Rollnik J D, Karst M, Fink M, Dengler R
Department of Neurology, Medical School of Hannover, Germany.
Headache. 2001 Nov-Dec;41(10):985-9. doi: 10.1046/j.1526-4610.2001.01193.x.
The pathogenesis of chronic tension-type headache remains unclear, and the role of muscle tension is especially controversial. Botulinum toxin type A, a potent inhibitor of muscle tone, has been used to treat chronic tension-type headache.
To determine whether clinical response to treatment of chronic tension-type headache with Botox A parallels changes in resting muscle activity recorded through serial electromyography (EMG).
We randomly assigned eight patients with chronic tension-type headache to pericranial injection of 500 MU Botox A versus placebo (isotonic saline).
At 6 and 12 weeks following treatment, there were no significant differences in clinical outcome between the placebo and the Botox A groups. This occurred despite EMG evidence of a reduction in resting muscle activity in the Botox A-treated patients.
These results support the hypothesis that peripheral mechanisms such as increased muscle tone play, at most, a minor role in the pathophysiology of chronic tension-type headache.
慢性紧张型头痛的发病机制尚不清楚，肌肉紧张的作用尤其具有争议性。A型肉毒毒素是一种有效的肌张力抑制剂，已被用于治疗慢性紧张型头痛。
确定使用A型肉毒毒素治疗慢性紧张型头痛的临床反应是否与通过连续肌电图（EMG）记录的静息肌肉活动变化平行。
我们将8例慢性紧张型头痛患者随机分为两组，一组接受500 MU A型肉毒毒素颅周注射，另一组接受安慰剂（等渗盐水）注射。
治疗后6周和12周，安慰剂组和A型肉毒毒素组的临床结局无显著差异。尽管有肌电图证据表明接受A型肉毒毒素治疗的患者静息肌肉活动减少，但仍出现了这种情况。
这些结果支持这样一种假设，即诸如肌张力增加等外周机制在慢性紧张型头痛的病理生理学中至多起次要作用。
