Increased muscle pain sensitivity in patients with tension-type headache
Increased muscle pain sensitivity in patients with tension-type headache
复制标题
紧张型头痛患者的肌肉疼痛敏感性增加
作者：
P. T. Schmidt;P. Svensson;L. Bendtsen;T. Graven‐Nielsen;F. Bach
紧张性头痛的伤害感受机制尚不清楚。目的是研究紧张性头痛患者颅周肌肉和肢体肌肉的疼痛敏感性。24例频繁发作性紧张性头痛患者（FETTH）、22例慢性紧张性头痛患者（CTTH）和26例年龄和性别匹配的健康受试者，将0.5 ml 1 M高渗生理盐水标准化注入颞前肌（TPA）和咬肌（MAS）两块颅面肌和一块肢体肌（胫前肌），诱导实验性肌肉疼痛。头痛患者接受两次检查，分别在有头痛和无头痛的日子。测定注射前后的压痛阈值（PPTs）。受试者在电子视觉模拟量表（VAS）上连续报告盐致疼痛强度，并在解剖图谱上绘制疼痛感知区域。头痛患者在所有测试肌肉部位均表现出较低的PPTs，较高的盐诱发VAS疼痛评分和较大的疼痛区域（P< 0.05）。三组受试者的pts评分和CTTH患者的VAS疼痛评分均存在显著的性别差异（P< 0.05）。在FETTH和CTTH之间以及有或没有头痛的患者之间，疼痛敏感性没有差异。总之，本研究表明，与对照组相比，FETTH和CTTH患者均存在广泛性疼痛超敏反应，这与实际头痛状态无关，并扩展到包括对临床高度相关的更长时间刺激的反应。在健康对照组和紧张性头痛患者中，深痛敏感性的性别差异似乎是一致的发现。缩写：TPA：前颞肌；MAS：咬肌；TA：胫骨前肌；FETTH：频繁发作性紧张性头痛；CTTH：慢性紧张性头痛；PPT：压痛阈值；VAS：视觉模拟量表；th：紧张性头痛。
Nociceptive mechanisms in tension-type headache are poorly understood. The aim was to investigate the pain sensitivity of pericranial muscles and a limb muscle in patients with tension-type headache. Experimental muscle pain was induced by standardized infusions of 0.5 ml of 1 M hypertonic saline into two craniofacial muscles (anterior temporalis (TPA) and masseter (MAS)) and a limb muscle (anterior tibial (TA)) in 24 frequent episodic tension-type headache patients (FETTH), 22 chronic tension-type headache patients (CTTH) and 26 age and gender matched healthy subjects. Headache patients were examined twice, both on days with and on days without headache. The pressure pain thresholds (PPTs) were determined before and after infusions. The subjects continuously reported intensity of saline-induced pain on an electronic visual analogue scale (VAS) and the perceived area of pain was drawn on anatomical maps. Headache patients demonstrated significantly lower PPTs, higher saline-evoked VAS pain scores and greater pain areas than healthy subjects at all the tested muscle sites (P< 0.05). There was a significant gender difference for the PPTs in all three groups of participants (P< 0.05) and for VAS pain scores in the CTTH patients (P< 0.05). There was no difference in pain sensitivity between FETTH and CTTH or between patients with or without headache. In conclusion, the present study demonstrates the presence of generalized pain hypersensitivity both in FETTH and CTTH compared to controls which is unrelated to actual headache status and extends to include responses to longer-lasting stimuli which are clinically highly relevant. Gender differences in deep pain sensitivity seem to be a consistent finding both in healthy controls and patients with tension-type headache.Abbreviations: TPA: anterior temporalis muscle; MAS: masseter muscle; TA: anterior tibial muscle; FETTH: frequent episodic tension-type headache; CTTH: chronic tension-type headache; PPT: pressure pain threshold; VAS: visual analogue scale; TTH: tension-type headache.