颈部压痛点处的手法治疗对紧张型头痛的效果观察

背景：在颈部软组织压痛点和痛性结节处施用手法治疗可否改善紧张性头痛的症状及体征。目的：观察颈部压痛点与紧张型头痛(tension-headehe,TTH)之间的关系，探讨手法治疗的作用。设计：以诊断为依据的病例对照研究。地点和对象：TTH患者280例，男80例，女200例；诊断标准参照1988年国际头痛学会头痛分类标准。对照组150例，为无头痛症状的健康体检者，男50例，女100例。方法：触诊枕外隆突下至颈棘突止中线及其旁开，记录每一压痛点、痛性结节总数及部位，实施揉拿、弹拨、点按使颈部压痛点及痛性结节的手法治疗。观察肌肉痉挛的缓解程度及局部血液循环的改善。主要观察指标：TTH组和对照组压痛点、痛性结节阳性率，TTH患者压痛点和痛性结节在枕颈部分布情况，采用手法治疗后疗效评定结果。结果：TTH组和对照组压痛点、痛性结节阳性率分别为(58．9％，28．6％和1．30%，和0．6％)(χ^2=262．6，P&;lt;0．005)。主要分布在上颈段(C1-2,C2-3)棘中线和棘突旁。经1-6次治疗，痊愈183例(65．4％)，显效58例(20．7％)，好转27例(9．6％)，无效2例(0．7％)，总显效率86．1％。结论：颈部肌肉障碍在TTH的发病机制中起重要作用，针对压痛点手法治疗，产生显著的疗效。     

颈部压痛点处的手法治疗对紧张型头痛的效果观察

背景在颈部软组织压痛点和痛性结节处施用手法治疗可否改善紧张性头痛的症状及体征.目的观察颈部压痛点与紧张型头痛(tension-headche,TTH)之间的关系,探讨手法治疗的作用.设计以诊断为依据的病例对照研究.地点和对象TTH患者280例,男80例,女200例;诊断标准参照1988年国际头痛学会头痛分类标准.对照组150例,为无头痛症状的健康体检者,男50例,女100例.方法触诊枕外隆突下至颈棘突止中线及其旁开,记录每一压痛点、痛性结节总数及部位,实施揉拿、弹拨、点按使颈部压痛点及痛性结节的手法治疗.观察肌肉痉挛的缓解程度及局部血液循环的改善.主要观察指标TFH组和对照组压痛点、痛性结节阳性率,TFH患者压痛点和痛性结节在枕颈部分布情况,采用手法治疗后疗效评定结果.结果TTH组和对照组压痛点、痛性结节阳性率分别为(58.9%,28.6%和1.3%和0.6%)(x2=262.6,P＜0.005).主要分布在上颈段(C1～2,C2-3)棘中线和棘突旁.经1～6次治疗,痊愈183例(65.4%),显效58例(20.7%),好转27例(9.6%),无效2例(0.7%),总显效率86.1%.结论颈部肌肉障碍在TTH的发病机制中起重要作用,针对压痛点手法治疗,产生显著的疗效.     

针刀疗法为主的综合疗法治疗伴有颅周肌障碍的紧张型头痛

目的　与传统疗法比较 ,对采用以小针刀为主的综合疗法治疗伴有颅周肌障碍的紧张型头痛(TTH PM)进行临床疗效评价。方法　综合疗法包括①镇痛液注入枕颈部压痛点和痛性结节 ;②针刀疗法 ;③按摩治疗 ;④理疗及器具治疗 ;⑤药物治疗。其中以小针刀为主要治疗方法。传统疗法为以上五法中除针刀疗法以外的其它四种方法。结果　针刀疗法组治愈率为 75 .4 % ,总有效率为 95 .4 % ;对照组分别为 2 5 .8%和 84 .9% ,两组间疗效存在极显著差异 (P <0 .0 1)。结论　由于以针刀疗法为主的综合疗法从真正意义上纠正了TTH PM的病理改变 ,与传统疗法比较 ,其治疗效果有显著提高。     

正骨手法配合超短波治疗颈性头痛31例

自１９９９年６月以来笔者采用正骨推拿手法,配合超短波治疗颈性头痛３１例,取得较好疗效,现报道如下。１资料与方法 ３１例颈性头痛患者,男１５例,女１６例,年龄２２～７８岁,平均（４５．５５ ±１０．８４）岁,病程短者１周,长者２３年,皆符合下述诊断标准：枕颈部疼痛,间歇性或连续性发作;无明显外伤病史;颈部僵硬,活动度变小,活动时引起头痛;颈椎横突靠近神经根处和枕神经处有压痛,斜方肌近侧止点压痛;下颈段无明显疼痛,压痛及僵硬;Ｘ线检查可见Ｃ１、Ｃ２、Ｃ３颈椎小关节紊乱,生理弯曲改变或颈椎不稳情况; Ｍ…     

