关于紧张型头痛患者情绪认知睡眠质量改变的研究

目的通过对紧张型头痛(tension-type headache,TTH)与情绪、睡眠质量之间关系的研究,探讨紧张型头痛的发病机制以指导紧张型头痛的诊治。方法共入选147例2013-07—2014-03就诊于潍坊市人民医院神经内二科门诊及病房诊断为紧张型头痛患者为TTH组,入选同期60例性别、年龄及受教育程度相匹配的健康体检者及病房健康陪护家属作为对照组。测评TTH组及对照组汉密顿焦虑量表、汉密顿抑郁量表、MoCA量表、匹茨堡睡眠质量指数量表得分。结果 TTH组患者汉密顿焦虑量表得分、汉密顿抑郁量表得分、匹茨堡睡眠质量指数量表得分明显高于健康对照组,差异有统计学意义(P0.05)。TTH组中MoCA量表得分明显低于健康对照组,差异有统计学意义(P0.05)。结论焦虑抑郁情绪及睡眠质量差是造成和加重紧张型头痛的重要危险因素。TTH可能对患者认知产生影响。     

Behavioral Treatments of Chronic Tension‐Type Headache in Adults: Are They Beneficial?

To assess the efficacy of behavioral treatments in patients with tension headache. Medline, Cinahl, EMBASE, and the Cochrane library were searched from inception to October 2007 and reference lists were checked. We selected randomized trials evaluating behavioral treatments (e.g., relaxation, electromyographic [EMG] biofeedback, and cognitive behavioral training) in patients with tension-type headache (TTH). We assessed the risk of bias using the Delphi list and extracted data from the original reports. A qualitative analysis was carried out. We found 44 trials (2618 patients), which were included in this review, of which only 5 studies (11.4%) were considered to have low risk of bias. Most trials lacked adequate power to show statistical significant differences, but frequently, recovery/improvement rates did not reach clinical relevance. In 8 studies, relaxation treatment was compared with waiting list conditions, and in 11 studies, biofeedback was compared with waiting list conditions, both showing inconsistent results. On the basis of the available literature, we found no indications that relaxation, EMG biofeedback, or cognitive behavioral treatment is better than no treatment, waiting list, or placebo controls.     

Towards a Functional Model of Chronic Headaches: Investigation of Antecedents and Consequences

SYNOPSIS
The traditional approach to classifying headache based on symptoms and assumed mechanisms is criticized as having limited utility when applied to tension-type headache and migraine. The study reported here was designed to explore an alternative method of conceptualizing chronic headaches based on functional characteristics or controlling variables. One hundred and ninety nine chronic headache sufferers completed questionnaires which enquired about the antecedents and consequences of their headaches. An attempt to build a categorical model driven by functional characteristics using cluster analysis was unsuccessful but a subsequent attempt to construct a dimensional model using factor analysis proved more successful. This approach led to the emergence of five antecedent dimensions and six consequences dimensions (three pertaining to the responses of sufferers and three to the reactions of significant others) which were readily identifiable. The functional dimensions were significantly related to traditional diagnostic categories but at a low level. Three functional dimensions predicted response to psychological treatment.     

帕罗西汀联合安定在预防紧张型头痛临床效果分析

目的探讨和分析神经内科门诊中帕罗西汀联合安定预防紧张型头痛的临床效果。方法随机性选取我院86例紧张型头痛患者分成联合组和对照组。联合组(46例)使用帕罗西汀(30 mg/d)联合安定进行抗焦虑治疗,对照组(40例)使用常规抗抑郁药联合安定治疗。分析对比两组对头痛的疗效和不良反应情况。结果联合组头痛疗效有效率为89.1%,头痛明显缓解,基本没有不良反应;与对照组治疗效果比较,差异均有统计学意义(P<0.05)。结论帕罗西汀联合安定预防和治疗紧张型头痛有显著的疗效,且不良反应少。     

Análisis de la efectividad de la técnica de punción seca en cefaleas: revisión sistemática

