Langemark M, Jensen K, Jensen T S, Olesen J
Department of Neurology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Pain. 1989 Aug;38(2):203-10. doi: 10.1016/0304-3959(89)90239-x.
The nociceptive thresholds to mechanical and thermal stimuli in patients with chronic tension-type headache were compared. Palpation of pericranial tenderness was performed in 50 patients and a total tenderness score (TTS) was calculated. Palpation was repeated, and pressure pain thresholds (PPTs) were determined with a pressure algometer in the temporal and occipital regions. In 32 of the patients, pain thresholds for heat and cold and limens for detection of non-painful temperature changes were determined in the hands and the temporal regions. Twenty-four healthy volunteers served as controls. Scores obtained by manual palpation (TTS) at the first and second visit were positively correlated. A negative correlation between headache severity and PPT was found in the temporal region. A positive correlation between PPT in the temporal and occipital region was found, and PPT and TTS were negatively correlated. Thermal pain thresholds were consistently less extreme in patients compared to controls, and patients reporting severe headache on the examination day were those most sensitive to thermal pain. No difference was found between patients and controls with respect to detection of temperature changes. A correlation was found between PPT and the corresponding cold pain thresholds, but no correlation could be demonstrated between TTS and thermal pain thresholds. In conclusion, headache patients had decreased pain perception thresholds. Chronic tension-type headache might be a result of dysmodulation of nociceptive impulses, but it is likely that sensitized nociceptors also play a role.
比较了慢性紧张型头痛患者对机械性和热刺激的伤害性感受阈值。对50例患者进行了颅周压痛触诊，并计算了总压痛评分（TTS）。重复触诊，并用压力痛觉计测定颞部和枕部区域的压力痛阈（PPT）。在32例患者中，测定了手部和颞部区域的热痛阈、冷痛阈以及非痛性温度变化的感觉阈。24名健康志愿者作为对照。首次和第二次就诊时通过手动触诊获得的评分（TTS）呈正相关。在颞部区域发现头痛严重程度与PPT呈负相关。发现颞部和枕部区域的PPT呈正相关，且PPT与TTS呈负相关。与对照组相比，患者的热痛阈始终较低，并且在检查当天报告严重头痛的患者对热痛最为敏感。在温度变化检测方面，患者与对照组之间未发现差异。发现PPT与相应的冷痛阈之间存在相关性，但未证明TTS与热痛阈之间存在相关性。总之，头痛患者的痛觉感受阈值降低。慢性紧张型头痛可能是伤害性冲动调节异常的结果，但致敏的伤害感受器可能也起作用。
