Jensen R, Bendtsen L, Olesen J
Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.
Headache. 1998 Jan;38(1):10-7. doi: 10.1046/j.1526-4610.1998.3801010.x.
Recent studies have indicated that muscular disorders may be of importance for the development of increased pain sensitivity in patients with chronic tension-type headache. The objective of the present study was to investigate this hypothesis by examining the pain perception in tension-type headache with and without muscular disorders defined as increased tenderness. We examined 28 patients with episodic tension-type headache, 28 patients with chronic tension-type headache, and 30 healthy controls. Pericranial myofascial tenderness was recorded with manual palpation, and pressure pain detection and tolerances in cephalic and extracephalic locations with an electronic pressure algometer. In addition, thermal pain sensitivity and electromyographic activity were recorded. The main result was significantly lower pressure pain detection thresholds and tolerances in all the examined locations in patients with chronic tension-type headache with a muscular disorder compared to those without a muscular disorder. There were no such differences in any of the examined locations when the two subgroups of patients with episodic tension-type headache were compared. Thermal pain sensitivity did not differ between patients with and without a muscular disorder, while electromyographic activity levels were significantly higher in patients with chronic tension-type headache with than in those without a muscular disorder. Our results strongly indicate that prolonged nociceptive stimuli from the pericranial myofascial tissue sensitize the central nervous system and, thereby, lead to an increased general pain sensitivity. Muscular factors may, therefore, be of major importance for the conversion of episodic into chronic tension-type headache. The present study complements the understanding of the important interactions between peripheral and central factors in tension-type headache and may lead to a better prevention and treatment of the most prevalent type of headache.
近期研究表明，肌肉疾病可能在慢性紧张型头痛患者疼痛敏感性增加的发展过程中具有重要作用。本研究的目的是通过检查伴有和不伴有定义为压痛增加的肌肉疾病的紧张型头痛患者的疼痛感知来探究这一假设。我们检查了28例发作性紧张型头痛患者、28例慢性紧张型头痛患者和30名健康对照者。通过手动触诊记录颅周肌筋膜压痛，并使用电子压力痛觉计测量头部和头部以外部位的压痛检测和耐受性。此外，还记录了热痛敏感性和肌电图活动。主要结果是，与无肌肉疾病的慢性紧张型头痛患者相比，伴有肌肉疾病的慢性紧张型头痛患者在所有检查部位的压痛检测阈值和耐受性显著更低。比较发作性紧张型头痛患者的两个亚组时，在任何检查部位均未发现此类差异。有或无肌肉疾病的患者之间热痛敏感性无差异，而伴有肌肉疾病的慢性紧张型头痛患者的肌电图活动水平显著高于无肌肉疾病的患者。我们的结果强烈表明，来自颅周肌筋膜组织的长时间伤害性刺激会使中枢神经系统敏感化，从而导致总体疼痛敏感性增加。因此，肌肉因素可能在发作性紧张型头痛转变为慢性紧张型头痛过程中起主要作用。本研究补充了对紧张型头痛中外周和中枢因素之间重要相互作用的理解，并可能有助于更好地预防和治疗最常见的头痛类型。
