Wang W, De Pasqua V, Gerard P, Schoenen J
Department of Neurology, University of Liège, CHR Citadelle, Belgium.
Headache. 1995 Feb;35(2):85-8. doi: 10.1111/j.1526-4610.1995.hed3502085.x.
We have evaluated the specificity and sensitivity of temporalis ES2 measurements for the diagnosis of primary headaches. Ninety-four outpatients diagnosed according to IHS criteria were prospectively included: 25 had chronic tension-type headache (code 2.2.), 15 episodic tension-type headache (code 2.1.), 20 migraine without aura (code 1.1.) and 34 chronic daily headaches with daily analgesics/ergotamine abuse (code 8.2.). In chronic tension-type, the sensitivity of the ES2 test was 84% at the 0.1 and the 0.5 Hz, but only 56% at the 2Hz stimulation rates. Its specificity was 100% at 0.1Hz, 90% at 0.5Hz and 95% at 2Hz compared to migraine; positive predictive values were at similar levels. Sensitivity of ES2 at 0.1 Hz was 67% in episodic tension-type headache, but its positive predictive value versus migraine was excellent. Comparing chronic tension-type headache and analgesic abusers, the specificity and positive predictive value of the ES2 test for diagnosing chronic tension-type headache were less satisfactory (60%) while the negative predictive values, however, remained good (83% at 0.1Hz). The results confirm that the temporalis ES2 test has a higher diagnostic sensitivity in chronic and episodic tension-type headache, but that it has a high negative predictive value for both types of tension-type headache compared to other primary headaches. For diagnostic purposes, the 0.1Hz stimulation rate seems optimal. The 2Hz stimulation rate is the least sensitive, although it may induce total disappearance of ES2 in up to 40% of patients. ES2 is of limited usefulness for separating chronic tension-type headache and chronic drug-abuse headache, possibly because the latter group comprises both tension-type headache and migraine patients.
我们评估了颞肌ES2测量对原发性头痛诊断的特异性和敏感性。前瞻性纳入了94例根据国际头痛疾病分类（IHS）标准诊断的门诊患者：25例为慢性紧张型头痛（编码2.2.），15例为发作性紧张型头痛（编码2.1.），20例为无先兆偏头痛（编码1.1.），34例为因每日滥用镇痛药/麦角胺所致的慢性每日头痛（编码8.2.）。在慢性紧张型头痛中，ES2测试在0.1Hz和0.5Hz时的敏感性为84%，但在2Hz刺激频率下仅为56%。与偏头痛相比，其特异性在0.1Hz时为100%，在0.5Hz时为90%，在2Hz时为95%；阳性预测值处于相似水平。ES2在0.1Hz时对发作性紧张型头痛的敏感性为67%，但其对偏头痛的阳性预测值极佳。比较慢性紧张型头痛患者和镇痛药滥用者，ES2测试对诊断慢性紧张型头痛的特异性和阳性预测值不太令人满意（60%），而阴性预测值仍然良好（0.1Hz时为83%）。结果证实，颞肌ES2测试在慢性和发作性紧张型头痛中具有较高的诊断敏感性，但与其他原发性头痛相比，对两种类型的紧张型头痛均具有较高的阴性预测值。为了诊断目的，0.1Hz的刺激频率似乎是最佳的。2Hz的刺激频率最不敏感，尽管它可能导致高达40%的患者ES2完全消失。ES2在区分慢性紧张型头痛和慢性药物滥用性头痛方面作用有限，可能是因为后一组包括紧张型头痛患者和偏头痛患者。