IntroductionNon-pharmacological treatment of patients with headache, such as dry needling (DN), is associated with less morbidity and mortality and lower costs than pharmacological treatment. Some of these techniques are useful in clinical practice. The aim of this study was to review the level of evidence for DN in patients with headache.MethodsWe performed a systematic review of randomised clinical trials on headache and DN on the PubMed, Web of Science, Scopus, and PEDro databases. Methodological quality was evaluated with the Spanish version of the PEDro scale by 2 independent reviewers.ResultsOf a total of 136 studies, we selected 8 randomised clinical trials published between 1994 and 2019, including a total of 577 patients. Two studies evaluated patients with cervicogenic headache, 2 evaluated patients with tension-type headache, one study assessed patients with migraine, and the remaining 3 evaluated patients with mixed-type headache (tension-type headache/migraine). Quality ratings ranged from low (3/10) to high (7/10). The effectiveness of DN was similar to that of the other interventions. DN was associated with significant improvements in functional and sensory outcomes.ConclusionsDry needling should be considered for the treatment of headache, and may be applied either alone or in combination with pharmacological treatments.     

Headache

Headache, an almost universal human experience, is one of the most common complaints encountered in medicine and neurology. Described and categorized since antiquity, with the first classification by Aretaeus of Cappadocia, other classifications followed. The evaluation of this condition may be straightforward or challenging, and, though often benign, headache may prove to be an ominous symptom. This review discusses the current diagnosis and classification of headache disorders and principles of management, with a focus on migraine, tension-type headache, trigeminal autonomic cephalgias, and various types of daily headache.     

紧张型头痛患者咀嚼肌外感受抑制实验研究

目的:探讨三叉神经颞肌、咬肌外感受抑制(ES)检测紧张型头痛(TTH)的应用价值。方法:对30名紧张型头痛患者及30名正常志愿者利用肌电图(EMG)刺激眶下神经进行ES试验,检测颞肌、咬肌ES的潜伏期和时限。结果:与正常对照相比,紧张型头痛患者的第二抑制期(ES2)潜伏期延长,时限缩短,出现率降低(P<0.05)。结论:外感受抑制检查对紧张型头痛具有一定的诊断和研究价值。     

Headache, anxiety and depressive disorders: the HADAS study

The objective of this paper was to assess prevalence and characteristics of anxiety and depression in migraine without aura and tension-type headache, either isolated or in combination. Although the association between headache and psychiatric disorders is undisputed, patients with migraine and/or tension-type headache have been frequently investigated in different settings and using different tests, which prevents meaningful comparisons. Psychiatric comorbidity was tested through structured interview and the MINI inventory in 158 adults with migraine without aura and in 216 persons with tension-type headache or migraine plus tension-type headache. 49 patients reported psychiatric disorders: migraine 10.9%, tension-type headache 12.8%, and migraine plus tension-type headache 21.4%. The MINI detected a depressive episode in 59.9, 67.0, and 69.6% of cases. Values were 18.4, 19.3, and 18.4% for anxiety, 12.7, 5.5, and 14.2%, for panic disorder and 2.3, 1.1 and 9.4% (p = 0.009) for obsessive–compulsive disorder. Multivariate analysis showed panic disorder prevailing in migraine compared with the other groups (OR 2.9; 95% CI 1.2–7.0). The association was higher (OR 6.3; 95% CI 1.4–28.5) when migraine (with or without tension-type headache) was compared to pure tension-type headache. This also applied to obsessive–compulsive disorder (OR 4.8; 95% CI 1.1–20.9) in migraine plus tension-type headache. Psychopathology of primary headache can reflect shared risk factors, pathophysiologic mechanisms, and disease burden.     

Needle acupuncture in tension-type headache: a randomized, placebo-controlled study

A study with needle acupuncture was performed in tension-type headache employing a new placebo acupuncture METHOD: Sixty-nine patients (mean age 48.1 years, SD = 14.1) fulfilling the International Headache Society criteria for tension-type headache were randomly assigned to verum or placebo condition. No significant differences between placebo and verum with respect to visual analogue scale and frequency of headache attacks could be observed immediately, 6 weeks and 5 months after the end of treatment. There was a significant but weak improvement in quality of life parameters (clinical global impressions, Nottingham Health Profile) after verum treatment. In decision tree analyses, the changes in clinical global impressions and headache frequency depended significantly on primary headache frequency with a limit value of 24.5 days headache per month. High values in the von Zerssen Depression Score resulted in high mean visual analogue scale values.