Википедија

Главобоља — разлика између измена

Интерактиван преглед историје
← Старија изменаНовија измена →
Садржај обрисан Садржај додат
ВизуелноВикитекст
Нема описа измене
.
Ред 1:
{{Болест
| називName = Главобоља
|Image = Migraine.jpg
| латински = Cefalalgia
|Caption = Особа са главобољом
| слика =
| Field = [[Неурологија]]
| текст уз слику =
| synonyms = цефалалгија
| Field = [[Психијатрија]]<br />[[Неурологија]]
|ICD10 = {{ICD10|G|43||g|40}}-{{ICD10|G|44||g|40}}, {{ICD10|R|51||r|50}}
|ICD9 = {{ICD9|339}}, {{ICD9|784.0}}
|DiseasesDB = 19825
|MedlinePlus = 003024
|eMedicineSubj = neuro
|eMedicineTopic = 517
|eMedicine_mult = {{eMedicine2|neuro|70}}
|MeshID = D006261
}}
{{рут}}
'''Главобоља''' је један од најчешћих [[симптом]]а код људи, који подразумева [[бол]] у пределу главе, лица и горњег дела [[врат]]а. Главобоља настаје као последица различитих поремећаја: од безазлених стања која не захтевају никакво лечење до по живот опасних [[болест]]и.
'''Главобоља''' је један од најчешћих [[симптом]]а код људи, који подразумева [[бол]] у пределу главе, лица и горњег дела [[врат]]а. Главобоља настаје као последица различитих поремећаја: од безазлених стања која не захтевају никакво лечење до по живот опасних [[болест]]и. Она се јавља услед [[мигрена]] (оштрих, или мучних болова), [[Тензијска главобоља |тензијских главобоља]], и [[Кластер главобоља |кластерних главобоља]].<ref name=WHO2012/> Честе главобоље могу да утичу на односе и запослење.<ref name=WHO2012/> Постоји и повећан ризик од депресије код оних са јаким главобољама.<ref name=WHO2012/>
 
Главобоља се јавља код приближно 10% људи у популацији западне хемисфере и због овог симптома се око 30% болесника јавља свом лекару. Током живота главобоља се јавља најмање једанпут код 70-95% особа и то најчешће у узрасту од 20 до 40 година.<ref name=vodic>Републичка стручна комисија за израду и имплементацију водича у клиничкој пракси, Министарство здравља Републике Србије, Српско лекарско друштво: ''Главобоља - национални водич за лекаре у примарној здравственој заштити'', Београд, новембар 2005. ISBN 86-85313-31-7</ref>
 
<!-- Cause -->
Главобоље могу настати као резултат многих поремећаја, било озбиљних или не. Постоји низ различитих класификационих система за главобоље. Најпознатији је онај од [[Међународно друштво за главобољу |Међународног друштва за главобоље]]. Узроци главобоље могу да обухватају умор, депривацију сна, стрес, ефекте медикација, ефекте рекреативних лекова, вирусне инфекције, гласне буке, обичне прехладе, повреде главе, брзо гутање веома хладне хране или напитка, и проблеме зуба или синуса.
 
<!-- Prevention and Treatment -->
Третман главобоље зависи од темељног узрока, али најчешће подразумева [[аналгетик |лек за болове]]. Неке врсте главобоље се убрајају међу најчешће физичке непријатности.
 
<!-- Epidemiology -->
Око половине одраслих има главобољу бар једном годишње.<ref name=WHO2012>{{cite web|title=Headache disorders Fact sheet N°277|url=http://www.who.int/mediacentre/factsheets/fs277/en/|accessdate=15 February 2016|date=October 2012}}</ref> Најчешће су главобоље услед напетости, које утичу на око 1,6 милијарди људи (21,8% популације), а њима следе мигренске главобоље које утичу на око 848 милиона (11,7%).<ref>{{cite journal|last1=Global Burden of Disease Study 2013|first1=Collaborators|title=Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.|journal=Lancet|date=22 August 2015|volume=386|issue=9995|pages=743–800|pmid=26063472|doi=10.1016/s0140-6736(15)60692-4|pmc=4561509}}</ref>
{{TOC limit|3}}
 
