神经病学（人卫九版）11-脊髓疾病.ppt

* * * * 11.7 Headache or facial pain attributed to temporomandibular joint disorder 12. Headache attributed to psychiatric disorderNew section in classification 12. Headache attributed to psychiatric disorderNotes 12.1 Headache attributed to somatisation disorder 12.2 Headache attributed to psychotic disorder Part 3:Cranial neuralgias, central and primary facial pain and other headaches 3. Cranial neuralgias and central causes of facial pain 13.1 Trigeminal neuralgia 13.1.1 Classical trigeminal neuralgia 13.1.2 Symptomatic trigeminal neuralgia 13.18.4 Persistent idiopathicfacial pain Previously used term: Atypical facial pain ACUTE HEADACHE IN THEEMERGENCY DEPARTMENT * * * * * * * * * * * * * * * * * * * * * * * * * * * People at risk Prevalence peaks at age 40-49 in both sexes Mean life time prevalence is 46% Chronic tension type headache affects 3% of general population Female to male ratio is 4:5 Prevalence increases with educational level Can occur in children Presentation Mild to moderate bilateral pain Sensation of muscle tightness or pressure Lasts hours to days Not associated with constitutional or neurological symptoms People with chronic tension headache more likely to seek help often have a history of episodic headache but delayed until frequency and disability are high Differential diagnosis Migraine – in chronic form characteristic features disappear and pain is less severe Neck problems – muscle tenderness of tension type headache may involve the neck Medication overuse headache – consider in patients taking opioid or combination analgesics for an average of 10 days/month Examination and investigation Examination Neurological examination Manual palpation of pericranial muscles ( frontal, temporal, masseter, pterygoid, sternomastoid, splenius and trapezius. Fundoscopy for papilloedema Investigations If neuro examination normal none needed Investigation Neuroimaging should be arranged if Atypical pattern of headache History of seizures Neurologi