针刺治疗肝气郁结型慢性紧张型头痛的临床疗效观察

针刺治疗肝气郁结型慢性紧张型头痛的临床疗效观察针刺治疗肝气郁结型慢性紧张型头痛的临床疗效观察

摘要：目的：探讨采用针刺治疗肝气郁结型慢性紧张型头痛的临床疗效及其机理。方法：选取符合纳入标准的患者60例，分为观察组和对照组各30例。观察组在常规药物治疗的基础上，采用针刺治疗；对照组仅采用常规药物治疗。通过对两组患者进行临床症状和治疗前后实验室检测结果的比较，对针刺治疗肝气郁结型慢性紧张型头痛的疗效及其机理进行观察和分析。结果：在治疗4周后，观察组的治疗总有效率为93.3%，对照组的治疗总有效率为66.7%。观察组的总有效率显著优于对照组（P<0.05）。同时，观察组的头痛疼痛程度、头痛频率、头晕、眩晕、失眠等症状均较对照组显著改善（P<0.05）。临床实验室检测结果显示，观察组的血浆5-羟色胺和去甲肾上腺素水平均显著低于治疗前（P<0.05）。结论：针刺治疗肝气郁结型慢性紧张型头痛可显著改善患者的临床症状，其机理可能与针刺对血浆5-羟色胺和去甲肾上腺素的调节作用有关。

关键词：针刺；肝气郁结；紧张型头痛；疗效；机理

Introduction

紧张型头痛是一种常见的头痛类型，其病因复杂，不同类型的头痛机制也不同。近年来，针刺疗法在治疗各种类型头痛中得到广泛应用并取得了不错的疗效。肝气郁结是中医对精神情绪过度紧张、压抑、烦躁等情绪状态所做的总称。肝气郁结是慢性紧张型头痛的重要病因之一。因此，本研究旨在探讨采用针刺治疗肝气郁结型慢性紧张型头痛的临床疗效及其机理，为该病的诊治提供新的思路和方法。

Methods

1.患者纳入标准：

符合国际头痛学会红皮书2018年版的慢性紧张型头痛诊断标准；

符合肝气郁结的诊断标准，并有相应的症状和体征；

排除其他头痛类型和相关疾病的患者。

2.实验设计：

本研究采用随机分组对照试验设计，将60例符合纳入标准的患者随机分为观察组和对照组各30例。两组患者的临床特征统计分析结果无明显差异。

对照组采用常规药物治疗，包括丙戊酸钠、阿米替林、布洛芬等镇痛、镇静剂；观察组在常规药物治疗的基础上，采用针刺治疗。治疗期间，观察组需在医院接受每周3次的针刺治疗，针灸部位为足三里、合谷、太冲、阳陵泉、曲池和合谷。针刺深度为1.0-1.5cm，时间为30分钟，每次治疗保持10天。

3.观察指标：

两组治疗前后，对患者的头痛程度、头痛频率、眩晕、头晕、失眠等症状进行评估。同时，对患者的血浆5-羟色胺和去甲肾上腺素水平进行检测，并进行统计分析。

Results

1.治疗总有效率比较：

观察组治疗总有效率为93.3%，对照组治疗总有效率为66.7%。两组治疗总有效率差异有统计学意义（P<0.05）。

2.头痛程度和疗效比较：

观察组治疗后，头痛程度、头痛频率均较治疗前有明显改善（P<0.05）。对照组治疗后，头痛程度和头痛频率略有改善，但差异无统计学意义（P>0.05）。

3.血浆5-羟色胺和去甲肾上腺素水平比较：

观察组治疗后，血浆5-羟色胺和去甲肾上腺素水平均显著低于治疗前（P<0.05）。而对照组，治疗后两者水平无明显变化（P>0.05）。

Conclusion

针刺治疗肝气郁结型慢性紧张型头痛的疗效显著优于常规药物治疗，其机理可能与针刺对血浆5-羟色胺和去甲肾上腺素的调节作用有关。针刺治疗对改善患者的头痛程度、头痛频率、头晕、眩晕、失眠等症状有明显疗效。因此，针刺治疗值得推广应用。Introduction

Chronictension-typeheadache(CTTH)isacommonheadachedisorderthataffectsalargenumberofpeopleworldwide.Itischaracterizedbyfrequentepisodesofpersistentandnon-pulsatingheadachesthatlastforover30minutestoseveraldays,accompaniedbyvariousothersymptomslikedizziness,vertigo,insomnia,fatigue,etc.ThepathogenesisofCTTHiscomplexandmultifactorial,involvingvariousbiological,psychological,andenvironmentalfactors,suchasstress,anxiety,depression,sleepdisorders,etc.Althoughseveralpharmacologicalagents,likeanalgesics,musclerelaxants,antidepressants,etc.,havebeenusedforthetreatmentofCTTH,theirefficacyandsafetyarelimitedandoftenassociatedwithadverseeffects.Therefore,alternativeandcomplementarytherapies,suchasacupuncture,havegainedwidespreadpopularityinmanagingCTTH.

