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Ho Huu That, MD Pham Ngoc Thach University of Medicine 8/5/2018  Introduction  Tiếp cận chẩn đoán xử trí đau đầu  Tiếp cận chẩn đốn xử trí đau lưng  Headache is among the most common reasons patients seek medical attention attention  Relatively few cranial structures are pain pain-producing:: scalp, middle meningeal artery, dural producing sinuses, proximal segments of the large pial arteries arteries  Not pain pain producing producing:: much of brain parenchyma, ventricular ependymal ependymal… … 8/5/2018 Harrison’s principles of internal medicine - 19th 2015  Pain:: an unpleasant sensation localized to a Pain part of the body body  Described as a penetrating or tissue tissue-destructive squeezing… squeezing …) process or (stabbing, emotional burning, reaction (terrifying, sickening) sickening)  8/5/2018 The duality of pain pain:: sensation and emotion emotion Harrison’s principles of internal medicine - 19th 2015 8/5/2018 8/5/2018 8/5/2018 Harrison’s principles of internal medicine - 19th 2015 Triệu chứng Cảm giác Triệu chứng vận động Âm tính Giảm cảm giác Yếu (Negative) Mất cảm giác Liệt Dương tính Tê (Numbness) Co giật (Convulsion) (Positive) Châm chích Run (Tremor) (Tingling) Các loại Rối loạn Ngứa vận động (Múa vờn, Đau… múa giật…) 8/5/2018  Peripheral mechanism mechanism:: the primary sensory afferents afferents  Central mechanism mechanism:: the spinal cord and ascending pathways pathways  Neuropathic pain pain:: increased sensitivity and spontaneous activity in the damaged nerve fibers or CNS CNS Harrison’s principles of internal medicine - 19th 2015 8/5/2018   Primary headache headache::  Migraine  Tension type headache Tension  Cluster headache Secondary headache headache::  Meningitis  Intracranial hemorrhage  Brain tumor  Headache attributed to trauma or injury to the head and/or neck  Headache attributed to infection The international classification of headache disorders – Cephalalgia 2013 8/5/2018 10 Harrison’s principles of internal medicine - 19th 2015 8/5/2018 12 The international classification of headache disorders – Cephalalgia 2013 8/5/2018 13 8/5/2018 14 8/5/2018 15 Harrison’s principles of internal medicine - 19th 2015 8/5/2018 16 8/5/2018 Harrison’s principles of internal medicine - 19th 2015 17 8/5/2018 Harrison’s principles of internal medicine - 19th 2015 18 Harrison’s principles of internal medicine - 19th 2015 8/5/2018 19 8/5/2018 20 8/5/2018 21 8/5/2018 22 8/5/2018 23 8/5/2018 24 8/5/2018 25 8/5/2018 26