== Класификација ==
 
Кроз историју је постојало неколико класификација главобоља, а данас се највише користи она коју је објавило Међународно удружење за главобољу ({{јез-енг|International Headache Society}}), а назива се ''Међународна класификација главобоља'' ({{јез-енг|The International Classification of Headache Disorders (ICHD)}}). Прва верзија те класификације (-{ICHD-1}-) објављена је [[1988]]. године, док је тренутна ревизија -{ICHD-2}- објављена [[2004]].<ref name=vodic/>
 
Главобоље су широко класификоване као „примарне” или „секундарне”.<ref>{{cite web|url=http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/headache/conditions/primary_vs_secondary_headaches.html|title=The Johns Hopkins Headache Center - Primary Exertion Headache|author=Cecilia B Young|date=3 January 2012|work=hopkinsmedicine.org}}</ref> Примарне главобоље су бенигне, рекурентне главобоље које нису узроковане болестима или структурним проблемима. На пример, [[мигрена]] је врста примарне главобоље. Док примарне главобоље могу изазвати значајан дневни бол и инвалидитет, оне нису опасне. Секундарне главобоље су узроковане основном болешћу, као што је [[системска инфекција |инфекција]], [[повреда главе]], [[Васкуларна болест |васкуларни поремећаји]], [[Субарахноидално крварење |крварење мозга]] или [[Тумори лобањске дупље |тумори]]. Секундарне главобоље могу бити безопасне или опасне. Поједине „црвене заставице” или знакови упозорења указују на то да секундарна главобоља може бити опасна.<ref name="Goadsby">Goadsby PJ, Raskin NH. Chapter 14. Headache. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012.</ref>
 
Према новој класификацији главобоље се деле у 14 класа. Прве четири класе обухватају примарне, следећих осам обухватају секундарне главобоље, у класи 13 су кранијалне неуралгије, примарни и централни узроци бола лица, док су у класи 14 некласификоване и недовољно специфичне главобоље.
 
*; '''Примарне главобоље''':
 
**1. [[Мигрена|Васкуларна главобоља]] (мигрена),
**2. [[Тензиона главобоља|Главобоља условљена укоченошћу мишића]] (тензиона главобоља),
**3. [[Кластер главобоља]] и остале тригеминоаутономне главобоље,
**4. Остале примарне главобоље.
 
*; '''Секундарне или симптоматске главобоље''':
 
**5. Главобоља повезана са повредом главе и/или врата,
**6. Главобоља повезана са васкуларним поремећајима главе или врата,
**7. Главобоља узрокована неваскуларним интракранијалним поремећајима,
**8. Главобоља узрокована разним супстанцама или прекидом њиховог узимања,
**9. Главобоља узрокована општим инфекцијама,
**10. Главобоља повезана са поремећајима хомеостазе,
**11. Главобоља или бол лица узрокован поремећајима лобање, врата, уха, носа, синуса или осталих структура лица и лобање,
**12. Главобоља повезана са психијатријским поремећајима.
 
*'''; Неуралгије и остале главобоље''':
 
**13. Кранијалне неуралигије, централна и примарна бол лица,
**14. Остале главобоље.<ref name=vodic/>
 
== Узрок ==
 
Постоји више од две стотине типова главобоља. Неке су безазлене, док су друге опасен по живот. Ошис главобоље и налази на [[Неуролошки преглед |неуролошком прегледу]], одређују да ли су додатни тестови неопходни и који је третман најподеснији.<ref name=SIGN>{{cite book |author= Scottish Intercollegiate Guideline Network |title= Diagnosis and management of headache in adults |location= Edinburgh |date=November 2008 |isbn= 978-1-905813-39-1 |url= http://www.sign.ac.uk/guidelines/fulltext/107/ |publisher= [[NHS Scotland|NHS Quality Improvement Scotland]]}}</ref>
 
