Göbel H, Weigle L, Kropp P, Soyka D
Neurological Clinic, University of Kiel, Germany.
Cephalalgia. 1992 Jun;12(3):142-51. doi: 10.1046/j.1468-2982.1992.1203142.x.
We investigated whether experimentally determined, suprathreshold pain sensitivity of pericranial musculature in patients with tension-type headache differs from that of migraine patients or from that of healthy subjects. Furthermore, we looked to see whether differences could be found in the effects of experimental pain induction on EMG activity of pericranial musculature and whether subgroups could be discovered with higher and lower pericranial pain sensitivity within the three diagnostic groups in terms of neurophysiological, psychological and clinical variables. In 20 patients with tension-type headache, 23 patients with migraine without aura, and 29 healthy individuals experimental pain was induced in the temporal muscle by mechanical pressure; pain sensitivity in the entire metrically subdivided suprathreshold pain sensitivity range was measured. Surface EMG activity of pericranial muscles was determined before, during and after experimental pain induction. In addition, headache characteristics as well as personality and mood states were determined and recorded in a standardized fashion. There were no significant differences in pain sensitivity of pericranial musculature between the three groups. Patients with tension-type headache showed significantly higher EMG scores during suprathreshold pain stimulation than did migraine patients. EMG scores of healthy subjects fell between these two groups. With respect to pericranial tenderness significant differences in clinical, neurophysiological and psychological variables were found only between subgroups within the group of patients with tension-type headache. The results indicate that significant differences in the examined groups are found not in pain perception but in the processing or reaction to experimental headache stimuli. In patients with tension-type headache subgroups evolve based on pericranial pain sensitivity with quantitatively and/or qualitatively impaired reactions; for this reason diagnostic grouping according to the IHS classification seems to be pathophysiologically relevant. The intraindividual phasic comparison of pain reactions appears to be more important than the absolute interindividual tonic comparison.
我们研究了紧张型头痛患者经实验测定的颅周肌肉超阈值疼痛敏感性是否不同于偏头痛患者或健康受试者。此外，我们还观察了实验性疼痛诱发对颅周肌肉肌电图活动的影响是否存在差异，以及在神经生理、心理和临床变量方面，能否在这三个诊断组中发现颅周疼痛敏感性较高和较低的亚组。对20例紧张型头痛患者、23例无先兆偏头痛患者和29名健康个体，通过机械压力在颞肌诱发实验性疼痛；测量整个超阈值疼痛敏感性范围内的疼痛敏感性。在实验性疼痛诱发前、诱发期间和诱发后，测定颅周肌肉的表面肌电图活动。此外，以标准化方式确定并记录头痛特征以及个性和情绪状态。三组之间颅周肌肉的疼痛敏感性无显著差异。在超阈值疼痛刺激期间，紧张型头痛患者的肌电图评分显著高于偏头痛患者。健康受试者的肌电图评分介于这两组之间。关于颅周压痛，仅在紧张型头痛患者组内的亚组之间发现临床、神经生理和心理变量存在显著差异。结果表明，在所检查的组中，显著差异并非存在于疼痛感知，而是存在于对实验性头痛刺激的处理或反应中。在紧张型头痛患者中，基于颅周疼痛敏感性会形成亚组，其反应在数量和/或质量上受损；因此，根据国际头痛协会（IHS）分类进行的诊断分组似乎具有病理生理学相关性。疼痛反应的个体内阶段性比较似乎比个体间绝对的紧张性比较更为重要。
