Department Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, University Rey Juan Carlos, Alcorcón, Spain.
Department of Health Science and Technology, Faculty of Medicine, Center for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark.
BMC Neurol. 2020 Feb 1;20(1):43. doi: 10.1186/s12883-020-1624-8.
Pharmacological treatment of patients with tension-type headache (TTH) includes symptomatic (acute) and prophylactic (preventive) medication. No previous study has investigated variables associated to symptomatic medication intake in TTH. Our aim was to assess the association of clinical, psychological and neurophysiological outcomes with the use and timing of the use of symptomatic medication in TTH.
A longitudinal observational study was conducted. One hundred and sixty-eight (n = 168) patients with TTH participated. Pain features of the headache (intensity, frequency, duration), burden of headache (Headache Disability Inventory), sleep quality (Pittsburgh Sleep Quality Index), anxiety/depression (Hospital Anxiety and Depression Scale), trait/state anxiety levels (State-Trait Anxiety Inventory), and bilateral pressure pain thresholds on the temporalis, C5-C6 joint, second metacarpal and tibialis anterior were assessed. Symptomatic medication intake was also collected for a 6-months follow-up period. Differences between patients using or not using symptomatic medication, depending on self-perceived effectiveness, and time (early during an attack, i.e., the first 5 min, or when headache attack is intense) when the symptomatic medication was taken were calculated.
One hundred and thirty-six (n = 136, 80%) reported symptomatic medication intake for headache (73% NSAIDs). Sixteen (12%) reported no pain relief, 81 (59%) experienced moderate relief and 39 (29%) total pain relief. Fifty-eight (43%) took 'early medication' whereas 78 (57%) took 'late medication'. Patients taking symptomatic medication in general showed lower headache frequency and lower depressive levels than those patients not taking medication. Symptomatic medication was more effective in patients with lower headache history, frequency, and duration, and lower emotional burden. No differences in pressure pain sensitivity were found depending on the self-perceived effectiveness of medication. Patients taking 'late symptomatic' medication exhibited more widespread pressure pain sensitivity than those taking 'early medication'.
This study found that the effectiveness of symptomatic medication was associated with better headache parameters (history, frequency, or duration) and lower emotional burden. Further, consuming early symptomatic medication at the beginning of a headache attack (the first 5 min) could limit widespread pressure pain sensitivity.
张力型头痛（TTH）患者的药物治疗包括对症（急性）和预防（预防性）药物治疗。以前没有研究调查过 TTH 中与对症药物摄入相关的变量。我们的目的是评估临床、心理和神经生理结果与 TTH 中对症药物使用和使用时间的关系。
进行了一项纵向观察性研究。168 名 TTH 患者参与了研究。头痛的疼痛特征（强度、频率、持续时间）、头痛负担（头痛残疾问卷）、睡眠质量（匹兹堡睡眠质量指数）、焦虑/抑郁（医院焦虑和抑郁量表）、特质/状态焦虑水平（状态-特质焦虑量表）以及颞肌、C5-C6 关节、第二掌骨和胫骨前肌的双侧压痛阈值均进行了评估。在 6 个月的随访期间还收集了对症药物的使用情况。根据自我感知的有效性以及使用时间（在头痛发作的早期，即前 5 分钟，或头痛发作强烈时），计算了使用或不使用对症药物的患者之间的差异。
136 名（n=136，80%）患者报告了头痛的对症药物治疗（73%为 NSAIDs）。16 名（12%）患者报告无疼痛缓解，81 名（59%）患者报告中度缓解，39 名（29%）患者报告完全缓解。58 名（43%）患者服用“早期药物”，而 78 名（57%）患者服用“晚期药物”。一般来说，服用对症药物的患者头痛发作频率和抑郁程度较低。对症药物对头痛病史、频率和持续时间较短以及情绪负担较低的患者更有效。自我感知的药物有效性与压痛敏感性无差异。服用“晚期对症”药物的患者比服用“早期药物”的患者表现出更广泛的压痛敏感性。
本研究发现，对症药物的疗效与更好的头痛参数（病史、频率或持续时间）和较低的情绪负担有关。此外，在头痛发作的早期（前 5 分钟）服用早期对症药物可能会限制广泛的压痛敏感性。
