Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MB, USA.
Danish Headache Center, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
J Headache Pain. 2022 Aug 8;23(1):96. doi: 10.1186/s10194-022-01457-1.
To investigate whether persistent post-traumatic headache attributed to mild traumatic brain injury (TBI) is associated with more pronounced pericranial tenderness and lower pressure pain thresholds (PPTs) in the head and neck region, compared with healthy controls.
Patients with persistent post-traumatic headache (n = 100) and age- and gender-matched healthy controls (n = 100) were included between July 2018 and June 2019. Total tenderness score (TTS) was used to assess pericranial tenderness by bilateral manual palpation in eight muscles or tendon insertions. Summation was then used to calculate a TTS from 0 to 48 based on individual right- and left-sided scores; higher TTS score indicated more pronounced pericranial tenderness. PPTs were examined in m. temporalis and m. trapezius (upper and middle part) using an electronic pressure algometer that applies increasing blunt pressure at a constant rate.
The TTS score was higher in patients with persistent post-traumatic headache (median, 21; IQR, 12-31), compared with healthy controls (median, 10; IQR, 6-17; P < .001). PPTs were lower in patients with persistent post-traumatic headache than in controls in both the left-sided m. temporalis (mean ± SD, 157.5 ± 59.9 vs. 201.1 ± 65.2; P < .001) and right-sided m. temporalis (mean ± SD, 159.5 ± 63.8 vs. 212.3 ± 61.9; P < .001). Furthermore, patients with persistent post-traumatic headache also had lower left- and right-sided PPTs in the upper as well as middle part of m. trapezius, compared with healthy controls; all P values were .05 or less.
Among patients with persistent post-traumatic headache, pericranial tenderness was more pronounced and PPTs in the head and neck region were lower than in healthy controls free of headache and mild TBI. Further research is needed to better understand the involvement of pericranial myofascial nociceptors in the disease mechanisms underlying post-traumatic headache.
研究与健康对照组相比，轻度创伤性脑损伤（TBI）后持续创伤后头痛是否与头部和颈部区域更明显的颅周压痛和更低的压力痛阈值（PPT）相关。
纳入 2018 年 7 月至 2019 年 6 月间的 100 例持续创伤后头痛患者（病例组）和 100 例年龄和性别匹配的健康对照者（对照组）。采用双侧手动触诊评估颅周压痛，在 8 块肌肉或肌腱附着处进行总压痛评分（TTS）。根据右侧和左侧的单侧评分，计算总和得出 0 到 48 分的 TTS；TTS 评分越高，颅周压痛越明显。采用电子压力测痛仪在颞肌和斜方肌（上部和中部）检查 PPT，该仪器以恒定速率施加逐渐增加的钝压力。
病例组的 TTS 评分（中位数 21 分，IQR 12-31）高于对照组（中位数 10 分，IQR 6-17；P<0.001）。病例组左侧颞肌（左 TTS）和右侧颞肌（右 TTS）的 PPT 均低于对照组，差异均有统计学意义（左 TTS：平均±标准差，157.5±59.9 比 201.1±65.2；P<0.001；右 TTS：平均±标准差，159.5±63.8 比 212.3±61.9；P<0.001）。此外，病例组左侧和右侧斜方肌上部及中部的 PPT 也均低于对照组，差异均有统计学意义（P 值均<0.05）。
在持续创伤后头痛患者中，颅周压痛更明显，头部和颈部区域的 PPT 低于无头痛和轻度 TBI 的健康对照组。需要进一步研究以更好地了解颅周肌筋膜伤害感受器在创伤后头痛发病机制中的作用。
