医学知识双语阅读：头痛

1、医学知识双语阅读：头痛头痛可能是一种原发性疾病(如偏头痛，丛集性头痛或紧张型头痛)，也可能是某些疾病的继发症状，如急性全身性感染或颅内感染、颅内肿瘤、头外伤、严重的高血压、脑缺氧、及眼、耳、鼻、喉、口腔牙齿和颈椎等多种疾病，有时找不到任何病因。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 c

2、ranial 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 he

3、adaches is extracranial rather than intracranial. Stroke, vascular abnormalities, and venous thromboses are uncommon causes of headache. 对头部任何疼痛敏感结构的刺激、 牵引或压迫都能引起头痛，这些结构包括覆盖头颅的所有组织;第 5、9、10颅神经 ;上部颈神经 ;颅内大静脉窦 ;颅底大动脉 ;硬脑膜大动脉以及颅底硬脑膜。血管壁的扩张或收缩刺激神经末梢，引起头痛。大多数头痛的病因为颅外性而非颅内性。因脑卒中、血管畸形与静脉血栓形成引起的头痛并不常见。蛛网膜下腔

4、出血也能引起急性头痛，常伴有脑膜刺激的症状与体征。占位性病变常常引起亚急性、渐进性头痛。40 岁以后新发病的头痛始终需要彻底的评估。.颅内占位性病变引起的头痛可出现下列情况：睡醒时或夜间头痛，体位改变引起头痛变化，恶心和呕吐。其他神经性疾病主诉，如惊厥发作、精神错乱、无力或感觉异常变化等，出现较迟，为恶性症状。Tension headache tends to be chronic or continuous and commonlyoriginates in the occipital or bifrontal region, then spreads over the entire hea

5、d. 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. 紧张型头痛往往表现为慢性或持续性，通常始于枕部或双额部，然后扩散到整个头部，常被病人描述为受压感或颅紧箍感。发热性疾病、动脉性高血压以及偏头痛通常引起搏动性头痛，可出现

6、在头部任何部位。如对最近发生的持续、反复、或程度加重的头痛，无法查明其原因的，就应作 MRI 和/ 或 CT检查，特别是出现异常神经体征时。Treatment Many headaches are of short duration and require no treatment other than mild analgesics (eg, aspirin, acetaminophen) and rest. 治疗很多头痛都是短期的， 除服用一些轻镇痛剂 (如阿司匹林或扑热息痛 )及休息外，无需其他治疗。Treatment of primary headaches is discussed

7、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 a

8、lternative treatment poses little risk, it may be tried, with the idea that effective headache management is multidimensional. 原发性头痛的治疗将在下文讨论。有人主张采用不同的治疗措施，如生物反馈、针灸、饮食调控及某些较少使用的治疗方式。这些治疗措施都未能在严格的检验中证明其明确的疗效。不过，既然这些另类治疗措施几乎没什么风险，试一下倒也不妨，因为有效的头痛治疗本来也是多种多样的。Treatment of secondary headaches depends on t

9、reatment of theunderlying 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 corticost

10、eroids, and headache due to benign intracranial hypertension is treated with acetazolamide or diuretics and weight loss. Subduralhematomas or brain tumors may be treated surgically. 继发性头痛的治疗取决于潜在疾病的治疗。对脑膜炎而言，即时的抗生素治疗至关重要。以后，镇痛剂，包括扑热息痛、 非类固醇抗炎药或阿片类麻醉剂，都可用于缓解头痛症状。有些疾病则需要更专门的治疗。如，颞动脉炎需用肾上腺皮质激素治疗，由良性颅内压

11、增高引导的头痛则可用乙酰唑胺或利尿剂，并配合减轻体重。硬膜下血肿或脑肿瘤则需进行外科手术。医生可以安慰病人，告诉他并不存在器质性病变，并量出一些环境适应方面的建议及消除刺激与压力方法。对一些特别难处理的病情，则应交给由临床医生、心理治疗医生和理疗师组成的医疗小组来处理，他们在治疗慢性头痛方面是最为有效的。Night sweats are drenching sweats that require a change of bedding.盗汗为淋透性出汗，需换床单。I. Approach. The first priority is to exclude night sweats caused

12、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 nocturnalhyp

13、oglycemia), 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. 诊断。首先要排除发烧引起的出汗。发烧性出汗应另行诊断。20 世纪前，盗汗通常提示有结核菌感染。现在，其他很多不适都与此症状相关。盗汗通常是某已知病

14、症的标志，如糖尿病 (特别是伴夜间低血糖者)、癌症、头外伤和各种风湿病。盗汗也可能是新的疾病的一种症状，在给盗汗报告病人进行检查时，需检查既往病史及新的症状。免疫代偿病人感染风险增加，特别是非典型性病原体感染。有药物滥用史病人需询问其针头使用及其他接触状况。A. Review of systems. Other symptoms that can accompany nightsweats include flushing (carcinoid syndrome, pheochromocytoma), joint pain, sleep apnea, menstrual irregularit

15、ies, reflux, cough, headache, dysuria, dyspnea, rashes, fatigue, palpitations, and weight and bowel habit changes. A. 系统检查。伴随盗汗的其他症状包括潮红(类癌综合症、嗜铬细胞瘤 )、关节痛、睡眠性呼吸暂停、月经不调、反流、咳嗽、头痛、排尿困难、睡眠困难、皮疹、疲乏、心悸及体重与排便习惯改变。B. Exposure factors. Inquire about recent immunizations or new medicines such as antidepressan

16、ts, 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,

17、tuberculosis, or occupational and travel-related exposures. Also ask about increases in general changes in the ambient night temperature. B. 暴露因素。询问最近免疫及新药使用情况，如抗抑郁剂、胆碱能药、哌替定、雌激素抑制剂、促性腺激素抑制剂、烟酸、类固醇、兴奋剂、非处方制剂、解热剂和自然疗法。询问病人有无接触性传染病(STD)、HIV、肝炎、结核病，有否职业性及旅游相关性接触。也应询问周围夜间体温总体变化增多情况。根据病人症状及暴露情况决定是否进行其他检查

18、，包括结合病纯蛋白衍生物皮肤测试、排除甲状腺机能亢进的游离T4 水平检验、全血计数及分类 (感染 )、促卵泡激素检查停经可能性。有旅游相关及 STD接触病人可能需要进行特种检验。V. Diagnostic assessment. Night sweating as a single entity is notworrisome. V. 诊断评估。盗汗作为单一征状并不令人担心。Explore the likelihood of exacerbation of known conditions or the onset of a new disease process. The history i

19、s 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 ca