Mongini Franco, Deregibus Andrea, Raviola Fabio, Mongini Tullia
Headache and Facial Pain Unit, Department of Clinical Pathophysiology, University of Turin, Italy.
Headache. 2003 Sep;43(8):867-77. doi: 10.1046/j.1526-4610.2003.03165.x.
To investigate if the McGill Pain Questionnaire confirms the distinction between chronic migraine and chronic tension-type headache.
It has been suggested that different categories of chronic daily headache should be distinguished; in particular, chronic migraine and chronic tension-type headache.
The McGill Pain Questionnaire and a visual analog scale were administered to 40 patients with chronic daily headache, 85 patients with migraine, and 47 patients with episodic tension-type headache. The patients with chronic daily headache were subdivided, according to criteria described by other authors, into those with chronic migraine (n=29) and those with chronic tension-type headache (n=11). Weighted McGill Pain Questionnaire item scores, subscales, total pain rating indexes, and choice frequency of the descriptors were calculated. The data of chronic migraine and chronic tension-type headache were compared and tested for significant differences (Student t test). The same was done for migraine and episodic tension-type headache. Data were also processed through the Self-organizing Map, a system based on a counter-propagation neural network.
In the chronic migraine group, compared with the chronic tension-type headache group, scores were higher in 17 of 20 McGill Pain Questionnaire items (significantly in 5) and for the sensory and affective subscales (significantly). In the migraine group, compared with the episodic tension-type headache group, scores were higher for 18 McGill Pain Questionnaire items (significantly in 7), and for the sensory, affective, and mixed affective-evaluative subscales, total pain-rating index, and visual analog scale (all significantly). The coincidence of descriptors of first choice was low between chronic migraine and chronic tension-type headache, but it was high between chronic migraine and migraine and between chronic tension-type headache and episodic tension-type headache. After Self-organizing Map analysis, chronic migraine and chronic tension-type headache were prevalently distributed in 2 different areas of the map.
In the disorders characterized by a daily and near-daily headache, the McGill Pain Questionnaire consistently can discriminate between those evolving from migraine and those evolving from tension-type headache, indirectly confirming the validity of a distinction between these 2 clinical conditions. The differences are similar to those observed between patients with migraine and patients with episodic tension-type headache. This seems to be independent of the pain level since the difference of the total pain-rating index and the visual analog scale between chronic migraine and chronic tension-type headache was not statistically significant.
探讨麦吉尔疼痛问卷是否能证实慢性偏头痛与慢性紧张型头痛之间的区别。
有人提出应区分不同类型的慢性每日头痛；尤其是慢性偏头痛和慢性紧张型头痛。
对40例慢性每日头痛患者、85例偏头痛患者和47例发作性紧张型头痛患者进行麦吉尔疼痛问卷和视觉模拟评分。根据其他作者描述的标准，将慢性每日头痛患者分为慢性偏头痛患者（n = 29）和慢性紧张型头痛患者（n = 11）。计算麦吉尔疼痛问卷项目的加权得分、分量表、总疼痛评分指数以及描述词的选择频率。比较慢性偏头痛和慢性紧张型头痛的数据并检验是否存在显著差异（学生t检验）。对偏头痛和发作性紧张型头痛也进行同样的操作。数据还通过自组织映射进行处理，自组织映射是一种基于反向传播神经网络的系统。
在慢性偏头痛组中，与慢性紧张型头痛组相比，麦吉尔疼痛问卷20个项目中的17个项目得分更高（5个项目显著更高），感觉和情感分量表得分也更高（显著更高）。在偏头痛组中，与发作性紧张型头痛组相比，麦吉尔疼痛问卷18个项目得分更高（7个项目显著更高），感觉、情感以及情感 - 评价混合分量表、总疼痛评分指数和视觉模拟评分得分均更高（均显著更高）。慢性偏头痛和慢性紧张型头痛之间首选描述词的一致性较低，但慢性偏头痛与偏头痛之间以及慢性紧张型头痛与发作性紧张型头痛之间的一致性较高。经过自组织映射分析后，慢性偏头痛和慢性紧张型头痛主要分布在映射图的2个不同区域。
在以每日或近乎每日头痛为特征的疾病中，麦吉尔疼痛问卷始终能够区分由偏头痛演变而来的头痛和由紧张型头痛演变而来的头痛，间接证实了这两种临床情况区分的有效性。这些差异与偏头痛患者和发作性紧张型头痛患者之间观察到的差异相似。这似乎与疼痛程度无关，因为慢性偏头痛和慢性紧张型头痛之间的总疼痛评分指数和视觉模拟评分差异无统计学意义。
