Chronic post-traumatic headache: clinical findings and possible mechanisms
Chronic post-traumatic headache: clinical findings and possible mechanisms
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DOI：
10.1179/2042618613y.0000000053
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发表时间：
2014-01-01
影响因子：
2
通讯作者：
Defrin, Ruth
中科院分区：
文献类型：
--
作者：
Defrin, Ruth
慢性创伤后头痛（CPTHA）是创伤性脑损伤（TBI）后最常见的主诉，严重影响生活质量和功能。尽管其高患病率和持久性，CPTHA的机制知之甚少。本文就CPTHA的特点和感觉特征的研究结果进行综述，以阐明其可能的机制。在MEDLINE、CINAHL和PubMed中检索了1960年至2013年期间发表的英语文章。评估TBI后头痛临床特征的研究以及对CPTHA患者和其他类型疼痛患者进行定量体感测试（QST）的研究均纳入其中。CPTHA的临床特征与原发性头痛相似，尤其是紧张型和偏头痛。阳性和阴性体征在CPTHA患者中普遍存在，在头部和其他身体部位，表明存在局部（颅）机械超敏反应，以及全身热感觉减退和痛觉减退。还观察到疼痛调节功能障碍的证据。慢性创伤后头痛可能是由于颅内和周围组织的损伤导致这些组织的慢性致敏。或者，虽然不相互排斥，CPTHA可能是一种形式的中枢疼痛，由于参与疼痛处理的大脑结构受损。这些，其他的可能性，以及CPTHA的风险因素进行了详细讨论。
Chronic post-traumatic headache (CPTHA), the most frequent complaint after traumatic brain injury (TBI), dramatically affects quality of life and function. Despite its high prevalence and persistence, the mechanism of CPTHA is poorly understood. This literature review aimed to analyze the results of studies assessing the characteristics and sensory profile of CPTHA in order to shed light on its possible underlying mechanisms. The search for English language articles published between 1960 and 2013 was conducted in MEDLINE, CINAHL, and PubMed. Studies assessing clinical features of headache after TBI as well as studies conducting quantitative somatosensory testing (QST) in individuals with CPTHA and in individuals suffering from other types of pain were included. Studies on animal models of pain following damage to peripheral tissues and to the peripheral and central nervous system were also included.The clinical features of CPTHA resembled those of primary headache, especially tension-type and migraine headache. Positive and negative signs were prevalent among individuals with CPTHA, in both the head and in other body regions, suggesting the presence of local (cranial) mechanical hypersensitivity, together with generalized thermal hypoesthesia and hypoalgesia. Evidence of dysfunctional pain modulation was also observed. Chronic post-traumatic headache can result from damage to intra-and pericranial tissues that caused chronic sensitization of these tissues. Alternatively, although not mutually exclusive, CPTHA might possibly be a form of central pain due to damage to brain structures involved in pain processing. These, other possibilities, as well as risk factors for CPTHA are discussed at length.