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紧张型头痛和颈源性头痛手法治疗管理的临床推理

Clinical reasoning for manual therapy management of tension type and cervicogenic headache.

作者信息

Fernández-de-Las-Peñas César, Courtney Carol A

机构信息

Department Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain ; Esthesiology Laboratory of Universidad Rey Juan Carlos, Madrid, Spain ; Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Madrid, Spain.

Department of Physical Therapy, University of Illinois at Chicago, USA.

出版信息

J Man Manip Ther. 2014 Feb;22(1):44-50. doi: 10.1179/2042618613Y.0000000050.

Abstract

In recent years, there has been an increasing knowledge in the pathogenesis and better management of chronic headaches. Current scientific evidence supports the role of manual therapies in the management of tension type and cervicogenic headache, but the results are still conflicting. These inconsistent results can be related to the fact that maybe not all manual therapies are appropriate for all types of headaches; or maybe not all patients with headache will benefit from manual therapies. There are preliminary data suggesting that patients with a lower degree of sensitization will benefit to a greater extent from manual therapies, although more studies are needed. In fact, there is evidence demonstrating the presence of peripheral and central sensitization in chronic headaches, particularly in tension type. Clinical management of patients with headache needs to extend beyond local tissue-based pathology, to incorporate strategies directed at normalizing central nervous system sensitivity. In such a scenario, this paper exposes some examples of manual therapies for tension type and cervicogenic headache, based on a nociceptive pain rationale, for modulating central nervous system hypersensitivity: trigger point therapy, joint mobilization, joint manipulation, exercise, and cognitive pain approaches.

摘要

近年来,人们对慢性头痛的发病机制有了越来越多的认识,并且在治疗方面也有了更好的管理方法。目前的科学证据支持手法治疗在紧张型头痛和颈源性头痛管理中的作用,但结果仍存在矛盾。这些不一致的结果可能与以下事实有关:也许并非所有手法治疗都适用于所有类型的头痛;或者也许并非所有头痛患者都能从手法治疗中获益。有初步数据表明,致敏程度较低的患者将从手法治疗中获益更大,不过还需要更多研究。事实上,有证据表明慢性头痛,尤其是紧张型头痛中存在外周和中枢致敏现象。头痛患者的临床管理需要超越基于局部组织的病理学,纳入旨在使中枢神经系统敏感性正常化的策略。在这种情况下,本文基于伤害性疼痛原理,列举了一些用于紧张型头痛和颈源性头痛的手法治疗示例,以调节中枢神经系统的超敏反应:触发点疗法、关节松动术、关节整复术、运动疗法和认知疼痛疗法。

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