偏头痛和紧张型头痛患者的应激性疼痛及肌肉活动

Stress-induced pain and muscle activity in patients with migraine and tension-type headache.

作者信息

Leistad R B, Sand T, Westgaard R H, Nilsen K B, Stovner L J

机构信息

Department of Neuroscience, Norwegian University of Technology and Science and Department of Neurology and Clinical Neurophysiology, St Olavs Hospital, Trondheim, Norway.

出版信息

Cephalalgia. 2006 Jan;26(1):64-73. doi: 10.1111/j.1468-2982.2005.00997.x.

Abstract

We recorded deep pain and surface electromyographic (EMG) responses to stress in 22 migraineurs during headache-free periods, 18 patients with tension-type headache (TTH), and 44 healthy controls. Sixty minutes of cognitive stress was followed by 30 min relaxation. EMG and pain (visual analogue scale) in the trapezius, neck (splenius), temporalis and frontalis areas were recorded. TTH patients had higher pain responses in temporalis and frontalis (with similar trends for trapezius and splenius) and more potentiation of pain during the test than controls. Migraine patients developed more pain in the splenius and temporalis than controls. Muscle pain responses were more regional (more pain in the neck and trapezius compared with the temporalis and frontalis) in migraine than in TTH patients. TTH patients had delayed pain recovery in all muscle regions compared with controls, while migraine patients had delayed pain recovery in a more restricted area (trapezius and temporalis). EMG responses were not different from controls in headache patients, and EMG responses did not correlate with pain responses. TTH patients had delayed EMG recovery in the trapezius compared with controls and migraine patients. These results support the concept that (probably central) sensitization of pain pathways and the motor system is important in TTH. Less pronounced and more regional (either peripheral or central) trigeminocervical sensitization seems to be important in migraine. Surface-detectable muscular activation does not seem to be causal for pain during cognitive stress either in migraine or in TTH.

摘要

我们记录了22名偏头痛患者在无头痛期、18名紧张型头痛(TTH)患者以及44名健康对照者对压力的深部疼痛和表面肌电图(EMG)反应。先进行60分钟的认知应激,随后是30分钟的放松。记录斜方肌、颈部(夹肌)、颞肌和额肌区域的肌电图和疼痛(视觉模拟量表)。TTH患者颞肌和额肌的疼痛反应更高(斜方肌和夹肌有类似趋势),且测试期间疼痛增强程度高于对照组。偏头痛患者夹肌和颞肌的疼痛比对照组更严重。与TTH患者相比,偏头痛患者的肌肉疼痛反应更具区域性(颈部和斜方肌疼痛比颞肌和额肌更明显)。与对照组相比,TTH患者所有肌肉区域的疼痛恢复延迟,而偏头痛患者疼痛恢复延迟的区域更局限(斜方肌和颞肌)。头痛患者的肌电图反应与对照组无差异,且肌电图反应与疼痛反应不相关。与对照组和偏头痛患者相比,TTH患者斜方肌的肌电图恢复延迟。这些结果支持这样一种观点,即疼痛通路和运动系统的(可能是中枢性的)敏化在TTH中很重要。不太明显且更具区域性(外周或中枢性)的三叉神经颈敏化在偏头痛中似乎很重要。在偏头痛或TTH中,表面可检测到的肌肉激活似乎都不是认知应激期间疼痛的原因。

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