Fumal Arnaud, Schoenen Jean
Department of Neurology, Headache Research Unit, Liège University, Liège, Belgium.
Lancet Neurol. 2008 Jan;7(1):70-83. doi: 10.1016/S1474-4422(07)70325-3.
Tension-type headache (TTH) is the most common form of headache, and chronic tension-type headache (CTTH) is one of the most neglected and difficult types of headache to treat. The pathogenesis of TTH is multifactorial and varies between forms and individuals. Peripheral mechanisms (myofascial nociception) and central mechanisms (sensitisation and inadequate endogenous pain control) are intermingled: the former predominate in infrequent and frequent TTH, whereas the latter predominate in CTTH. Acute therapy is effective for episodes of TTH, whereas preventive treatment--which is indicated for frequent and chronic TTH--is, on average, not effective. For most patients with CTTH, the combination of drug therapies and non-drug therapies (such as relaxation and stress management techniques or physical therapies) is recommended. There is clearly an urgent need to improve the management of patients who are disabled by headache. This Review summarises the present knowledge on TTH and discusses some of its more problematic features.
紧张型头痛（TTH）是最常见的头痛类型，而慢性紧张型头痛（CTTH）是最易被忽视且最难治疗的头痛类型之一。TTH的发病机制是多因素的，在不同类型和个体之间存在差异。外周机制（肌筋膜伤害感受）和中枢机制（敏化和内源性疼痛控制不足）相互交织：前者在偶发性和频发TTH中占主导，而后者在CTTH中占主导。急性治疗对TTH发作有效，而预防性治疗（适用于频发和慢性TTH）平均而言效果不佳。对于大多数CTTH患者，建议联合药物治疗和非药物治疗（如放松和压力管理技术或物理治疗）。显然，迫切需要改善因头痛而致残的患者的管理。本综述总结了目前关于TTH的知识，并讨论了其一些更具问题的特征。
