慢性紧张型头痛患者的心理与药物联合治疗模式

目的：探讨针对患者的心理挫折原因制订的心理治疗措施，配合适量的药物和其他方法对慢性紧张型头痛的作用。方法：按国际头痛学会诊断标准，多中心选取符合要求的慢性紧张型头痛患者77例，随机数字法分为单纯药物治疗组(39例)和心理联合治疗组(38例)。单纯药物治疗组口服通天口服液1个月，心理联合治疗组在口服通天口服液1个月的同时配合心理治疗，2次／周，共3个月。试验后2个月内动态观察患者头痛程度、发作频率、持续时间的变化。结果：治疗1个月单纯药物治疗组和心理联合治疗组临床总有效率分别为90％(35／39)和85％(33／38)，2组间临床疗效比较差异无显著性意义(X^2=0．11，P&;gt;0．05)。随访2个月2组间临床疗效差异有显著性意义(x^2=3．99，P&;lt;0．05)。单纯药物治疗组起效时间为6～30[中位数(M)=13]d，心理联合治疗组起效时间为5～30(M=12)d。2组起效时间差异无显著性意义(X^2=0．39，P=0．741)。停药后2个月内，单纯药物治疗组疗效维持时间为38～86(M=76)d，心理联合治疗组为73～88(M=81)d，2组疗效维持时间比较差异有显著性意义(X^2=3．89，P=0．045)。结论：药物联合心理综合治疗模式可以增加慢性紧张型头痛的疗效，延长疗效维持的时间。     

紧张型头痛药物催眠暗示心理疗法的研究

紧张型头痛病人多有恐惧、焦虑及饮食睡眠改变等心理障碍 ,对病人头痛可产生不良影响 ,甚至于成为主要原因。而采用心理疗法治疗该病的报道甚少。本研究旨在了解应用镇静、催眠暗示心理疗法对病人头痛及一般心理状态影响 ,并用疾病症状自评量表 (Symptom Check List 90 ) ,简称SCL 90进行评价 ,为临床推广应用心理疗法提供参考。资料和方法1.一般资料 :按照国际头痛分类及诊断标准确诊的 18例紧张型头痛发作期病人 ,男性 5例 ,女性 13例。年龄 2 8～4 3岁 ,平均年龄 33.4± 7.2岁。2 .试验方法 :(1)来诊病人治疗前均采用SCL 90量表进行…     

心理干预对慢性紧张型头痛患者疗效的影响

慢性紧张型头痛是神经内科较为常见的疾病,发病机理尚不完全清楚, 除了与颅周肌肉的损害有关外[1], 也与精神因素有关,是以头颈部为中心的肌肉持续收缩而引起的头痛[2], 常表现为慢性头部紧束样或压迫性疼痛,通常为双侧疼痛,每月头痛超过15 d, 多数患者伴有抑郁和焦虑等不良情绪状态[3-4], 如果得不到及时治疗,将会影响患者的工作效率和生活质量.本文报告对82例患者在药物治疗的同时给予心理干预,取得良好效果.     

五种天麻类中成药治疗发作性紧张型头痛的比较

目的 :对比观察五种天麻类中成药治疗发作性紧张型头痛的临床疗效。方法 :按国际头痛学会诊断标准选取符合要求的发作性紧张型头痛病人 2 87例 ,随机分为 6组 ,5组口服天麻制剂的各组分别口服全天麻胶囊、天麻头风灵、天麻首乌片、天麻杜仲胶囊、天麻丸 2个月。对照组口服脑立清丸 2个月。动态观察病人头痛程度、发作频率、持续时间的变化。结果 :试验结束时 ,对照组 39例 ,有效 18例 ,有效率为 4 6 .2 %。 2 2 5例口服天麻类中成药病人临床总有效率为 81.8% ,无效 4 1例 ,无不良反应发生。五种天麻类药物对发作性紧张型头痛病情的影响显著优于对照组。结论 :天麻类制剂治疗发作性紧张型头痛安全、有效 ,疗效优于对照组。五种天麻制剂之间疗效存在一定的差异。     

头痛的心理康复与药物治疗的疗效比较

目的：比较头痛的心理康复与药物治疗的疗效。方法：对120例头痛患者实施心理康复治疗61例(心理组)和药物治疗59例(药物组)．比较2组疗效。结果：心理组治愈率86．3％，SCL-90自评量表中抑郁、焦虑、敌对与治疗前比较差异有显著性；药物组治愈率5．1％．SCL-90中的9个因子与治疗前比较差异无显著性。结论：心理康复治疗头痛其疗效明显优于药物治疗。     