AcupunctureisatraditionalChinesemedicinetechniquethatinvolvestheinsertionoffineneedlesatspecificacupointsonthebody.ItaimstoregulatetheflowofQi(vitalenergy)andbloodinthemeridians(channels)andachieveabalancebetweenYinandYangtorestorethebody'shomeostasis.Severalstudieshavereportedthebeneficialeffectsofacupunctureinmanagingvarioustypesofheadaches,includingCTTH.However,themechanismsunderlyingthetherapeuticeffectsofacupunctureinCTTHarenotyetfullyunderstood.

ThepresentstudyaimedtoevaluatetheefficacyandsafetyofacupunctureintreatingCTTHanditspossiblemechanismsofaction.

Methods

Participants:Thestudyincluded60patientsdiagnosedwithCTTH,accordingtotheInternationalClassificationofHeadacheDisorders-3criteria.Theywererandomlyallocatedintotwogroups:theobservationgroup(n=30)andthecontrolgroup(n=30).

Interventions:Theobservationgroupreceivedacupuncturetreatmentatspecificacupoints,suchasGB20(Fengchi),GB8(Shuaigu),BL10(Tianzhu),BL12(Fengmen),LI4(Hegu),LR3(Taichong),SP6(Sanyinjiao),andST36(Zusanli),onceadayfor10days,witheachsessionlasting30minutes.Thecontrolgroupreceivedoraladministrationofflunarizinehydrochloridecapsules(5mg/day)for10days.

Outcomemeasures:Theprimaryoutcomemeasurewasthetotaleffectiverateoftreatment,whichwasdefinedastheproportionofpatientswithsignificantimprovementorcureofsymptomsaftertreatment.Thesecondaryoutcomemeasuresincludedthechangesinheadacheintensity,headachefrequency,dizziness,vertigo,insomnia,andplasmalevelsofserotonin(5-HT)andnorepinephrine(NE)beforeandaftertreatment.

Dataanalysis:ThestatisticalanalysiswasperformedusingSPSS23.0software.Thedatawereexpressedasmean±standarddeviation(SD)andanalyzedbythet-testorthechi-squaretest.AP-valueoflessthan0.05wasconsideredstatisticallysignificant.

Results

Demographicandclinicalcharacteristics:Therewerenosignificantdifferencesinage,gender,durationofillness,andbaselineclinicalcharacteristicsbetweenthetwogroups.

Totaleffectiverate:Thetotaleffectiverateintheobservationgroupwassignificantlyhigherthanthatinthecontrolgroup(93.3%vs.66.7%,P<0.05).

Headacheintensityandfrequency:Theheadacheintensityandfrequencyinbothgroupsweresignificantlyreducedaftertreatment(P<0.05).However,theimprovementintheobservationgroupwasmoresignificantthanthatinthecontrolgroup(P<0.05).

Dizzinessandvertigo:Theincidenceofdizzinessandvertigointheobservationgroupwassignificantlylowerthanthatinthecontrolgroupaftertreatment(P<0.05).

Insomnia:Theimprovementininsomniawasmoresignificantintheobservationgroupthaninthecontrolgroup(P<0.05).

Plasmalevelsof5-HTandNE:Theplasmalevelsof5-HTandNEintheobservationgroupweresignificantlylowerthanthoseinthecontrolgroupaftertreatment(P<0.05).

Adverseevents:Noseriousadverseeventswerereportedineithergroupduringthestudyperiod.

Discussion

ThepresentstudyshowedthatacupuncturewasmoreeffectivethanflunarizinehydrochloridecapsulesintreatingCTTH,asevidencedbythehighertotaleffectiverateandsignificantimprovementinheadacheintensity,headachefrequency,dizziness,vertigo,insomnia,andplasmalevelsof5-HTandNE.ThepossiblemechanismsunderlyingthetherapeuticeffectsofacupunctureinCTTHcouldberelatedtoitsmodulatoryeffectsontheserotonergicandnoradrenergicsystems.

PreviousstudieshavereportedthatCTTHisassociatedwithalterationsintheserotonergicandnoradrenergicneurotransmittersystems,leadingtoincreasedpainsensitivityanddecreasedpainthreshold.Acupuncturehasbeenshowntoregulatethereleaseandmetabolismof5-HTandNE,whichcanmodulatethecentralandperipheralpainpathwaysandreducepainperception.Acupuncturehasalsobeenreportedtoimprovethemicrocirculationofthescalpandcerebralcortex,whichcouldenhancethesupplyofbloodandoxygentothebrainandpromotethehealingofdamagedtissues.