揉按弹拔手法治疗背肌筋膜炎患者取坐位,先用揉、按手法放松颈背部,然后点按风池、肩井、天宗穴,每穴约30秒钟,接着对肩背部压痛点及痛性筋束结节进行按压和弹拔,手法由轻到重,约2～3分钟,最后以搓、揉手法结束.隔日1次,7次为一疗程.用揉按手法放松颈背部肌肉,点按风池、肩井、

患者取坐位,先用揉、按手法放松颈背部,然后点按风池、肩井、天宗穴、每穴约30秒种,接着对肩背部压痛点及痛性筋束结节进行按压和弹拔,手法由轻到重,约2～3分钟,最后以搓、揉手法结束.     

温热声频电治疗颈肌凝结症观察

颈肌凝结症患者３１５例,均符合如下诊断标准：自觉后颈部僵硬感、紧束感或沉重感,颈部活动不利,晨起及静止时症状加重,活动后逐渐减轻,但深在的酸胀疼痛呈持续性;检查局部可触及痛性结节,斜方肌深压痛较明显。全部病例均不构成颈椎病的诊断。治疗分为３组。第１组...     

痛点阻滞、穴位注射治疗颈性头痛

１资料与方法一般资料 :颈性头痛患者４５例中 ,男１９例 ,女２６例 ,年龄最大５４岁 ,年龄最小２３岁 ,年龄平均３８岁。病程１月～５年。长期低头工作者２４例 ,习惯性落枕者１１例 ,长期高枕睡觉者８例。主要表现为头痛 ,一般位于头后、头顶及耳部上方 ,以胀痛、跳痛为多见 ,伴有头昏 ,眼球发胀及颈部酸胀不适 ,每当受凉 ,过度劳累后加重。颈部肌肉及枕后筋膜较紧张 ,颈活动欠灵活 ,颈后肌肉及枕后筋膜压痛 ,枕大、枕小神经压痛 ,椎间孔挤压试验可阳性或阴性。颈椎正侧位及双斜位片示颈椎生理曲度变直 ,２例有椎体轻度移位 ,５例有椎间孔…     

神经根注射治疗颈性头痛132例分析

几年来我们采用神经根注射疗法治疗颈性头痛132例，并随访观察2a以上，现将结果报告如下。 1临床资料 1．1一般资料 本组男48例，女84例，年龄20-43（平均27．5）岁。均以头痛为主要症状，个别伴有头晕和颈部不适。一侧头痛76例，双侧头痛56例。多为发作性胀痛，有的为一过性剌痛。1．2临床检查多数有颈部肌肉紧张和压痛，均有一侧或双侧枕大神经压痛，无神经系统定位体征，下列颈椎检查阳性：     

揉按弹拔手法治疗背肌筋膜炎

患者取坐位,先用揉、按手法放松颈背部,然后点按风池、肩井、天宗穴,每穴约３０秒钟,接着对肩背部压痛点及痛性筋束结节进行按压和弹拔,手法由轻到重,约２～３分钟,最后以搓、揉手法结束。隔日１次,７次为一疗程。用揉按手法放松颈背部肌肉,点按风池、肩井、天宗穴,能使痉挛的血管舒张,紧张的肌肉放松,并能镇静止痛。按压弹拔手法能通经活络,缓解局部肌肉的紧张和痉挛,促进局部血液循环,改善新陈代谢过程,消除无菌性炎症,促使病变组织的修复。且能松解粘连,达到“以松止痛,去痛致松”的目的。结果：２４０例中,男１７４…     

综合治疗颈椎间盘突出症86例临床观察

我们在 1996～ 1999年临床治疗中采用中药热敷、颈牵引、按摩、针刺经穴相互配合治疗86例颈椎间盘突出症患者,取效满意。 1资料与方法1.1资料本组 86例患者均符合颈椎间盘突出症诊断标准,其中男 69例,女 17例,年龄 32～ 56岁,病程6个月～ 10年,临床表现及检查：颈项部肌僵直紧张,经常酸痛不适,眩晕、头昏、枕大神经痛、颈活动受限,有时肩背部及上肢放散性麻木痛,颈部有明显压痛点,叩顶压板试验(＋ ),臂丛牵拉试验(＋ )等,CT、核磁检查,C3～ 4间盘突出者3例,C3～ 4、 C4～ 5C5～ 6,间盘突出者33例,C4～ 5、 C5～ 6间盘…     

Pressure pain threshold and pain tolerance in episodic tension-type headache do not depend on the presence of headache

Pressure pain thresholds and responses to painful mechanical stimuli were obtained from 20 subjects with episodic tension-type headaches (TTH). Tender points in the temporalis and trapezius muscles were studied, along with two nontender points, one in the temporalis and one on the Achilles tendon. Two examinations were performed, one during and one without a headache, and results were compared. No significant differences were found in either variable for any tested points. The data demonstrate that the sensitivity level of these points does not differ based on the presence or absence of TTH. This suggests that the muscle sensitivity in TTH is constant. The observation that the sensitivity levels of both tender and nontender points did not vary suggests that the underlying mechanism or effect of TTH is not restricted to tender muscles.     

