Schulman E A
Neurological Associates of Delaware Valley, Ambulatory Care Pavilion, Suite 533, One Medical Center Boulevard, Upland, PA 19013, USA.
Curr Pain Headache Rep. 2001 Oct;5(5):454-62. doi: 10.1007/s11916-001-0057-3.
Tension-type headache (TTH) is the most prevalent form of headache. Although it is not the most severe form of headache, it has a significant impact on society. In spite of this, little is known about its pathophysiology. Current International Headache Society classification has been called into question, and new classification approaches have been suggested. With reference to chronic TTH, the issue of analgesic rebound may confound the diagnosis. Transformed migraine and new persistent daily headaches are clarified and differentiated from chronic TTHs (CTTHs). The best documented abnormality found in TTHs is the presence of pericranial tenderness. It is generally believed that pain is initiated by a peripheral mechanism, most likely increased input from the myofascial nociceptors. In CTTH, there may be an impaired supraspinal modulation of the incoming stimuli. Whether there is an overlap in the continuum between TTH and migraine is controversial. Abortive and prophylactic treatments are discussed and wellness and adjunct therapy are also emphasized. Lastly, special attention is paid to the doctor-patient relationship in patients with difficult headaches.
紧张型头痛（TTH）是最常见的头痛类型。尽管它并非最严重的头痛形式，但对社会有重大影响。尽管如此，人们对其病理生理学知之甚少。当前国际头痛协会的分类受到质疑，新的分类方法已被提出。关于慢性紧张型头痛，止痛药物反跳问题可能会混淆诊断。转化型偏头痛和新的持续性每日头痛已与慢性紧张型头痛（CTTH）区分开来。紧张型头痛中记录最充分的异常是颅周压痛的存在。一般认为疼痛由外周机制引发，最有可能是肌筋膜伤害感受器的输入增加。在慢性紧张型头痛中，对传入刺激的脊髓上调制可能受损。紧张型头痛和偏头痛之间的连续体是否存在重叠存在争议。讨论了发作期和预防性治疗，同时也强调了健康和辅助治疗。最后，对于难治性头痛患者的医患关系给予了特别关注。