=== Примарне главобоље ===
 
90% свих главобоља су примарне главобоље. Примарне главобоље се обично прво јављају кад су људи између 20 и 40 година стари.<ref name="Clinch">{{cite web|url=https://www.amazon.co.uk/CURRENT-Diagnosis-Treatment-Medicine-Edition/dp/0071624368|title=Clinch C. Chapter 28. Evaluation & Management of Headache - CURRENT Diagnosis & Treatment in Family Medicine, Third Edition (Lange Current Series): Jeannette E. South-Paul, Samuel C. Matheny, Evelyn L. Lewis: |isbn=9780071624367|publisher=McGraw-Hill|year= 2011}}</ref> The most common types of primary headaches are migraines and tension-type headaches.<ref name="Clinch" /> They have different characteristics. Migraines typically present with pulsing head pain, nausea, photophobia (sensitivity to light) and phonophobia (sensitivity to sound). Tension-type headaches usually present with non-pulsing "bandlike" pressure on both sides of the head, not accompanied by other symptoms.<ref name="Detsky">{{cite journal |vauthors = Detsky ME, McDonald DR, Baerlocher MR | year = 2006 | title = Does this patient with headache have a migraine or need neuroimaging? | url = | journal = JAMA | volume = 296 | issue = 10| pages = 1274–1283 | pmid = 16968852 | doi=10.1001/jama.296.10.1274 }}</ref> Other very rare types of primary headaches include:<ref name="Goadsby" />
* [[cluster headaches]]: short episodes (15–180 minutes) of severe pain, usually around one eye, with autonomic symptoms (tearing, red eye, nasal congestion) which occur at the same time every day. Cluster headaches can be treated with triptans and prevented with prednisone, ergotamine or lithium.
* [[trigeminal neuralgia]] or [[occipital neuralgia]]: shooting face pain
* [[hemicrania continua]]: continuous unilateral pain with episodes of severe pain. Hemicrania continua can be relieved by the medication indomethacin.
* primary stabbing headache: recurrent episodes of stabbing "ice pick pain" or "jabs and jolts" for 1 second to several minutes without autonomic symptoms (tearing, red eye, nasal congestion). These headaches can be treated with [[indomethacin]].
* primary cough headache: starts suddenly and lasts for several minutes after coughing, sneezing or straining (anything that may increase pressure in the head). Serious causes (see secondary headaches red flag section) must be ruled out before a diagnosis of "benign" primary cough headache can be made.
* primary exertional headache: throbbing, pulsatile pain which starts during or after exercising, lasting for 5 minutes to 24 hours. The mechanism behind these headaches is unclear, possibly due to straining causing veins in the head to dilate, causing pain. These headaches can be prevented by not exercising too strenuously and can be treated with medications such as [[indomethacin]].
* [[Sexual headache|primary sex headache]]: dull, bilateral headache that starts during sexual activity and becomes much worse during orgasm. These headaches are thought to be due to lower pressure in the head during sex. It is important to realize that headaches that begin during orgasm may be due to a subarachnoid hemorrhage, so serious causes must be ruled out first. These headaches are treated by advising the person to stop sex if they develop a headache. Medications such as [[propranolol]] and [[diltiazem]] can also be helpful.
* hypnic headache: moderate-severe headache that starts a few hours after falling asleep and lasts 15–30 minutes. The headache may recur several times during night. Hypnic headaches are usually in older women. They may be treated with [[lithium]].
 
=== Секундарне главобоље ===
 
Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as [[cervicogenic headache]] (pain arising from the neck muscles). [[Medication overuse headache]] may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches.<ref name=SIGN />
 
More serious causes of secondary headaches include:<ref name="Goadsby" />
* [[meningitis]]: inflammation of the meninges which presents with fever and meningismus, or stiff neck
* bleeding inside the brain ([[intracranial hemorrhage]])
* [[subarachnoid hemorrhage]] (acute, severe headache, stiff neck WITHOUT fever)
* [[ruptured aneurysm]], [[arteriovenous malformation]], [[intraparenchymal hemorrhage]] (headache only)
* [[brain tumor]]: dull headache, worse with exertion and change in position, accompanied by nausea and vomiting. Often, the person will have nausea and vomiting for weeks before the headache starts.
* [[temporal arteritis]]: inflammatory disease of arteries common in the elderly (average age 70) with fever, headache, weight loss, jaw claudication, tender vessels by the temples, polymyalgia rheumatica
* [[Glaucoma|acute closed angle glaucoma]] (increased pressure in the eyeball): headache that starts with eye pain, blurry vision, associated with nausea and vomiting. On physical exam, the person will have a red eye and a fixed, mid dilated pupil.
* Post-ictal headaches: Headaches that happen after a convulsion or other type of seizure, as part of the period after the seizure (the [[post-ictal]] state)
 