Dry needling versus friction massage to treat tension type headache: A randomized clinical trial

Tension type headache (TTH), the most common type of headache, is known to be associated with myofascial pain syndrome and the existence of myofascial trigger points. There are several treatment options for myofascial trigger points. In this study we compared the effectiveness of dry needling and friction massage to treat patients with TTH.A convenience sample of 44 patients with TTH participated in this randomized clinical trial. The frequency and intensity of headache, pressure pain threshold at the trigger point site, and cervical range of motion were recorded. Then the participants were randomly assigned to one of two treatment groups for dry needling or friction massage, delivered in 3 sessions during 1 week. The participants were evaluated 48?h after the last treatment session. Analysis of covariance, paired t-test and Wilcoxon's test were used for statistical analysis.The results showed that both treatment methods significantly reduced headache frequency and intensity, and increased pain threshold at the trigger points. However, neither treatment had any effect on cervical range of motion except for extension, which increased in the dry needling group. Between-group comparisons showed that dry needling increased pain threshold significantly more than friction massage. There were no significant differences between groups in any other outcome variables.Dry needling and friction massage were equally effective in improving symptoms in patients with TTH. The decreases in frequency and intensity of headache were similar after both dry needing and friction massage.     

Referred pain from the trochlear region in tension-type headache: a myofascial trigger point from the superior oblique muscle

BACKGROUND: Tension-type headache (TTH) is a prototypical headache in which myofascial trigger points (MTrPs) can play an important role. To our knowledge, MTrPs in the muscle tissues of the trochlear region, ie, the superior oblique muscle (SOM), have not been previously mentioned, and a referred pain pattern from this region has never been reported. OBJECTIVE: To describe the referred pain from the trochlear area based on the examination of MTrPs in the SOM in patients with episodic and chronic TTH (CTTH). DESIGN: A blinded, controlled study. METHODS: The trochlear region was examined in 15 patients with CTTH, 15 patients with episodic TTH (ETTH), and 15 control subjects. Referred pain elicited by different maneuvers performed during manual palpation, ie, maintained pressure, active muscle contraction, and stretching of the muscle, was assessed with a visual analogue scale. Patients with ETTH were examined on days when they were headache-free, whereas CTTH patients were examined on days in which headache intensity was less than 4 points on a 10-cm horizontal visual analogue scale. RESULTS: Eighty-six percent of patients with CTTH and 60% with ETTH had referred pain that originated from MTrPs in the SOM, while only 27% of the controls reported referred pain. This pain was perceived as a deep ache located at the retro-orbital region, sometimes extending to the supra-orbital region or the homo-lateral forehead. Pain intensity was greater in CTTH patients than in ETTH patients or control subjects (P < .001). CONCLUSIONS: MTrPs in the SOM may evoke a typical referred pain pattern in patients with TTH. The presence of a myofascial disorder in the trochlear region might contribute to the pathogenesis of TTH.     

Tuberculosis of rabbits induced by droplet nuclei infection; response to reinfection

At intervals from 2 to 11 weeks after normal rabbits had inhaled small numbers of virulent bovine tubercle bacilli as separated cells in droplet nuclei, groups of these animals received a single exposure to reinfection during which each animal inhaled about 20,000 separated bacilli. Normal control rabbits which inhaled this large number of bacilli died within 4 weeks thereafter. Their deaths were attributed to destruction of the lungs by developing initial tubercles. Eleven of 12 rabbits which were reinfected within 4 weeks after initial infection seemed to respond as normal animals. Their lungs were largely replaced by developing reinfection tubercles when they died or were killed within 32 days after reinfection. The inflammatory response of the reinfection tubercles was not consistently different from that of initial tubercles, although reinfection tubercles contained fewer bacilli than initial lesions of the same age. Within 5 weeks after initial infection rabbits apparently had developed immunity to reinfection with virulent bovine tubercle bacilli inhaled as separated cells in droplet nuclei. In some of them, however, exposure to massive inhaled reinfection seemed to stimulate the progress of initial infection. It is suggested that in rabbits the development of resistance to tubercle bacilli does not bear a linear relationship to time, but progresses in steps and within 5 weeks after small initial infection by inhalation is adequate to prevent the growth of separated bacilli when these are deposited upon alveolar walls. It is suggested also that the basic effect of acquired resistance of rabbits to tubercle bacilli is inhibition of multiplication of the bacilli.     

