Mraz M, Aull S, Feucht M, Ilieva D, Schnider P, Travniczek A, Zeiler K, Wessely P
Kopfschmerzambulanz der Neurologischen Universitätsklinik, Wien.
Wien Klin Wochenschr. 1993;105(2):42-52.
This study presents the history and clinical findings in 80 patients suffering from tension-type headache diagnosed according to the criteria (group 2) proposed in 1988 by the Headache Classification Committee of the International Headache Society (IHS). The aim of this investigation was to evaluate the extent to which the symptomatology in our cases still corresponds with the clinical picture of tension headache described in the older literature. A positive family history of headache was obtained in 59% of the patients; mothers of headache patients were affected five times more often than fathers; a history of migraine was reported as frequently as tension-type headache in the families of the investigated patients. The first manifestation of headaches arose almost exclusively in the first four decades of life, whereby two peaks (15-20 and 35-40 years) were observed in patients with the episodic form. Headache in younger patients showed no distinct diurnal pattern; headache in older patients, however, predominantly occurred immediately after awakening from sleep or in the morning. Changes of weather and psychosocial stress were the most frequent precipitating factors; additionally, the premenstrual period, occupational stress, and sleep deprivation were precipitating factors in female patients. Bilateral pain was most often located in the occipital/nuchal, in the frontal, and the periorbital regions. Headache was usually described as pressing/tightening in quality. Difficulties in concentration and the need of rest were the most important associated symptoms. Photophobia, phonophobia and autonomic symptoms were less frequent and are probably partially drug-related and may also be due to the fact that the selected group of patients suffered from severe forms of headache. 33 of our 80 patients belonged to the subgroup "with disorders of pericranial muscles" (IHS criteria: groups 2.1.1., 2.2.1). A remarkable low percentage of patients, especially of the male sufferers, reported regular smoking and/or drinking habits. Oral contraceptives influenced neither frequency nor intensity of headache attacks. Signs of depressive disorders were present in 28% of the female patients. The differences in symptomatology of tension-type headache between patients with episodic and chronic forms, between female and male patients, and also between younger and elderly patients are documented and have to be taken into account in the diagnostik evaluation of this condition.
本研究呈现了80例根据国际头痛协会（IHS）头痛分类委员会1988年提出的标准确诊为紧张型头痛患者的病史和临床发现。本调查的目的是评估我们病例中的症状学与旧文献中描述的紧张性头痛临床表现相符的程度。59%的患者有头痛家族史阳性；头痛患者的母亲受影响的频率比父亲高五倍；在所调查患者的家族中，偏头痛病史的报告频率与紧张型头痛相同。头痛的首次表现几乎都出现在生命的前四十年，其中发作性形式的患者观察到两个高峰（15 - 20岁和35 - 40岁）。年轻患者的头痛没有明显的昼夜模式；然而，老年患者的头痛主要发生在刚睡醒后或早晨。天气变化和心理社会压力是最常见的诱发因素；此外，经前期、职业压力和睡眠剥夺是女性患者的诱发因素。双侧疼痛最常位于枕部/颈部、额部和眶周区域。头痛通常被描述为压榨性/紧箍性。注意力不集中和需要休息是最重要的伴随症状。畏光、畏声和自主神经症状较少见，可能部分与药物有关，也可能是因为所选患者组患有严重形式的头痛。我们80例患者中有33例属于“伴有颅周肌肉障碍”亚组（IHS标准：2.1.1组、2.2.1组）。报告有规律吸烟和/或饮酒习惯的患者比例极低，尤其是男性患者。口服避孕药对头痛发作的频率和强度均无影响。28%的女性患者有抑郁障碍的体征。记录了发作性和慢性形式患者、女性和男性患者以及年轻和老年患者之间紧张型头痛症状学的差异，在对这种疾病的诊断评估中必须考虑这些差异。