[[Gastrointestinal disease|Gastrointestinal disorders]] may cause headaches, including [[Helicobacter pylori]] infection, [[celiac disease]], [[non-celiac gluten sensitivity]], [[irritable bowel syndrome]], [[inflammatory bowel disease]], [[gastroparesis]], and [[List of hepato-biliary diseases|hepatobiliary disorders]].<ref name=LionettiFrancavilla2010>{{cite journal| vauthors=Lionetti E, Francavilla R, Pavone P, Pavone L, Francavilla T, Pulvirenti A | title=The neurology of coeliac disease in childhood: what is the evidence? A systematic review and meta-analysis | journal=Dev Med Child Neurol | year= 2010 | volume= 52 | issue= 8 | pages= 700–7 | pmid=20345955 | doi=10.1111/j.1469-8749.2010.03647.x | url=http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2010.03647.x/full | type=Systematic review and meta-analysis}}{{open access}}</ref><ref name=AzizHadjivassiliou2015>{{cite journal |vauthors=Aziz I, Hadjivassiliou M, Sanders DS |title=The spectrum of noncoeliac gluten sensitivity |journal=Nat Rev Gastroenterol Hepatol |volume=12|issue=9|pages=516–26|date=Sep 2015|pmid=26122473 |doi=10.1038/nrgastro.2015.107 |type=Review}}</ref><ref name=CamaraLemarroyRodriguezGutierrez2016>{{cite journal| vauthors=Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A| title=Gastrointestinal disorders associated with migraine: A comprehensive review | journal=World J Gastroenterol | year= 2016 | volume= 22 | issue= 36 | pages= 8149–60 | pmid=27688656 | doi=10.3748/wjg.v22.i36.8149 | pmc=5037083 | type=Review }}</ref> The treatment of the gastrointestinal disorders may lead to a remission or improvement of headaches.<ref name=CamaraLemarroyRodriguezGutierrez2016 />
 
== Патофизиологија ==
 
The [[Human brain|brain]] itself is not sensitive to [[pain]], because it lacks [[nociceptor|pain receptor]]s. However, several areas of the [[head]] and [[neck]] do have pain receptors and can thus sense pain. These include the extracranial arteries, [[middle meningeal artery]], large veins, [[venous sinuses]], cranial and spinal nerves, head and neck muscles, the [[meninges]], [[falx cerebri]], parts of the brainstem, eyes, ears, teeth and lining of the mouth.<ref name=ACEP2008>{{cite journal |last1=Edlow |first1= J.A. |last2= Panagos |first2= P.D. |last3= Godwin |first3= S.A. |last4= Thomas |first4= T.L. |last5= Decker |first5= W.W. |title= Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache |journal= Annals of Emergency Medicine |volume= 52 |issue= 4 |pages= 407–36 |date=October 2008 |pmid= 18809105 |doi= 10.1016/j.annemergmed.2008.07.001 |url=}}</ref><ref name="Clinical Neurology">{{cite web|url=https://www.amazon.com/Clinical-Neurology-8-David-Greenberg/dp/0071759050|title=Chapter 6. Headache & Facial Pain in Clinical Neurology|veditors= Greenberg DA, Aminoff MJ, Simon RP |edition=8th|publisher= McGraw-Hill|year=2012 |isbn= 9780071759052|work=amazon.com}}</ref> Pial arteries, rather than pial veins are responsible for pain production.<ref name="Goadsby" />
 
Headaches often result from traction to or irritation of the meninges and blood vessels. The nociceptors may be stimulated by head trauma or tumors and cause headaches. Blood vessel spasms, dilated [[blood vessels]], inflammation or infection of meninges and muscular tension can also stimulate nociceptors and cause pain.<ref name="Clinical Neurology" /> Once stimulated, a nociceptor sends a message up the length of the nerve fiber to the nerve cells in the brain, signaling that a part of the body hurts.
 
Primary headaches are more difficult to understand than secondary headaches. The exact mechanisms which cause migraines, tension headaches and cluster headaches are not known. There have been different theories over time which attempt to explain what happens in the brain to cause these headaches.
 
