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背景:在颈部软组织压痛点和痛性结节处施用手法治疗可否改善紧张性头痛的症状及体征。目的:观察颈部压痛点与紧张型头痛(tension-headche,TTH)之间的关系,探讨手法治疗的作用。设计:以诊断为依据的病例对照研究。地点和对象:TTH患者280例,男80例,女200例;诊断标准参照1988年国际头痛学会头痛分类标准。对照组150例,为无头痛症状的健康体检者,男50例,女100例。方法:触诊枕外隆突下至颈棘突止中线及其旁开,记录每一压痛点、痛性结节总数及部位,实施揉拿、弹拨、点按使颈部压痛点及痛性结节的手法治疗。观察肌肉痉挛的缓解程度及局部血液循环的改善。主要观察指标:TTH组和对照组压痛点、痛性结节阳性率,TTH患者压痛点和痛性结节在枕颈部分布情况,采用手法治疗后疗效评定结果。结果:TTH组和对照组压痛点、痛性结节阳性率分别为(58.9%,28.6%和1.3%和0.6%)(χ2=262.6,P<0.005)。主要分布在上颈段(C1～2,C2～3)棘中线和棘突旁。经1～6次治疗,痊愈183例(65.4%),显效58例(20.7%),好转27例(9.6%),无效2例(0.7%),总显效率86.1%。结论:颈部肌肉障碍在TTH的发病机制中起重要作用,针对压痛点手法治疗,产生显著的疗效。
Background: The management of tension and painful nodules at the neck soft tissue can improve the symptoms and signs of tension headache. Objective: To observe the relationship between neck tenderness point and tension-headache (TTH) and to explore the effect of manual therapy. Design: A case-control study based on diagnosis. Location and object: TTH patients 280 cases, 80 males and 200 females; diagnostic criteria with reference to the 1988 International Headache Society headache classification criteria. The control group of 150 patients without headache symptoms of physical examination, 50 males and 100 females. Method: palpate the occipital cord to the genitalscentral line and its next to open, record each tenderness point, the total number of painful nodules and sites, the implementation of rubbing, plucked, click to the neck tenderness and pain Nodular manipulation. To observe the degree of remission of muscle spasms and local blood circulation improvement. MAIN OUTCOME MEASURES: The tenderness point, the positive rate of painful nodules in TTH group and the control group, the distribution of tenderness point and painful nodules in the occipitocervical neck in TTH patients, and the curative effect evaluation results after manipulation. Results: The positive rates of tenderness and painful nodules in TTH group and control group were 58.9%, 28.6% and 1.3%, 0.6%, respectively (χ2 = 262.6, P <0.005). Mainly located in the upper cervical segment (C1 ~ 2, C2 ~ 3) spine midline and spinous process. After 1 to 6 treatments, 183 cases (65.4%) were cured, 58 (20.7%) were cured, 27 (9.6%) were improved, 2 were ineffective (0.7%) and the total effective rate was 86.1%. CONCLUSIONS: Neck muscle disorder plays an important role in the pathogenesis of TTH, and has significant therapeutic effect on the tender point.