두통의 임상적 평가-일이차 두통의 감별진단
Clinical Evaluation of Headache-Differential Diagnosis between Primary and Secondary Headache
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초록
두통환자의 임상적 평가는 이상에서 간단히 살펴본 것처럼 여러 가지 면에서 접근 할 수 있다. 임상에서는 일차두통이 이차두통보다는 흔한 것이 사실이다. 하지만 법의학적인 문제에서나 환자를 위해서나 이차두통을 배제하기 위한 노력을 게을리 하지 말아야 한다. 두통환자를 대하면서 섬세한 문진과 검사를 통한 접근이야말로 해결의 열쇠라는 것을 잊지 말아야 할 것이다.
Abstract
Headache is one of the most common reasons for neurologic consultation. We should always distinguish primary from secondary headaches. In the absence of secondary headache, the clinician proceeds to diagnosing a primary headache disorder. The clinician must remain vigilant concerning secondary and alert to the "red flags". Headache management starts with diagnosis and this begins with a good history and physical examination. This clinical process provides clear information for the clinician and sets patients at ease in the knowledge that the doctor is interested in their problem. With the publication of the second edition of The International Classification of Headache Disorders (ICHD-2) in January 2004, clinicians who treat headache should become familiar with the revised criteria, which will become the standard for treatment and research. I offer orderly approach to primary headache diagnosis based on attack frequency and duration, using the ICHD-2. In this article, clinical evaluation of headache and differential diagnosis between primary and secondary headache will be reviewed.
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