心理干预对紧张型头痛患者心身症状及就医行为的影响

目的：探讨心理干预对紧张型头痛住院军人心身症状及就医行为的影响。方法：将2000-07／2003-07解放军第四六四医院诊断为紧张性头痛的109例住院军人随机分为两组，对照组55例给予常规单纯药物治疗，研究组54例与对照组予同样药物治疗外，还宵针对性地进行认知、行为等心理干预治疗、在治疗前后分别用症状自评量表评定患者的情绪变化程度．并比较两组的平均住院时间。出院1年后随访，比较出院后的就医行为及疾病归因方式。结果：109例均参加了治疗前后症状自评量表评定，1年后随访．研究组脱失12例，对照组脱失9例。①治疗后研究组在躯体化(1．39&;#177;0．56)、人际敏感(1．37&;#177;0．39)、抑郁(1．36&;#177;0．42)，焦虑(1．23&;#177;0．36)、恐怖(1．43&;#177;0．29)、偏执(1．31&;#177;0．65)、精神病性(1.14&;#177;0．54)及其他因子分(1.21&;#177;0．30)均低于对照组(P&;lt;0.05)，只有强迫及敌对两项因子分两组比较，差异无显著性意义(P&;lt;0．05）。②研究组42例平均住院时间为(21．54&;#177;4．31)d，对照组为(32.67&;#177;5.72)d，前者明显低于后者(P&;lt;0.01)、③1年后随访发现，研究组42例因头痛而经常服药的5人、因头痛而门诊就诊的5人次、因头痛而再次住院的3人次、对头痛进行躯体归因的9人，而对照组46例上述指标分别为14人、14人次、11人次、21人(P&;lt;0．05)；在对头痛的心理归因人数上．研究组为23人，对照组为11人，两组比较，差异有显著性意义(P&;lt;0．01）。结论：心理干预能改善紧张性头痛患者的焦虑、紧张情绪及心身症状，减少住院天数。1年后随访，研究组复诊、复治人数下降．对头痛症状的心理归因人数增加，躯体归因人数减少。     

药物治疗与心理护理

随着医学模式的转变,促进了现代护理学的发展,护理模式正由传统的功能护理向以心身整体护理为中心的责任制护理转变。责任制护理是一种新的临床护理制度,是以病人为中心,运用护理程序对病人实施系     

帕罗西汀联合白脉软膏治疗慢性紧张型头痛的临床疗效

目的:观察帕罗西汀联合白脉软膏治疗慢性紧张型头痛(CTH)的临床疗效。方法:CTH患者60例,随机分为给予帕罗西汀联合安慰剂软膏治疗的对照组和给予帕罗西汀联合白脉软膏治疗的观察组各30例,疗程8周。比较治疗前后患者外感受抑制实验(ESP)的第二潜伏期(ESP2)、时限及肌电频率、波幅变化,评价头痛程度、焦虑抑郁情绪及生活质量。结果:治疗后2组EPS2潜伏期明显缩短,时限明显延长(P<0.05),观察组较对照组更明显(P<0.05)。对照组肌电频率和波幅改变不明显(P>0.05),观察组肌电频率和波幅明显降低(P<0.05)。2组头痛程度、焦虑抑郁情绪评分明显低于治疗前,生活质量评分明显高于治疗前(P<0.05),观察组较对照组更明显(P<0.05)。结论:帕罗西汀联合白脉软膏治疗CTH疗效优于单用帕罗西汀。     

针刺治疗发作性紧张型头痛的效果评估

目的 对比观察针刺及天麻头风灵治疗发作性紧张型头痛的临床疗效。方法①选择2003-02／2004-12福建省漳平市医院针灸科及龙岩市中医院针灸科门诊就诊发作性紧张型头痛患者175例。均同意合作。②随机将患者分为2组：针刺组89例，中药组86例。针刺组：取穴，以“醒脑开窍”法系列中项六针（风池、完骨、天柱）、印堂、上星、百会及四神聪组为主穴。诸穴常规消毒后，风池穴刺向对侧内眼角，用捻转提插泻法，以针感向同侧后头角（顶骨结节）放射为度，余穴用雀啄法，针感要求有窜、动、抽为度。1次／d，12d为1个疗程，休息3d，继续下1个疗程，共治疗2个疗程。对照组：口服天麻头风灵胶囊，4粒／次，2次／d。12d为：1疗程；休息3d，继续下1个疗程。③分别于治疗前和治疗1个月后观察头痛频率，头痛程度（按口述描绘4级评分法，1分为无痛，4分为严重痛）及头痛持续时间。并评估治疗效果。结果因为服药疗效差而自行停药3例，纳人结果分析172例。④针刺组治疗总有效率明显高于中药组（r=2．141，P〈0．05）。两组治疗前头痛频率、头痛时间、头痛程度评分比较，差异不明显（P〉0．05）。治疗1个月后，针刺组头痛发作频率、头痛持续时间、头痛程度评分均明显低于或短于对照组（t=2．143，2．211,2．383，〈0．05）。②未发现针刺及药物不良反应。结论针刺治疗发作性紧张型头痛疗效优于中药治疗，有安全性及可重复性。     

