Fernández-de-Las-Peñas César, Benito-González Elena, Palacios-Ceña María, Wang Kelun, Castaldo Matteo, Arendt-Nielsen Lars
Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.
Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
J Headache Pain. 2017 Dec;18(1):43. doi: 10.1186/s10194-017-0751-0. Epub 2017 Apr 11.
Identification of subgroups of patients with different levels of sensitization and clinical features can help to identify groups at risk and the development of better therapeutic strategies. The aim of this study was to identify subgroups of patients with tension type headache (TTH) with different levels of sensitization, clinical pain features, and psychological outcomes.
A total of 197 individuals with TTH participated. Headache intensity, frequency, and duration and medication intake were collected with a 4-weeks diary. Pressure pain thresholds were assessed bilaterally over the temporalis muscle, C5-C6 joint, second metacarpal and tibialis anterior muscle to determine widespread pressure pain hyperalgesia. The Hospital Anxiety and Depression Scale assessed anxiety and depression. The State-Trait Anxiety Inventory evaluated the state and trait levels of anxiety. The Headache Disability Inventory evaluated the burden of headache. Health-related quality of life was determined with the SF-36 questionnaire. Groups were considered as positive (three or more criteria) or negative (less than three criteria) on a clinical prediction rule: headache duration <8.5 h/day; headache frequency <5.5 days/week; bodily pain <47 and vitality <47.5.
The ANCOVA revealed that subjects in group 1 (positive rule, n = 89) exhibited longer headache history, shorter headache duration, lower headache frequency, higher widespread pressure hyperalgesia, higher anxiety trait levels, and lower quality of life (all, P < 0.01) than those subjects within group 2 (negative rule, n = 108). Differences were similar between men and women.
This study identified a subgroup of patients with TTH with higher sensitization, higher chronicity of headaches and worse quality of life but lower frequency and duration of headache episodes. This subgroup of individuals with TTH may need particular attention and specific therapeutic programs for avoiding potential chronification.
识别具有不同致敏水平和临床特征的患者亚组有助于确定风险群体并制定更好的治疗策略。本研究的目的是识别紧张型头痛（TTH）患者中具有不同致敏水平、临床疼痛特征和心理结果的亚组。
共有197名TTH患者参与。通过4周的日记收集头痛强度、频率、持续时间和药物摄入量。双侧评估颞肌、C5 - C6关节、第二掌骨和胫前肌的压痛阈值，以确定广泛的压痛性痛觉过敏。使用医院焦虑抑郁量表评估焦虑和抑郁。状态 - 特质焦虑量表评估焦虑的状态和特质水平。头痛残疾量表评估头痛负担。使用SF - 36问卷确定与健康相关的生活质量。根据临床预测规则将患者分为阳性（三个或更多标准）或阴性（少于三个标准）：头痛持续时间<8.5小时/天；头痛频率<5.5天/周；身体疼痛<47且活力<47.5。
协方差分析显示，第1组（阳性规则，n = 89）的受试者比第2组（阴性规则，n = 108）的受试者表现出更长的头痛病史、更短的头痛持续时间、更低的头痛频率、更高的广泛压痛过敏、更高的特质焦虑水平和更低的生活质量（均P < 0.01）。男性和女性之间的差异相似。
本研究确定了一组TTH患者亚组，其致敏性更高、头痛慢性化程度更高、生活质量更差，但头痛发作频率和持续时间更低。这一TTH患者亚组可能需要特别关注和特定的治疗方案以避免潜在的慢性化。
