Kaniecki Robert G
University of Pittsburgh Headache Center, Pittsburgh, PA, USA.
Continuum (Minneap Minn). 2012 Aug;18(4):823-34. doi: 10.1212/01.CON.0000418645.32032.32.
This article provides an update on the appropriate diagnosis and evaluation of patients with tension-type headache, with reviews of the latest concepts regarding pathogenesis and the evidence-based recommendations for management of this disorder.
Pericranial myofascial mechanisms are probably of importance in episodic tension-type headache, whereas sensitization of central nociceptive pathways and inadequate endogenous antinociceptive circuitry seem to be more relevant in chronic tension-type headache. While acute treatment with simple analgesics is generally helpful, recent data attempting to document the efficacy of preventive therapies are unconvincing.
Tension-type headache is the most common form of headache in the general population. It is characterized by recurrent episodes of headache that are relatively featureless and mild to moderate in intensity. The diagnosis is based solely on the history and examination. Exclusion of secondary headaches or forms of migraine is important in the assessment process. Despite extensive investigation, the underlying pathophysiology remains a matter of speculation, with peripheral muscular and CNS components both likely involved. Acute management with simple analgesics, nonsteroidal anti-inflammatory drugs, and caffeine-containing compounds is typically effective. Preventive therapies include a number of nonpharmacologic recommendations as well as several antidepressant drugs. Prognosis is generally favorable.
本文提供了关于紧张型头痛患者恰当诊断和评估的最新信息，回顾了有关发病机制的最新概念以及该疾病管理的循证建议。
颅周肌筋膜机制在发作性紧张型头痛中可能很重要，而中枢伤害感受通路的敏化和内源性抗伤害感受回路不足在慢性紧张型头痛中似乎更为相关。虽然使用简单镇痛药进行急性治疗通常有帮助，但近期试图证明预防性治疗疗效的数据并不令人信服。
紧张型头痛是普通人群中最常见的头痛形式。其特征为头痛反复发作，相对无特异性，强度为轻至中度。诊断仅基于病史和体格检查。在评估过程中，排除继发性头痛或偏头痛形式很重要。尽管进行了广泛研究，但其潜在病理生理学仍存在推测，外周肌肉和中枢神经系统成分可能均有涉及。使用简单镇痛药、非甾体抗炎药和含咖啡因化合物进行急性治疗通常有效。预防性治疗包括一些非药物建议以及几种抗抑郁药物。总体预后良好。
