Neuroimaging Guidelines in Nonacute Headaches

本小組針對非急性頭痛患者安排神經影像檢查之適應症，以實證醫學的方式，評估過去文獻的品質、證據等級並參考歐美國家的相關率則，歷經數次討論與意見整合，提出共識。非急性且反覆發作的偏頭痛或緊縮型頭痛，若頭痛特徵近期內無改變，且神經學檢查爲正常時，影像檢查並非必要。非急性頭痛患者且有異常的神經學檢查，建議應接受影像檢查。對於被診斷爲叢發性頭痛且從未接受過神經影像檢查或是有非典型症狀的叢發性頭痛的病人，應考慮做影像檢查。對於有咳嗽頭痛、運動頭痛（出力頭痛）及與性行爲相關頭痛的病人，建議應接受影像檢查。雖然磁振造影的敏感度優於電腦斷層，但目前無足夠證據來建議應選擇磁振造影或電腦斷層，醫師仍應根據病患個別的病況來判斷。

關鍵字

頭痛；電腦斷層；磁振造影

並列摘要

The Treatment Guideline Subcommittee of the Taiwan Headache Society evaluated the indication of neuroimaging for nonacute headache according to the principles of evidence-based medicine. We have assessed the qualities of studies, levels of evidence, and referred to other guidelines proposed by Western countries. After several panel discussions, we merged opinions from the subcommittee members and proposed a Taiwan consensus. Neuroimaging is not necessary for patients with nonacute and recurrent migraine or tension-type headache when there is no recent change of headache characteristics and neurological examinations are normal. Neuroimaging is suggested for patients who have headaches with abnormal neurological examinations. For patients who are diagnosed as having cluster headache and have never received neuroimaging studies, or patients whose headache characteristics are atypical for cluster headaches, neuroimaging studies should be considered. Neuroimaging is also recommended for patients with cough headache, exertional headache and headache associated with sexual activity. Although the resolution of MRI is superior to CT, evidence is insufficient to make recommendation regarding the choice of MRI or CT for the evaluation of nonacute headache patient. Clinicians should make a judgment by themselves according to the patient’s specific conditions.

並列關鍵字

headache ； computed tomography ； magnetic resonance imaging

國際替代計量

Neuroimaging Guidelines in Nonacute Headaches

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