神经病学（人卫九版）15-肌肉痛.ppt

* * * * * * * * * * 11.5 Headache attributed to rhinosinusitis 11.5 Headache attributed to rhinosinusitisNotes 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 * * * * * * * * * * * * * * * * * * * * * * Categories Infrequent episodic tension type headache Occurs 1 day per month ( 12 days/year) Frequent episodic tension type headache Occurs 1 and 15 days/month ( 12 and 180 days/year) Chronic tension type headache Occurs 15 days/month ( 180 or more days/year) Causes Uncertain ? Activation of hyper excitable peripheral afferent neurons from head and neck muscles Associated with and aggravated by muscle tenderness and psychological tension but do not cause it Abnormalities in central pain processing and generalised increased pain sensitivity are found in some individuals Genetic factors 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