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1、紧张型头痛诊疗专家共识解读,共识简介,疼痛学分会头面痛学组于2007年制定的紧张型头痛诊疗专家共识，极大地推动了紧张型头痛（TTH）的规范诊疗过去的七年中，我国开展了全国范围的基于人口的TTH患病率及疾病负担的流行病学调查，国内外在TTH的发病机制及诊疗取得了很多新的进展，国际头痛学会也于2013年发布了新的头痛疾患分类及诊断标准对原有专家共识进行修订，迫在眉睫！,目录,流行病学病因和发病机制临床表现和共病分类诊断与鉴别诊断治疗特殊类型紧张型头痛的治疗,TTH患病率因定义与标准不同而异,TTH的患病率因为定义概念的差异，调查结果也不同；同时得到的年发病率也不同，加之ICHD-和ICHD-的诊断
2、标准也略有不同TTH的患病率从欧洲的约80%到北美的20%30%不等，全球平均约为42%但世界各地的流行病学调查结果显示人种和地域的差异很大，1865岁人群中慢性TTH的患病率是0.5%,Stewart W F, Simon D, Shechter A, et al. Population variation in migraine prevalence: a meta-analysis J. J Clin Epidemiol, 1995, 48(2): 269-280.Stovner L, Hagen K, Jensen R, et al. The global burden of head
3、ache: a documentation of headache prevalence and disability worldwide J. Cephalalgia, 2007, 27(3): 193-210.Schramm SH， Obermann M, Katsarava Z et al. Epidemiological profiles of patients with chronic migraine and chronic tension type headache. The Journal of Headache and Pain 2013 14:40.,亚太地区的TTH患病率
4、略低于欧美国家年患病率介于10.8%33.3%,Yu S, Liu R, Zhao G, et al. The prevalence and burden of primary headaches in China: a population-based door-to-door survey J. Headache, 2012, 52(4): 582-591.Cheung R T. Prevalence of migraine, tension-type headache, and other headaches in Hong Kong J. Headache, 2000, 40(6):
5、473-479.Sakai F, Igarashi H. Prevalence of migraine in Japan: a nationwide survey J. Cephalalgia, 1997, 17(1): 15-22.Kim B K, Chu M K, Lee T G, et al. Prevalence and impact of migraine and tension-type headache in Korea J. J Clin Neurol, 2012, 8(3): 204-211.Ho K H, Ong B K. A community-based study o
6、f headache diagnosis and prevalence in Singapore J. Cephalalgia, 2003, 23(1): 6-13.Alders E E, Hentzen A, Tan C T. A community-based prevalence study on headache in Malaysia J. Headache, 1996, 36(6): 379-384.Chakravarty A, Mukherjee A, Roy D. Migraine pain location at onset and during established he
7、adaches in children and adolescents: a clinic-based study from eastern India J. Cephalalgia, 2007, 27(10): 1109-1114.,TTH年患病率（%）,亚太地区的TTH年患病率为10.8%33.3%，其中中国大陆、韩国和印度采用ICHD-的紧张型头痛标准,亚洲人群的TTH高发年龄多为中青年,我国TTH的高发年龄段为40-49岁，与日本、新加坡研究结果相一致,Yu S, Liu R, Zhao G, et al. The prevalence and burden of primary he
8、adaches in China: a population-based door-to-door survey J. Headache, 2012, 52(4): 582-591.Cheng X. Epidemiologic survey of migraine in six cities of China J. Zhonghua Shen Jing Jing Shen Ke Za Zhi, 1990, 23(1): 44-46, 64.Roh J K, Kim J S, Ahn Y O. Epidemiologic and clinical characteristics of migra
9、ine and tension-type headache in Korea J. Headache, 1998, 38(5): 356-365.Kim B K, Chu M K, Lee T G, et al. Prevalence and impact of migraine and tension-type headache in Korea J. J Clin Neurol, 2012, 8(3): 204-211.Takeshima T, Ishizaki K, Fukuhara Y, et al. Population-based door-to-door survey of mi
10、graine in Japan: the Daisen study J. Headache, 2004, 44(1): 8-19.Cheung R T. Prevalence of migraine, tension-type headache, and other headaches in Hong Kong J. Headache, 2000, 40(6): 473-479.Alders E E, Hentzen A, Tan C T. A community-based prevalence study on headache in Malaysia J. Headache, 1996,
11、 36(6): 379-384.,亚洲人群的TTH以女性略为多见,多数亚洲人群的研究结果是女性略多，男女患病比为1:1.721-4一项针对来自解放军总医院国际头痛中心的310例TTH患者的临床特点进行的分析结果显示，女性TTH患病率略高于男性但新加坡和韩国的研究结果为男女没有差别6,7,Takeshima T, Ishizaki K, Fukuhara Y, et al. Population-based door-to-door survey of migraine in Japan: the Daisen study J. Headache, 2004, 44(1): 8-19.Cheun
12、g R T. Prevalence of migraine, tension-type headache, and other headaches in Hong Kong J. Headache, 2000, 40(6): 473-479.Alders E E, Hentzen A, Tan C T. A community-based prevalence study on headache in Malaysia J. Headache, 1996, 36(6): 379-384.Yu S, Liu R, Zhao G, et al. The prevalence and burden
13、of primary headaches in China: a population-based door-to-door survey J. Headache, 2012, 52(4): 582-591.朱玉飞, 等. 310例紧张型头痛患者临床特点分析. 2014, 20(8):565-8.Roh J K, Kim J S, Ahn Y O. Epidemiologic and clinical characteristics of migraine and tension-type headache in Korea J. Headache, 1998, 38(5): 356-365.
14、Ho K H, Ong B K. A community-based study of headache diagnosis and prevalence in Singapore J. Cephalalgia, 2003, 23(1): 6-13.,目录,流行病学病因和发病机制临床表现和共病分类诊断与鉴别诊断治疗特殊类型紧张型头痛的治疗,多种因素参与TTH的发生,遗传和环境因素对TTH的影响,遗传流行病学的研究显示紧张型头痛具有家族聚集倾向，慢性紧张型头痛患者在一级亲属的发病危险性是普通人群的3.1倍，但环境因素对紧张型头痛的影响更大一项基于双胞胎进行的人群研究结果显示：遗传作用在TTH发生
15、中起近一半的作用,Kaniecki R G. Tension-type headache.J. Continuum (Minneap Minn). 2012, 18(4): 823-834.Russell M B. Genetics of tension-type headacheJ. J Headache Pain. 2007, 8(2): 71-76.,遗传可能性（%）,N=7360对双胞胎（年龄12-41岁）,http:/ C, et al. Myofascial trigger points and sensitization: an updated pain model for te
16、nsion-type headache. Cephalalgia. 2007;27(5):383-93.,慢性TTH的病理生理机制模型,Fumal A, Schoenen J. Tension-type headache: current research and clinical management. Lancet Neurol. 2008 Jan;7(1):70-83.,TTH主要源于颅周肌肉收缩和中枢疼痛调节机制的异常等多因素共同作用的结果,Fernndez-de-las-Peas C, et al. Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia. 2007;27(5):383-93.,
