Bendtsen Lars, Jensen Rigmor
Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.
Curr Opin Neurol. 2006 Jun;19(3):305-9. doi: 10.1097/01.wco.0000227043.00824.a9.
Tension-type headache is the most common type of headache and, in its chronic form, one of the most neglected and difficult types of headache to treat. Recently published data will be reviewed.
The prevalence of frequent tension-type headache increased significantly from 1989 to 2001, and several risk factors have been identified. The incidence decreases markedly with age. The prognosis is fairly favorable for the episodic forms. Chronic tension-type headache, coexisting migraine, sleep problems and not being married were identified as risk factors for a poor outcome. Previous reports of sensitization of the central nervous system in patients with chronic tension-type headache were confirmed by the findings of generalized pain hypersensitivity both in skin and in muscles, and of a decrease in the volume of gray matter in brain structures. A promising new animal model of tension-type headache has been developed. In addition, the efficacy of a prophylactic drug, mirtazapine, with fewer side-effects than the tricyclic antidepressants has been demonstrated.
The new data on the prevalence, incidence and prognosis of tension-type headache are valuable for health care planning and in daily clinical practice. The increased knowledge with regard to abnormal central pain modulation, together with the development of an animal model, hold promise for much-needed improvements in the understanding of pathophysiological mechanisms and treatment.
紧张型头痛是最常见的头痛类型，其慢性形式是最易被忽视且最难治疗的头痛类型之一。本文将对近期发表的数据进行综述。
1989年至2001年间，频发紧张型头痛的患病率显著上升，且已确定了多种风险因素。发病率随年龄增长显著下降。发作性紧张型头痛的预后相当良好。慢性紧张型头痛、合并偏头痛、睡眠问题及未婚被确定为预后不良的风险因素。既往关于慢性紧张型头痛患者中枢神经系统致敏的报道，经皮肤和肌肉的广泛性疼痛超敏反应以及脑结构灰质体积减少的研究结果得以证实。一种有前景的紧张型头痛新动物模型已被开发出来。此外，已证实一种预防性药物米氮平的疗效，其副作用比三环类抗抑郁药更少。
紧张型头痛患病率、发病率及预后的新数据，对医疗保健规划和日常临床实践具有重要价值。对中枢性疼痛调节异常的深入了解，以及动物模型的开发，有望在病理生理机制理解和治疗方面带来亟需的进展。