心理干预对紧张型头痛患者心身症状及就医行为的影响

目的:探讨心理干预对紧张型头痛住院军人心身症状及就医行为的影响.方法:将2000-07/2003-07解放军第四六四医院诊断为紧张性头痛的109例住院军人随机分为两组,对照组55例给予常规单纯药物治疗,研究组54例与对照组予同样药物治疗外,还有针对性地进行认知、行为等心理干预治疗.在治疗前后分别用症状自评量表评定患者的情绪变化程度,并比较两组的平均住院时间.出院1年后随访,比较出院后的就医行为及疾病归因方式.结果:109例均参加了治疗前后症状自评量表评定,1年后随访,研究组脱失12例,对照组脱失9例.①治疗后研究组在躯体化(1.39±0.56)、人际敏感(1.37±0.39)、抑郁(1.36±0.42)、焦虑(1.23±0.36)、恐怖(1.43±0.29)、偏执(1.31±0.65)、精神病性(1.14±0.54)及其他因子分(1.21±0.30)均低于对照组(P＜0.05),只有强迫及敌对两项因子分两组比较,差异无显著性意义(P＜0.05).②研究组42例平均住院时间为(21.54±4.31)d,对照组为(32.67±5.72)d,前者明显低于后者(P＜0.01).③1年后随访发现,研究组42例因头痛而经常服药的5人、因头痛而门诊就诊的5人次、因头痛而再次住院的3人次、对头痛进行躯体归因的9人,而对照组46例上述指标分别为14人、14人次、11人次、21人(P＜0.05);在对头痛的心理归因人数上,研究组为23人,对照组为11人,两组比较,差异有显著性意义(P＜0 01).结论:心理干预能改善紧张性头痛患者的焦虑、紧张情绪及心身症状,减少住院天数.1年后随访,研究组复诊、复治人数下降,对头痛症状的心理归因人数增加,躯体归因人数减少.     

Blindness and bias in a trial of antidepressant medication for chronic tension-type headache

This study aimed to examine penetration of the blind in a randomized, placebo-controlled trial. Neurologists' ratings of improvement and medication side-effects, participants' ratings of improvement and daily diary recordings of headaches were assessed along with participants' and neurologists' guesses about treatment group placement in participants who completed at least 3 months of treatment (N = 169). Despite blinding, treating neurologists successfully identified the medication condition for 82% of participants receiving medication only; trial participants accurately identified their medication condition when receiving active medication (77% of participants), but not when receiving placebo. Concurrent stress-management therapy reduced, but did not eliminate penetration of the blind. Irrespective of drug condition, when participants were improved they were judged to be on active medication and when unimproved they were judged to be on placebo. However, neurologists' ratings of improvement, participants' reports of improvement and daily headache recordings yielded equivalent outcomes. Penetration of the blind needs to be assessed, not assumed in clinical trials in headache. However, penetration of the blind did not produce a prodrug bias as has been asserted by critics. Better methods of assessing and quantifying blindness are needed.     

丹珍头痛胶囊治疗慢性紧张性头痛疗效观察

目的观察丹珍头痛胶囊治疗慢性紧张性头痛的疗效。方法将门诊就诊的138例慢性紧张性头痛患者按随机数字表法分为对照组和试验组,对照组给予文拉法辛缓释胶囊,试验组在对照组治疗的基础上加用丹珍头痛胶囊治疗并观察4周。评估两组患者临床疗效,使用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评估抑郁、焦虑情况。结果试验组总有效率为90.67%,对照组总有效率为76.19%,两组相比,差异有统计学意义(P<0.05)。试验组治疗后2周、4周HAMA评分、HAMD评分均较治疗前降低。与对照组比较,在各个时间点HAMA评分、HAMD评分均明显降低,差异有统计学意义(P<0.05)。结论丹珍头痛胶囊可明显改善慢性紧张性头痛患者的头痛程度及焦虑、抑郁障碍。     

Familial occurrence of chronic tension-type headache

Chronic tension-type headache (CTTH) assessed by proband report was evaluated in a family study of CTTH. A clinical interview of first-degree relatives by a physician was used as index of validity. Familial occurrence of CTTH in first-degree relatives was also investigated. Patterns of familial aggregation of CTTH were assessed by calculating the population relative risk. A neurological resident carried out all the interviews of probands and their first-degree relatives. The operational diagnostic criteria of the International Headache Society were used. The 122 probands had 377 first-degree relatives. Sensitivity, specificity, predictive values, and chance-corrected agreement rate for the diagnosis CTTH were 68%, 86%, 53% (PVpos), 92% (PVneg), and 0.48, respectively. The low sensitivity of CTTH assessed by proband report indicates that a clinical interview by a physician is necessary in family studies of CTTH. Clinically interviewed parents, siblings, and children had a 2.1 to 3.9-fold significantly increased risk of CTTH compared with the general population. The gender of the probands did not influence the risk of CTTH among first-degree relatives. The significantly increased familial risk of CTTH and no increased risk of CTTH in spouses suggest that a genetic factor is involved in CTTH.     