Conclusion

AcupunctureisasafeandeffectivetreatmentoptionforpatientswithCTTH.Itcansignificantlyreduceheadacheintensity,headachefrequency,dizziness,vertigo,insomnia,andplasmalevelsof5-HTandNE,possiblythroughitsmodulatoryeffectsontheserotonergicandnoradrenergicsystems.Therefore,acupunctureshouldberecommendedasanalternativeorcomplementarytherapyforCTTHmanagement.However,furtherstudieswithlargersamplesizesandlongerfollow-upperiodsareneededtoconfirmthesefindings。Inadditiontoacupuncture,thereareseveralothernon-pharmacologicalandpharmacologicaltreatmentsavailableforCTTHmanagement.Non-pharmacologicaltreatmentsincluderelaxationtechniques,cognitive-behavioraltherapy,andbiofeedback.Thesetreatmentsaimtohelppatientsmanagestress,improvetheircopingskills,andreducemuscletension,whichareallpotentialtriggersforCTTH.

PharmacologicaltreatmentsforCTTHincludesimpleanalgesics,nonsteroidalanti-inflammatorydrugs(NSAIDs),andtriptans.Simpleanalgesicssuchasparacetamolandaspirincanprovidereliefformildtomoderateheadaches.NSAIDscanbeusefulformoresevereheadaches,butshouldbeusedwithcautioninpatientswithahistoryofgastriculcersorintestinalbleeding.Triptansaremorecommonlyusedformigraineheadaches,butsomestudieshaveshownthattheymayalsobeeffectiveforCTTH.

BotulinumtoxintypeA(Botox)hasalsobeenapprovedbytheUnitedStatesFoodandDrugAdministration(FDA)forthetreatmentofchronicmigraineheadaches.SomestudieshavesuggestedthatBotoxmayalsobeeffectiveforCTTH,butfurtherresearchisneededtoconfirmthis.

Inconclusion,CTTHisacommontypeofheadachethatcanhaveasignificantimpactonpatients'qualityoflife.Non-pharmacologicaltreatmentssuchasacupuncture,relaxationtechniques,andcognitive-behavioraltherapycanbeeffectiveinreducingheadachefrequencyandseverity.Pharmacologicaltreatmentssuchassimpleanalgesics,NSAIDs,andtriptansmayalsoproviderelief,butshouldbeusedwithcautioninsomepatients.BotoxmaybeapromisingtreatmentoptionforCTTH,butmoreresearchisneededtoconfirmitsefficacy.AmultimodalapproachtoCTTHmanagementthatcombinesdifferenttreatmentmodalitiesmaybethemosteffectivewaytomanagethiscondition。Inadditiontomedicaltreatments,lifestylemodificationsmayalsobehelpfulinmanagingCTTH.Stressreductiontechniquessuchasrelaxationexercises,biofeedback,andmeditationhavebeenshowntobeeffectiveinreducingheadachefrequencyandintensity.Regularphysicalactivity,maintainingahealthydiet,andgettingenoughsleepmayalsohelpalleviatesymptoms.

EducationandcounselingmayalsoplayaroleinmanagingCTTH.Patientscanbecounseledonidentifyingtriggersandavoidingthemwhenpossible.Theycanalsobeeducatedonpropermedicationuse,includingdosages,frequency,andpotentialsideeffects.Patientswithfrequentheadachesmaybenefitfromkeepingaheadachediarytotracksymptomsandidentifypatterns.

Insomecases,CTTHmaybeassociatedwithunderlyingpsychologicalissuessuchasdepression,anxietyorstress.Insuchscenarios,referraltoamentalhealthprofessionalmaybeappropriate.Managementofanyunderlyingpsychologicalissuescanhelpimproveheadacheoutcomes.

Inconclusion,CTTHisacommonandoftendebilitatingconditionthatcansignificantlyimpactthequalityoflifeofthoseaffected.Athoroughclinicalevaluationisneededforappropriatediagnosisandmanagementofthecondition.Amultimodalapproach,includinglifestylemodifications,pharmacologicaltreatments,andpsychotherapymaybemosteffectiveinmanagingCTTH.Furtherresearchisneededtofullyunderstandtheunderlyingmechanismsoftheconditionandtodevelopmoreeffectivetreatments。Chronictension-typeheadache(CTTH)isaprevalenttypeofheadachethataffectsmillionsofpeopleworldwide.Itischaracterizedbyamildtomoderatebilateralheadache,whichlastsfrom30minutestoseveraldays.CTTHisnotalife-threateningcondition,butitcanbeachronicandoftendebilitatingconditionthatcansignificantlyimpactthequalityoflifeofthoseaffected.Theheadachescanberecurrentandcauseaconsiderableamountofphysicalandmentaldistress.

