醫(yī)學(xué)知識雙語閱讀：頭痛

　　下面學(xué)習(xí)啦小編為大家?guī)磲t(yī)學(xué)知識雙語閱讀：頭痛，歡迎大家學(xué)習(xí)!

　　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.　 頭痛是一種常見癥狀，常常與功能障礙有關(guān)，但很少危及生命。頭痛可能是一種原發(fā)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(fā)癥狀，如急性全身性感染或顱內(nèi)感染、顱內(nèi)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(jié)構(gòu)的刺激、牽引或壓迫都能引起頭痛，這些結(jié)構(gòu)包括覆蓋頭顱的所有組織;第5、9、10顱神經(jīng);上部頸神經(jīng);顱內(nèi)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(jīng)末梢，引起頭痛。大多數(shù)頭痛的病因為顱外性而非顱內(nèi)性。因腦卒中、血管畸形與靜脈血栓形成引起的頭痛并不常見。

　　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(nèi)容包括：頭痛的發(fā)生頻率、持續(xù)時間、部位、嚴重程度;改善或加劇頭痛的因素;相關(guān)癥狀與體征(如發(fā)熱、頸項強直、惡心與嘔吐);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(fā)性頭痛具有某些特定特征。急性、劇烈的滿頭痛伴發(fā)熱、畏光和頸項強直，提示感染，如腦膜炎，應(yīng)尋找證據(jù)加以排除。蛛網(wǎng)膜下腔出血也能引起急性頭痛，常伴有腦膜刺激的癥狀與體征。占位性病變常常引起亞急性、漸進性頭痛。40歲以后新發(fā)病的頭痛始終需要徹底的評估。.顱內(nèi)占位性病變引起的頭痛可出現(xiàn)下列情況：睡醒時或夜間頭痛，體位改變引起頭痛變化，惡心和嘔吐。其他神經(jīng)性疾病主訴，如驚厥發(fā)作、精神錯亂、無力或感覺異常變化等，出現(xiàn)較遲，為惡性癥狀。

　　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(xiàn)為慢性或持續(xù)性，通常始于枕部或雙額部，然后擴散到整個頭部，常被病人描述為受壓感或顱緊箍感。發(fā)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(xiàn)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(guī)、梅毒血清試驗、血生化分析、血沉與腦脊液檢查，如有特殊癥狀，應(yīng)進行視覺檢查(視敏度、視野、屈光、眼內(nèi)壓)或鼻竇X線檢查。如對最近發(fā)生的持續(xù)、反復(fù)、或程度加重的頭痛，無法查明其原因的，就應(yīng)作MRI和/或CT檢查，特別是出現(xiàn)異常神經(jīng)體征時。

　　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(zhèn)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(fā)性頭痛的治療將在下文討論。有人主張采用不同的治療措施，如生物反饋、針灸、飲食調(diào)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么風(fēng)險，試一下倒也不妨，因為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(fā)性頭痛的治療取決于潛在疾病的治療。對腦膜炎而言，即時的抗生素治療至關(guān)重要。以后，鎮(zhèn)痛劑，包括撲熱息痛、非類固醇抗炎藥或阿片類麻醉劑，都可用于緩解頭痛癥狀。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(zhì)激素治療，由良性顱內(nèi)壓增高引導(dǎo)的頭痛則可用乙酰唑胺或利尿劑，并配合減輕體重。硬膜下血腫或腦腫瘤則需進行外科手術(shù)。

　　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(yī)生的減壓療法常?？梢詼p少頭痛的發(fā)病率。不過，大多數(shù)病人還是要由懂行的醫(yī)生來治療，定期隨訪，鼓勵討論一些情感問題，不管這些習(xí)慢性頭痛是否由這些因素引起或是頭痛導(dǎo)致這些問題，醫(yī)生的這些措施對病人都是有幫助的。醫(yī)生可以安慰病人，告訴他并不存在器質(zhì)性病變，并量出一些環(huán)境適應(yīng)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(yīng)交給由臨床醫(yī)生、心理治療醫(yī)生和理療師組成的醫(yī)療小組來處理，他們在治療慢性頭痛方面是最為有效的。

　　Night sweats are drenching sweats that require a change of bedding. 盜汗為淋透性出汗，需換床單。

　　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(fā)燒引起的出汗。發(fā)燒性出汗應(yīng)另行診斷。20世紀(jì)前，盜汗通常提示有結(jié)核菌感染。現(xiàn)在，其他很多不適都與此癥狀相關(guān)。盜汗通常是某已知病癥的標(biāo)志，如糖尿病(特別是伴夜間低血糖者)、癌癥、頭外傷和各種風(fēng)濕病。盜汗也可能是新的疾病的一種癥狀，在給盜汗報告病人進行檢查時，需檢查既往病史及新的癥狀。

　　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(fā)作時間、次數(shù)、加劇及癥狀消退加以確定。詢問病人已知疾病。多汗也與夜間血糖控制不良有關(guān)。風(fēng)濕性疾病(如類風(fēng)濕關(guān)節(jié)炎、狼瘡、幼兒性類風(fēng)濕性關(guān)節(jié)炎、顳關(guān)節(jié)炎等)也導(dǎo)致出汗，婦娠也會暫時的改變很多婦女的體溫狀況，導(dǎo)致出汗過多。免疫代償病人感染風(fēng)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(tǒng)檢查。伴隨盜汗的其他癥狀包括潮紅(類癌綜合癥、嗜鉻細胞瘤)、關(guān)節(jié)痛、睡眠性呼吸暫停、月經(jīng)不調(diào)、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(xí)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，如抗抑郁劑、膽堿能藥、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、非處方制劑、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(jié)核病，有否職業(yè)性及旅游相關(guān)性接觸。也應(yīng)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(dǎo)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(yīng)進行適當(dāng)?shù)暮Y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(yīng)針對病人醫(yī)療史中的相關(guān)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(jié)徹底檢查有助于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(yīng)檢查病人是否有膿腫、皮膚潰瘍、關(guān)節(jié)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. 臨床實驗室檢查。對有已知病癥病人，應(yīng)檢測病癥是否加?。貉?感染、骨髓炎和顳關(guān)節(jié)炎)、C反應(yīng)蛋白(風(fēng)濕性疾病)和血紅蛋白AIC(糖尿病)。根據(jù)病人癥狀及暴露情況決定是否進行其他檢查，包括結(jié)合病純蛋白衍生物皮膚測試、排除甲狀腺機能亢進的游離T4水平檢驗、全血計數(shù)及分類(感染)、促卵泡激素檢查停經(jīng)可能性。有旅游相關(guān)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：吸煙史、工業(yè)性接觸或咳嗽。這些病人需要進行潛在惡性腫瘤篩檢。CT掃描通常并不合適，除非其他癥狀或體征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。盜汗作為單一征狀并不令人擔(dān)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(fā)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(fā)展的早期癥狀，因此觀察等待是有用的。應(yīng)指導(dǎo)病人留意體重變化、發(fā)燒及睡眠和情緒變化。病人可填寫一份癥狀日誌，它對臨床醫(yī)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、巴氏涂片及糞便潛血試驗篩檢常見惡性腫瘤，既適于健康維持，也是當(dāng)前盜汗主訴檢查的內(nèi)容之一。