颈部压痛点处的手法治疗对紧张型头痛的效果观察

摘要

BACKGROUND: Whether maneuver treatment on cervical pain point and painful tubercle can improve the symptoms and signs of tension headache.OBJECTIVE: To study the relationship between cervical pain point and tension headache and explore the effect of maneuver treatment.DESIGN: A ease-control study based on diagnosis was conducted.SETTING and PARTICIPANTS: There were 280 eases of tension headache(80 males, 200 females) that were diagnosed according to the standard issued by International Headache Society in 1988. There were 150health people in control group(50 males, 100 females).METHODS: The number and position of pain points and painful tubercles on median and paramedian part from external occipital protuberance to the 7th cervical spine were marked. Maneuver treatment including malaxation,plucking and pressing on pain point and painful tubercle was used. Relief of muscle spasm and improvement of local circulation were measured.MAIN OUTCOME MEASURES: Positive rate of pain point and painful tubercle in tension headache and control group; The distribution of cervical pain point and painful tubercle in headache group; Assessment of the effect of maneuver treatment.RESULTS: Positive rate of pain point and painful tubercle in tension headache and control group were 58.9%, 28.6% and 1.3%, 0.6% respectively(x2 =262.6, P ＜ 0. 005) . After 1 -6 times of treatment, 183cases recovered(65.4% ), 58 cases improved significantly(20. 7% ), 27cases improved(9.6% ), 2 cases showed no effect(0.7% ). Total improvement rate was 86. 1%.%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:TFH组和对照组压痛点、痛性结节阳性率,TFH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%)(x2=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.