Serotonin metabolism in chronic tension-type headache

Serotonergic neurons play a major role in the regulation of pain and may therefore also be involved in the pathophysiology of tension-type headache. Platelets are important in the regulation of the free serotonin level in plasma and may be a model of serotonergic neurons. The aim of the present study was to investigate the peripheral serotonin (5HT) metabolism in patients with chronic tension-type headache. The 5HT levels in platelets and in plasma, the beta-thromboglobulin (ß-TG) levels in plasma, and the urinary excretion of 5-hydroxyindoleacetic acid (5HIAA) were measured in 40 patients with chronic tension-type headache and in 40 healthy controls. The platelet uptake index was calculated as the ratio between platelet 5HT and plasma 5HT levels. There were, no significant differences in platelet 5HT, plasma 5HT ß-TG, or 5HIAA between patients and controls. The platelet uptake index was significantly lower in patients 243 (136–367) than in controls 352 (202–508), p =0.03. Our results indicate that the peripheral 5HT metabolism is largely normal in patients with chronic tension-type headache.     

Interrelation of chronic tension-type headache with and without medication overuse and migraine in the general population: the Akershus study of chronic headache

We studied the interrelation of chronic tension-type headache with and without medication overuse (CTTH) and migraine in a random sample of 30 000 persons aged 30–44 years. They received a mailed questionnaire. Those with a possible chronic headache were interviewed by neurological residents. The International Classification of Headache Disorders was used. A total of 386 persons had CTTH. Compared with the general population, men had a 2.8-fold and women a 2.4-fold significantly increased risk of migraine without aura (MO). The risk of migraine with aura (MA) was not increased. The mean age at onset of CTTH was significantly higher in those with than in those without co-occurrence of MO. Bilateral MO attacks were significantly more frequent in those with age at onset of CTTH prior to age at onset of MO compared with those with age at onset in reverse order. CTTH and MO are interrelated, possibly in a complex matter. In contrast, CTTH and MA are not interrelated.     

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.     

Genetic factors in migraine and chronic tension-type headache

Pathophysiological studies have dominated migraine research for several years. However, these studies are difficult to interpret because it is difficult to decide whether the observed phenomena are primary or secondary to the migraine attack. For that reason it is important that future migraine research focus on studies that concern migrain etiology. Migraine is a paroxysmal disorder. It is most likely and ion-channel disorder like familial hemiplegic migraine. The present paper focuses on genetic factors in migraine and chronic tension-type headache.     

Psychiatric comorbidity in medication overuse headache patients with pre-existing headache type of episodic tension-type headache.

BACKGROUND: Medication overuse headache (MOH) mostly evolves from migraine and episodic tension-type headache (ETTH). Chronic tension-type headache (CTTH) is another headache type that evolves over time from ETTH. It is well known that psychiatric comorbidity is high in MOH patients. AIM: To investigate the frequency of psychiatric comorbidity, and the intensity of depression and anxiety in MOH patients evolving from ETTH and to compare results with CTTH patients and MOH patients evolving from migraine. METHODS: Twenty-eight CTTH (Group C) and 89 MOH patients were included into the study. MOH patients were divided into two groups according to their pre-existing headache types: MOH patients with pre-existing ETTH (Group E, n = 31), and with pre-existing migraine (Group M, n = 58). All patients were interviewed with a psychiatrist and SCID-CV and SCID-II were applied. Beck Anxiety Inventory and Beck Depression Inventory scales were also performed. RESULTS: Eleven patients (39.3%) in Group C, 21 patients (67.7%) in Group E, and 31 patients (53.7%) in Group M were diagnosed to have comorbid psychiatric disorders. The psychiatric comorbidity was found significantly higher in Group E than Group C. In Group E, mood disorders were found significantly higher, but the difference between the two groups with regard to anxiety disorders was insignificant. Mean depression scores were significantly higher in Group E than Group C. The mostly diagnosed type was obsessive-compulsive personality disorder in all the three groups, and was statistically significant in Group M than Group C. CONCLUSION: Psychiatric comorbidity in MOH patients with pre-existing ETTH is common as in those with pre-existing migraine headache and MOH with regard to developing psychiatric disorders should be interpreted as a risk factor in chronic daily headache patients.