メディカルスタッフレクチャー
患者が頭痛を訴えたら
キーワード:
The International Classification of Headache Disorders,
secondary headaches,
primary headaches,
migraine,
chronification
2019 年 36 巻 3 号 p. 194-197
詳細
2019 年 36 巻 3 号 p. 194-197
What should we do if the patient complains of a headache?
In general, it is essential to first check the vital signs, evaluate the level of consciousness, and decide whether or not it is in an emergency. Headache diagnosis will be followed without medical emergent situation. First of all, you should confirm whether it is “a headache that he/she has never experienced before” or “it is a headache that he/she always repeat”. If it is the former, there is a higher probability of a “secondary headache” which has other causes of headache, and if it is the latter, it may be a chronic headache of “primary headache” as the headache itself is a disease.
If you think of a secondary headache, you have to make sure that you don't miss a headache due to an urgent or progressive disease that can not be postponed. According to “Clinical Practice Guideline for Chronic Headache 2013”, in the following cases : (1) headache with sudden onset, (2) headache never experienced before, (3) headache different from the customary headache, (4) headache that has increased in frequency and intensity, (5) headache begins after age 50, (6) headache with neurological deficit, (7) headache in a patient with cancer or immunodeficiency, (8) headache in a patient with psychiatric symptoms, (9) headache in a patient with fever, neck stiffness or meningeal irritation, it is recommended that an aggressive search is necessary in doubt of secondary headache. It is important to keep in mind the characteristics and accompanying symptoms of headaches to search.
When considering primary headache that is a disease itself such as migraine, tension–type headache, and trigeminal autonomic cephalalgias, you should be clear whether the diagnosis is migraine, and if it is migraine, how the influence on daily life is.
One of the most difficult issues at present in daily practice of migraine headaches is to respond chronic headaches. It is necessary to search for chronification promoting factors that can be intervened and to treat migraine with considering the prevention against it.
Although everyone has experienced headaches at least once due to colds, lack of sleep, or hangovers, and headaches are one of the common complaints often encountered in daily practice, there is always the possibility that secondary headaches or severe migraine headaches are included in it. It is hoped that many headache patients will be able to spend their smiles as medical workers deal with appropriate headaches.
