人年齡組常見的疾病。通過乳房X線、巴氏塗片及糞便潛血試驗篩檢常見惡性腫瘤，既適於健康維持，也是當前盜汗主訴檢查的內容之一。