不同亚型紧张型头痛的心理因素及中枢调控机制研究

Psychological factors for different subtypes of tension-type headache and their central modulating mechanism

目的探讨不同亚型紧张型头痛的心理因素及中枢调控机制异常及其相互关系。方法选择紧张型头痛患者90例,根据分型标准分为偶发性紧张型头痛组30例,频发性紧张型头痛组30例,慢性紧张型头痛组30例,另选健康体检者30例为对照组。进行外感受抑制试验及神经心理评估,测定第一、第二外感受抑制期(ESP)的潜伏期、时程及焦虑评分、抑郁评分。结果偶发性紧张型头痛组ESP2潜伏期、时限及焦虑评分与对照组比较,差异无统计学意义(P>0.05);慢性紧张型头痛组ESP2潜伏期较对照组明显延长,时限较对照组明显缩短,焦虑评分较对照组明显增高(P<0.05,P<0.01);频发性紧张型头痛组ESP2潜伏期较对照组明显延长,时限较对照组明显缩短,但改变不及慢性紧张型头痛组显著(P<0.05)。结论偶发性紧张型头痛患者无明显心理障碍及中枢调控异常存在;慢性紧张型头痛患者存在中枢性疼痛调节机制异常及焦虑状态;频发性紧张型头痛患者存在相对轻微的中枢调控异常;心理因素或参与紧张型头痛中枢调控机制,促进中枢调控机制的异常。

Objective To study the relation between psychological factors for different subtypes of tension-type headache and their abnormal central modulating mechanism. Methods Ninety pa- tients with tension-type headache were divided into infrequent tension-type headache group, fre- quent tension-type headache group,and chronic tension-type headache group （30 in each group） according to its classification criteria. Thirty subjects undergoing health check served as a control group. After they underwent exteroceptive supperssion test and neuropsychological test,the latent period and duration of the first exteroceptive suppression period and the second exteroceptive sup- pression period （ESP2）,their anxiety and depression were scored. Results The latent ESP2 was significantly longer,the duration of ESP2 was significantly shorter,and the anxety score was sig- nificantly higher in chronic and frequent tension-type headache groups than in control group （P〈0. 05 , P〈0. 01）. Conclusion No significant mental disturbance and abnormal central modulating fuction are observed in batients with infrequent tension-type headache. Abnormal central modula- ting function and anxiety are found in patients with chronic tension-type headache. The abnormal central modulating function is mild in patients with frequent tension-type headache. Psychological factors may participate in central modulating mechanism underlying tension-type headache and lead to abnormal central modulating function.