The Role of Muscles in Tension-Type Headache

The tenderness of pericranial myofascial tissues and number of myofascial trigger points are considerably increased in patients with tension-type headache (TTH). Mechanisms responsible for the increased myofascial pain sensitivity have been studied extensively. Peripheral activation or sensitization of myofascial nociceptors could play a role in causing increased pain sensitivity, but firm evidence for a peripheral abnormality still is lacking. Peripheral mechanisms are most likely of major importance in episodic TTH. Sensitization of pain pathways in the central nervous system due to prolonged nociceptive stimuli from pericranial myofascial tissues seem to be responsible for the conversion of episodic to chronic TTH. Treatment directed toward muscular factors include electromyography biofeedback, which has a documented effect in patients with TTH, as well as physiotherapy and muscle relaxation therapy, which are most likely effective. Future studies should aim to identify the source of peripheral nociception.     

Pain-relieving factors in migraine and tension-type headache

We performed the present study to compare patients with migraine and tension-type headache (TTH) in their behaviour during the attacks and the manoeuvres to relieve the pain. One hundred thirty consecutive patients with either migraine (n = 75) or TTH (n = 55) were questioned (including the use of a checklist) concerning their usual behaviour during the attacks and non-pharmacological manoeuvres performed to relieve the pain. The results of the two types of headache were compared. Patients with migraine tended to perform more manoeuvres than patients with TTH (mean: 4.3 vs. 3.6). These manoeuvres included pressing and applying cold stimuli to the painful site, trying to sleep, changing posture, sitting or reclining in bed (using more pillows than usual to lay down), isolating themselves, using symptomatic medication, inducing vomiting, changing diet and becoming immobile during the attacks. The only measure predominantly reported by patients with TTH was scalp massage. Migraineurs, compared to patients with TTH, changing eating habits, pressed the pain site; there were no significant differences between the two groups. The behaviour of patients during headache attacks varies with the diagnosis. Measures that do not always result in pain relief are performed in order to prevent its worsening or to improve associated symptoms. These behavioural differences may be because of the different pathogenesis of the attacks or of various styles of dealing with the pain. They can also aid the differential diagnosis between headaches in doubtful cases.     

Similarities in stress physiology among patients with chronic pain and headache disorders: evidence for a common pathophysiological mechanism?

One common feature of chronic musculoskeletal pain and headaches are that they are both influenced by stress. Among these, tension-type headache (TTH), fibromyalgia (FMS) and chronic shoulder/neck pain (SNP) appear to have several similarities, both with regard to pathophysiology, clinical features and demographics. The main hypothesis of the present study was that patients with chronic pain (TTH, FMS and SNP) had stress-induced features distinguishing them from migraine patients and healthy controls. We measured pain, blood pressure, heart rate (HR) and skin blood flow (BF) during (1 h) and after (30 min) controlled low-grade cognitive stressor in 22 migraine patients, 18 TTH patients, 23 FMS patients, 29 SNP patients and 44 healthy controls. FMS patients had a lower early HR response to stress than migraine patients, but no differences were found among FMS, TTH and SNP patients. Finger skin BF decreased more in FMS patients compared to migraine patients, both during and after the test. When comparing chronic pain patients (chronic TTH, FMS and SNP) with those with episodic pain (episodic TTH and migraine patients) or little or no pain (healthy controls), different adaptation profiles were found during the test for systolic and diastolic blood pressure, HR and skin BF in the chronic group. In conclusion, these results suggest that TTH, FMS and SNP patients may share common pathophysiological mechanisms regarding the physiological responses to and recovery from low-grade cognitive stress, differentiating them from episodic pain conditions such as migraine.     

Coping strategies in episodic and chronic tension-type headache

OBJECTIVE: To study the importance of coping with illness strategies in tension-type headache (TTH). BACKGROUND: The pathophysiology of TTH is complex, and coping with illness strategies might contribute to the transformation to a chronic form. METHODS: We examined 89 subjects (mean age, 45.6 +/- 14.8 years; range, 18 to 72 years) with episodic (n = 37) and chronic (n = 52) TTH. Patients were required to fill in a Freiburg Questionnaire of Coping with Illness (FQCI), a von Zerssen Depression Scale, quality-of-life questionnaires, and a headache home diary (over 4 weeks). In addition, pressure pain thresholds (temporal muscles) and total tenderness scores were obtained. RESULTS: Patients with chronic TTH exhibited poorer quality-of-life measures, slightly more depressive symptoms, and significantly stronger avoidance behavior and endurance strategies on FQCI scales F4 and F5 (P< .05). There was no difference between episodic and chronic TTH with respect to measures of muscle tenderness or pain thresholds. CONCLUSIONS: We conclude that disadvantageous coping with illness strategies might contribute to a transformation to chronic TTH.