Zwart J A, Bovim G, Sand T, Sjaastad O
Department of Neurology, Regionsykehuset i Trondheim, Trondheim University Hospitals, Norway.
Headache. 1994 Sep;34(8):458-62. doi: 10.1111/j.1526-4610.1994.hed3408458.x.
The pathogenetic mechanism of tension headache (TH) is still unknown. The role of pericranial muscle tension in TH is also enigmatic. To evaluate this factor in chronic TH, pericranial muscles were paralysed in 6 chronic TH patients, using botulinum toxin. All patients fulfilled the IHS criteria of chronic TH associated with involvement of the pericranial muscles, but not the current criteria for cervicogenic headache. The patients were followed-up regularly with evaluation of the paralysis, changes in pain intensity, and pressure pain threshold measurements. We primarily only injected the temporal muscle on the one side, using the other side as a control. Contralateral muscles were in some cases injected at a later stage. In our study, we did not find any significant reduction in pain intensity, as measured by the visual analogue scale, nor any changes in pressure pain threshold, as measured by an algometer. On the basis of our observations, we conclude that muscle tension in these muscles possibly plays a minor role in the genesis of chronic TH. In our study, however, we have only treated a limited number of patients, and only one pericranial muscle has been injected systematically. Further studies of various neck/posterior head muscles ought to be performed in order to further evaluate a possible effect of tension in the pericranial musculature in producing this type of pain.
紧张性头痛(TH)的发病机制尚不清楚。颅周肌肉紧张在紧张性头痛中的作用也不明确。为了评估慢性紧张性头痛中的这一因素,我们使用肉毒杆菌毒素使6例慢性紧张性头痛患者的颅周肌肉麻痹。所有患者均符合国际头痛协会(IHS)关于伴有颅周肌肉受累的慢性紧张性头痛的标准,但不符合目前关于颈源性头痛的标准。对患者进行定期随访,评估肌肉麻痹情况、疼痛强度变化以及压痛阈值测量。我们主要仅在一侧注射颞肌,另一侧作为对照。在某些情况下,后期会注射对侧肌肉。在我们的研究中,通过视觉模拟量表测量,未发现疼痛强度有任何显著降低,通过痛觉计测量,也未发现压痛阈值有任何变化。基于我们的观察结果,我们得出结论,这些肌肉的紧张在慢性紧张性头痛的发生中可能起次要作用。然而,在我们的研究中,我们仅治疗了有限数量的患者,并且仅系统地注射了一块颅周肌肉。应该对各种颈部/头后部肌肉进行进一步研究,以进一步评估颅周肌肉组织紧张在产生这类疼痛中的可能作用。