Migraines are currently thought to be caused by dysfunction of the nerves in the brain.<ref name="uptodate">Cutrer, FM, Bajwa A, Sabhat M. Pathophysiology, clinical manifestations and diagnosis of migraine in adults. In: UpToDate, Post TW (Ed), UpToDate, San Francisco, CA. (Accessed on April 23, 2014.)</ref> Previously, migraines were thought to be caused by a primary problem with the blood vessels in the brain.<ref>{{cite journal |last=Goadsby |first= P.J. |title= The vascular theory of migraine--A great story wrecked by the facts |journal= Brain |volume= 132 |issue= Pt 1 |pages= 6–7 |date=January 2009 |pmid= 19098031 |doi= 10.1093/brain/awn321 |url= http://brain.oxfordjournals.org/content/132/1/6.full}}</ref> This vascular theory, which was developed in the 20th century by Wolff, suggested that the aura in [[migraines]] is caused by constriction of intracranial vessels (vessels inside the brain), and the headache itself is caused by rebound dilation of extracranial vessels (vessels just outside the brain). Dilation of these extracranial blood vessels activates the pain receptors in the surrounding nerves, causing a headache. The vascular theory is no longer accepted.<ref name="uptodate" /><ref name="Charles">{{cite journal | author = Charles A | year = 2013 | title = Vasodilation out of the picture as a cause of migraine headache | url = | journal = Lancet Neurol | volume = 12 | issue = 5| pages = 419–420 | doi=10.1016/s1474-4422(13)70051-6| pmid = 23578774 }}</ref> Studies have shown migraine head pain is not accompanied by extracranial vasodilation, but rather only has some mild intracranial vasodilation.<ref name="Amin">{{cite journal | vauthors = Amin FM, Asghar MS, Anders H | year = 2013 | title = Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross sectional study | url = | journal = Lancet Neurol | volume = 12| issue = 5| pages = 454–461| doi = 10.1016/S1474-4422(13)70067-X | pmid = 23578775 }}</ref>
 
Currently, most specialists think migraines are due to a primary problem with the nerves in the brain.<ref name="uptodate" /> Auras are thought to be caused by a wave of increased activity of neurons in the [[cerebral cortex]] (a part of the brain) known as cortical spreading depression<ref>{{cite journal|last1=HADJIKHANI|first1=N|last2=SANCHEZ DEL RIO|first2=M|last3=WU|first3=O |title=Mechanisms of migraine aura revealed by functional MRI in human visual cortex |journal=Proc Natl Acad Sci U S A |date=2001 |volume=98|pages=4687–92 |doi=10.1073/pnas.071582498 |pmid=11287655|pmc=31895|issue=8|bibcode=2001PNAS...98.4687H|last4=Bakker|first4=Dick|last5=Fischl|first5=Bruce|last6=Kwong|first6=Kenneth K.|last7=Cutrer|first7=F. Michael|last8=Rosen|first8=Bruce R.|last9=Tootell|first9=Roger B. H.|last10=Sorensen|first10=A. Gregory|last11=Moskowitz|first11=Michael A. |display-authors=etal}}</ref> followed by a period of depressed activity.<ref>{{cite journal|last1=Buzzi|first1=M.G.|last2=Moskowitz|first2=M|title=The pathophysiology of migraine: year 2005|journal=J Headache Pain|date=2005|volume=6|issue=3|pages=105–11|doi=10.1007/s10194-005-0165-2|pmid=16355290|pmc=3451639}}</ref> Some people think headaches are caused by the activation of [[sensory nerves]] which release peptides, such as serotonin, causing inflammation in arteries, dura and meninges and also cause some vasodilation. Triptans, medications which treat migraines, block serotonin receptors and constrict blood vessels.<ref>{{cite web|url=http://accessmedicine.mhmedical.com/content.aspx?bookid=348&sectionid=40381638|title=Denny CJ, Schull MJ. Chapter 159. Headache and Facial Pain. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011|work=mhmedical.com}}</ref>
 
People who are more susceptible to experience migraines without headache are those who have a family history of migraines, women, and women who are experiencing hormonal changes or are taking [[birth control pills]] or are prescribed [[Hormone replacement therapy (menopause)|hormone replacement therapy]].<ref>{{cite web|title=Migraine Without Headache|url=http://www.neurobalancechiropractic.com.au/migraine-without-headache/|publisher=Neurobalance|accessdate=16 July 2014}}</ref>
 
