紧张型头痛ppt课件

TENSION TYPE HEADACHE,Zhibin song,最常见,神经内科门诊,表现,慢性头部紧束样或压迫性疼痛，通常为双侧头痛,紧张型头痛(TENSION TYPE HEADACHE, TTH),Chin Neurol ,2007,40(7):496-497.,起病,可能与心理应激有关；转为慢性形式后常没有明显心理因素,Tension headache,Tension headache is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes, or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches.,Signs and symptoms,The pain is often described as a constant pressure, as if the head were being squeezed in a vise. The pain is frequently present on both sides of the head at the same time. Tension-type headache pain is typically mild to moderate, but may be severe.,Frequency and duration,It can be episodic or chronic. Episodic headaches are defined as tension-type headaches occurring fewer than 15 days a month. Chronic tension headaches occur 15 days or more a month for at least 6 months. Tension-type headaches can last from minutes to days, months or even years, though a typical tension headache lasts 46 hours.,Cause,Stress: usually occurs in the afternoon after long stressful work hours or after an exam Sleep deprivation Uncomfortable stressful position and/or bad posture Irregular meal time (hunger) Eyestrain,Tension-type headaches may be caused by muscle tension around the head and neck. a chronic contraction of the temporalis muscle,a malfunctioning pain filter which is located in the brain stem The view is that the brain misinterprets informationfor example from the temporal muscle or other musclesand interprets this signal as pain,One of the main neurotransmitters that is probably involved is serotonin. Evidence for this theory comes from the fact that chronic tension-type headaches may be successfully treated with certain antidepressants such as amitriptyline.,However, the analgesic effect of amitriptyline in chronic tension-type headache is not solely due to serotonin reuptake inhibition, and likely other mechanisms are involved. Recent studies of nitric oxide (NO) mechanisms suggest that NO may play a key role in the pathophysiology of CTTH,associated with activation of nitric oxide synthase (NOS) and the generation of NO. Patients with chronic tension-type headache have increased muscle and skin pain sensitivity, demonstrated by low mechanical, thermal and electrical pain thresholds,Hyperexcitability of central nociceptive neurons (in trigeminal spinal nucleus, thalamus, and cerebral cortex) is believed to be involved in the pathophysiology of chronic tension-type headache,颅周肌肉持续性收缩 和血流降低,疼痛介质释放1 （如 P物质、神经激肽A等 ）,紧张型头痛主要病因假说：颅周肌肉持续收缩1-4,1. Fernndez-de-las-Peas C, et al. Cephalalgia. 2007 May;27(5)383-93 .,4. Xue L, et al. Chinese Remedies&Clinics. 2009,9(7),620-622,2. WANG Meisheng,et al. PJCCPVD,2008,16(9) 28-29.,3. Alonso-Blanco C, et al. Expert Rev Neurother. 2012 Mar;12(3):315-22.,肌肉紧张,缺血 颈后肌肌肉血流量显著降低1,疼痛刺激,疼痛,斜方肌、颈后肌肌肉紧张度明显升高,“肌肉紧张-疼痛”恶性循环造成头痛症状无法缓解2-4,4.Xu MM. Journal of International Neurology and Neurosurgery. 2007,34(2):147-150.,1.Sakai F, et al. Brain. 1995 Apr;118 ( Pt 2):523-31.,2.Liu HX, et al. Foreign Medical Sciences Section on Neurology &Neurosurger. 2001,28(4)241-244.,3.Masahiro Izawa,et al. Reprinted from Consultation and New Drugs. Vo1.23, No.7(1986),provention,Lifestyle 1)Drinking water and avoiding dehydration helps in preventing tension headache. 2) relaxing often makes headaches less likely. 3)Drinking alcohol can make headaches more likely or severe. 4)Good posture might prevent headaches if there is neck pain. 5)People who have jaw clenching might develop headaches, and getting treatment from a dentist might prevent those headaches. 6) Biofeedback techniques may also help,Medications People who have 15 or more headaches in a month may be treated with certain types of daily antidepressants,全方位打破“肌紧张疼痛”恶性循环1-5,1.S. Araki et al. Clinical experiences with eperisone hydrochloride in muscle contraction headache. 2.Sakai Y, et al. Spine . 2008 Mar 15;33(6):581-7 3.Novales-Li P, et al. Eur J Pharmacol. 1989 Sep 22;168(3):299-305. 4.Chu XJ, et al. Chinese Journal of Medicine. 2013,4