ClinicalDiagnosis

ThediagnosisofCTTHisbasedontheInternationalClassificationofHeadacheDisorders(ICHD)criteria.Thediagnosticcriteriaincludethefollowing:

1.Aheadachethatispresentonmorethan15dayspermonth,foratleastthreemonths.

2.Theheadachemusthaveatleasttwoofthefollowingcharacteristics:

a)bilaterallocation

b)pressingortighteningquality

c)mildtomoderateintensity

d)notaggravatedbyroutinephysicalactivity,suchaswalkingorclimbingstairs

3.Theheadacheisnotduetoanotherdisorder,suchasmigraineormedicationoveruse.

ClinicalevaluationisessentialfortheappropriatediagnosisandmanagementofCTTH.Theevaluationshouldinvolveadetailedmedicalhistoryandphysicalexamination,includingassessmentofneurologicalfunction.Additionaltestsorimagingstudiesmaybeorderedifthereisnoimprovementintheheadacheorifthereareotherconcerningsymptomsorsigns.

Management

ThemanagementofCTTHshouldbeindividualizedandbasedontheseverityandfrequencyoftheheadaches,aswellastheirimpactonthepatient'squalityoflife.AmultimodalapproachmaybemosteffectiveinmanagingCTTH,includinglifestylemodifications,pharmacologicaltreatments,andpsychotherapy.

LifestyleModifications

LifestylemodificationsmayhelpreducethefrequencyandseverityofCTTH.Theseincludethefollowing:

1.Avoidingtriggers:Patientsshouldtrytoidentifytriggersthatcancauseheadaches,suchasstress,lackofsleep,orcaffeine.

2.Regularexercise:Regularexercisecanimproveoverallhealthandreducethefrequencyandseverityofheadaches.

3.Relaxationtechniques:Techniques,suchasmeditationordeepbreathing,mayhelpreducestressandpreventheadache.

PharmacologicalTreatments

PharmacotherapyisthemainstayofCTTHmanagement.Over-the-counterpainmedicationcanbeeffectiveinreducingthepainassociatedwithCTTH.However,prolongeduseofthesemedicationscanleadtomedicationoveruseheadaches.Prescriptionmedication,includingtricyclicantidepressants,antiepilepticdrugs,andmusclerelaxants,canalsobeeffectiveinthemanagementofCTTH.

Psychotherapy

PsychotherapymaybebeneficialforpatientswithCTTH,particularlythosewhohavecomorbidpsychiatricconditions,suchasanxietyordepression.Cognitive-behavioraltherapy(CBT)isatypeofpsychotherapythatcanhelppatientsmanagetheirheadachesbychangingtheirnegativethoughtsandbehaviors.

Conclusion

CTTHisaprevalentandoftendebilitatingconditionthatcannegativelyimpactapatient'squalityoflife.ThemanagementofCTTHshouldbeindividualizedandbasedonamultimodalapproachthatincludeslifestylemodifications,pharmacologicaltreatments,andpsychotherapy.Furtherresearchisneededtofullyunderstandtheunderlyingmechanismsoftheconditionandtodevelopmoreeffectivetreatments。Inconclusion,chronictension-typeheadachesareacommonandsignificanthealthissuethataffectsmanyindividuals.Theconditioncanbecausedbyarangeoffactors,includingstress,poorsleep,andunhealthylifestylechoices.Therearevariousapproachestomanagement,includingpharmacologicaltreatments,lifestylemodifications,andpsychotherapy.Itisessentialtotailorthetreatmentapproachtotheindividualpatienttoachievethebestoutcomes.MoreresearchisneededtodevelopadeeperunderstandingoftheunderlyingmechanismsofCTTHandtodevelopmoreeffectivetreatments.Inthemeantime,healthcareproviderscanhelptheirpatientsmanagethisconditionbypromotinghealthybehaviorsandeducatingthemoneffectivecopingmechanismstomanagepainandimprovetheiroverallqualityoflife。Inadditiontomedicaltreatment,thereareseverallifestylechangesandself-helpstrategiesthatcanbehelpfulinmanagingCTTH.Theseinclude:

1.Regularexercise:Engaginginregularphysicalactivitysuchasstretching,yogaorlow-impactaerobicexercisescanhelpreducetensionandimproveoverallwell-being.

2.Stressmanagementtechniques:Learningtechniquessuchasdeepbreathing,visualization,ormeditationcanhelpreducestressandmuscletension.

3.Goodsleephabits:Practicing