Sakai Neurosurgical Clinic, Tomitsuka-cho 55, Chuo-ku, Shizuoka prefecture, Hamamatsu city, 432-8002, Shizuoka, Japan.
School of Rehabilitation Science, Seirei Christopher University, Mikatahara-cho 3453, Chuo- ku, Shizuoka prefecture, Hamamatsu city, 433-8558, Shizuoka, Japan.
BMC Neurol. 2024 Sep 4;24(1):316. doi: 10.1186/s12883-024-03833-7.
Tension-type headache (TTH) and migraine are prevalent neurological conditions in children and adolescents that significantly impact activity of daily living (ADL) and quality of life (QOL). Although physical therapy targeting cervical myofascial trigger points (MTrPs) on TTH and migraine has been extensively studied in adults, the efficacy in pediatric patients remains unexplored. The aim of this study is to reveal the effect of physical therapy integrated with pharmacotherapy on TTH and migraine in children and adolescents.
We conducted a prospective, observational cohort study recruiting consecutive patients aged 6 to 18 years with TTH and migraine with cervical MTrPs. They were classified into 4 types of headaches: frequent episodic TTH (FRTTH), chronic TTH (CTTH), episodic migraine (EM) and chronic migraine (CM). The once-weekly 40-minutes physical therapy session integrated with pharmacotherapy (integrated physical therapy) was continued until the treatment goals (headache days per week less than 2 days, headache impact test-6 (HIT-6) score to below of 50, and the ability to attend school daily) was achieved. Multifaceted assessments including headache frequency (headache days per week), headache intensity using the Visual Analogue Scale (VAS), pain catastrophizing score (PCS), hospital anxiety and depression scale (HADS) score, HIT-6 scores, and EuroQol 5 dimensions 5-level questionnaire (EQ-5D-5 L) scores, were conducted to evaluate the treatment effects.
161 patients were enrolled in this study. 106 patients (65.8%) were diagnosed with TTH: 70 (66.8%) with FETHH, 36 (34.0%) with CTTH, and 55 patients (34.2%) were diagnosed with migraine: 43 patients (78.2%) with EM, 12 patients (21.8%) with CM. We observed significant improvements in headache frequency, headache intensity, PCS, HADS score, HIT-6 scores, and EQ-5D-5 L scores before and after the treatment in all 4 types of headaches. The average number of sessions required to achieve the treatment goals was 4 times (weeks) for patients with FETTH and EM, 5.5 for those with CTTH, and 7.5 for those with chronic migraine.
The integrated physical therapy on pediatric TTH and migraine patients with the cervical MTrPs was significantly effective in reducing headache symptoms and improving ADL and QOL.
紧张型头痛（TTH）和偏头痛是儿童和青少年中常见的神经疾病，它们严重影响日常生活活动（ADL）和生活质量（QOL）。虽然针对 TTH 和偏头痛的颈椎肌筋膜触发点（MTrP）的物理治疗在成年人中已经得到了广泛的研究，但在儿科患者中的疗效仍未得到探索。本研究旨在揭示针对儿童和青少年 TTH 和偏头痛的物理治疗与药物治疗相结合的效果。
我们进行了一项前瞻性、观察性队列研究，招募了年龄在 6 至 18 岁之间、有颈椎 MTrP 的 TTH 和偏头痛的连续患者。他们被分为 4 种头痛类型：频发发作性 TTH（FRTTH）、慢性 TTH（CTTH）、发作性偏头痛（EM）和慢性偏头痛（CM）。每周一次 40 分钟的物理治疗与药物治疗相结合（综合物理治疗），一直持续到达到治疗目标（每周头痛天数少于 2 天、头痛影响测试-6（HIT-6）评分低于 50 分、以及每天上学的能力）。采用多方面评估，包括头痛频率（每周头痛天数）、使用视觉模拟量表（VAS）评估头痛强度、疼痛灾难化评分（PCS）、医院焦虑和抑郁量表（HADS）评分、HIT-6 评分和欧洲五维健康量表（EQ-5D-5L）评分，评估治疗效果。
本研究共纳入 161 名患者。106 名患者（65.8%）被诊断为 TTH：70 名（66.8%）为 FETHH，36 名（34.0%）为 CTTH，55 名患者（34.2%）被诊断为偏头痛：43 名（78.2%）为 EM，12 名（21.8%）为 CM。我们观察到所有 4 种头痛类型在治疗前后的头痛频率、头痛强度、PCS、HADS 评分、HIT-6 评分和 EQ-5D-5L 评分均有显著改善。达到治疗目标所需的平均治疗次数为 FETTH 和 EM 患者 4 次（周），CTTH 患者 5.5 次，慢性偏头痛患者 7.5 次。
针对有颈椎 MTrP 的儿科 TTH 和偏头痛患者的综合物理治疗在减轻头痛症状和提高 ADL 和 QOL 方面具有显著效果。
