继发性头痛的危险信号:临床实践中的挑战

Maria Clea Marinho Lima, Giovanni Silveira Maioli, M. Valença
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摘要

世界卫生组织(WHO)将偏头痛列为全球每年健康寿命受损的前20大原因之一。在发达国家,每100万居民每年因偏头痛损失40万个工作日。头痛可能是全世界五大最重要的致残原因之一。方法检索Pubmed、Lilacs和Scopus数据库,使用虚拟健康图书馆的健康科学描述符(Health Science Descriptors, DeCS),特别是WHO或各国卫生实体收集的当前数据:“继发性头痛”、“危险信号”和“综述”进行文献综述。文章以葡萄牙语和英语发表。定义纳入文章的资格标准是针对所选主题的研究。结果在临床实践中使用“危险信号”具有相当大的相关性。“危险信号”、记忆、体格检查、实验室检查和影像学检查的结合,加强了预测继发性头痛发病的病因的可能性。然而,尽管这种广泛使用的筛查工具,在预后方面仍然存在差距。结论由于缺乏前瞻性流行病学研究,许多问题尚不清楚。此外,一些“危险信号”,如模式变化,没有得到很好的阐明。由于许多继发原因的发生率较低,需要进行大规模的研究。新发头痛患者应使用SNNOOP10清单进行筛查,以增加发现继发原因的可能性。
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Red flags for secondary headaches: challenges in clinical practice
Introduction The World Health Organization (WHO) ranks migraine as one of the top 20 causes of impaired healthy life years per year worldwide. Migraine alone is responsible for about 400,000 lost workdays per year per one million inhabitants in developed countries. Headache is probably among the five most important causes of disability worldwide.  Method This literature review was carried out by searching the Pubmed, Lilacs and Scopus databases, using the following Health Science Descriptors (DeCS) of the Virtual Health Library and in particular the current data collected by the WHO or health entities in the various countries: "secondary headaches" AND "red flags" AND "review". Articles published in Portuguese and English were selected. The eligibility criteria defined for the inclusion of articles were studies that addressed the chosen theme.  Results The use of "Red Flags" in clinical practice is of considerable relevance. The combination of "Red Flags", anamnesis, physical examination, laboratory, and imaging examination accentuate the probability of predicting the etiology that may underlie the onset of a secondary headache.  However, despite this widely useful screening tool, there are still gaps in the prognosis.  Conclusion Much remains unclear as there is a lack of prospective epidemiological studies. In addition, some "Red Flags" such as pattern change are poorly elucidated. Large-scale studies are needed due to the low incidence of many secondary causes. New patients with headache should be screened using the SNNOOP10 list to increase the likelihood of detecting a secondary cause.
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