[[Tension headaches]] are thought to be caused by activation of peripheral nerves in the head and neck muscles <ref name="Loder">{{cite journal | vauthors = Loder E, Rizzoli P | year = 2008 | title = Tension-type headache | url = | journal = BMJ | volume = 336 | issue = 7635| pages = 88–92 | doi=10.1136/bmj.39412.705868.ad| pmid = 18187725 | pmc=2190284}}</ref>
 
[[Cluster headaches]] involve overactivation of the [[trigeminal nerve]] and [[hypothalamus]] in the brain, but the exact cause is unknown.<ref name="Leroux">{{cite journal |vauthors = Leroux E, Ducros A | year = 2008 | title = Cluster headache | url = | journal = Orphanet J Rare Dis. | volume = 3 | issue = 1| page = 20 | doi = 10.1186/1750-1172-3-20 | pmid = 18651939 | pmc = 2517059 }}</ref>
 
== Дијагностички приступ ==
{|border="1" class="wikitable"
|+ Диференцијална дијагностика главобоље
 
![[Tension headache]]
![[New daily persistent headache]]
![[Cluster headache]]
![[Migraine]]
|-
| mild to moderate dull or aching pain|| || severe pain|| moderate to severe pain
|-
| duration of 30 minutes to several hours
|| duration of at least four hours daily
|| duration of 30 minutes to 3 hours
|| duration of 4 hours to 3 days
|-
|
|| Occur in periods of 15 days a month for three months
|| may happen multiple times in a day for months
|| periodic occurrence; several per month to several per year
|-
|located as tightness or pressure across head
|| located on one or both sides of head
|| located one side of head focused at eye or [[Temple (anatomy)|temple]]
|| located on one or both sides of head
|-
|
|| consistent pain
|| pain describable as sharp or stabbing
|| pulsating or throbbing pain
|-
|no nausea or vomiting
||
||
||nausea, perhaps with vomiting
|-
| no [[Aura (symptom)|aura]]
||no aura
||
||auras
|-
|uncommonly, [[Photosensitivity in humans|light sensitivity]] or noise sensitivity
||
|| may be accompanied by [[running nose]], [[tears]], and [[Ptosis (eyelid)|drooping eyelid]], often only on one side
||sensitivity to movement, light, and noise
|-
|
|| exacerbated by regular use of [[acetaminophen]] or [[NSAIDS]]
||
|| may exist with tension headache<ref name="BBDtriptans">{{cite journal |publisher=[[Consumers Union]] of US |journal=Consumer Reports Best Buy Drugs |date=March 2013 |title=Using the triptans to treat: Migraine headaches: Comparing effectiveness, safety, and price |page=8 |url =http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/triptanFINAL.pdf |accessdate=18 March 2013}}</ref>
|}
 
Most headaches can be diagnosed by the clinical history alone.<ref name=Goadsby /> If the symptoms described by the person sound dangerous, further testing with neuroimaging or lumbar puncture may be necessary. Electroencephalography (EEG) is not useful for headache diagnosis.<ref>{{cite journal |last1=Gronseth |first1=G.S. |last2=Greenberg |first2=M.K. |title=The utility of the electroencephalogram in the evaluation of patients presenting with headache: A review of the literature |journal=Neurology |date=July 1995 |volume=45 |issue=7 |pages=1263–7 |pmid=7617180 |doi=10.1212/WNL.45.7.1263}}</ref>
 
The first step to diagnosing a headache is to determine if the headache is old or new.<ref name="Smetana">[http://accessmedicine.mhmedical.com/content.aspx?bookid=500&sectionid=41026552 Smetana GW. Chapter 9. "Headache." In: Henderson MC, Tierney LM, Jr., Smetana GW. eds. ''The Patient History: An Evidence-Based Approach to Differential Diagnosis''. New York, NY: McGraw-Hill; 2012]</ref> A "new headache" can be a headache that has started recently, or a chronic headache that has changed character.<ref name=Smetana /> For example, if a person has chronic weekly headaches with pressure on both sides of his head, and then develops a sudden severe throbbing headache on one side of his head, he has a new headache.
 
== Извори ==
{{reflist|30em}}
 
{{-}}
== Спољашње везе ==
* {{dmoz|Health/Conditions_and_Diseases/Neurological_Disorders/Headaches/}}
 
{{Листа симптома болести}}
{{Authority control}}
{{Порталбар|Медицина}}
{{медицинско упозорење}}
 
Преузето из „https://sr.wikipedia.org/wiki/Главобоља”