紧张型头痛教材教学课件.pptxVIP

TENSION TYPE HEADACHEZhibin song紧张型头痛(TENSION TYPE HEADACHE, TTH)表现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慢性头部紧束样或压迫性疼痛，通常为双侧头痛最常见神经内科门诊Chin Neurol ,2007,40(7):496-497.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 4–6 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 information—for example from the temporal muscle or other muscles—and interprets this signal as pain 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 精神因素2（紧张、焦虑、抑郁）头颈部姿势异常2（激发性颈椎病）激活潜在颅周肌筋膜触发点4(触发点区肌肉伴局部触痛点、紧张感、可触及硬结、假性无力和活动受限)脊髓背角Ⅱ级神经元敏化3（增强痛觉传递）紧束样或压迫性疼痛骨骼肌收缩是产生头痛的基本原因紧张型头痛主要病因假说：颅周肌肉持续收缩1-4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 ）1. F