• 简介　　　　　• 一览表　　　　　• 症状　　　　• 治疗

• 生活方式的改变　　　　 • 营养补充剂　　　　• 草药

• 整体疗法　　　• 参考文献

　　“紧张性头痛”是一种较为常见的头痛类型，其典型表现为“颈后部”出现无悸动的钝痛感，一般呈“头巾样”分布特点。[1]它可能与头颈部的结节有关，这些结节一般会有压痛，又叫做“触发点”，[2]另外，它也可能与头部周围肌肉群的压痛有关。[3]

紧张性头痛的辅助疗法

紧张性头痛的症状

　　头痛患者可能有以下症状：全身感觉不适、头部疼痛感、悸动、迟钝、沉重感以及紧绷感。头痛患者的不适感可能会因为运动或压力而加重，并可能与易怒、睡眠问题和疲劳乏力相关。

医药治疗

　　常规推荐的非处方镇痛药包括“阿司匹林”（aspirin，Bayer®，Ecotrin®，Bufferin®），“退热净”（acetaminophen，Tylenol®），以及“布洛芬”（ibuprofen，Motrin®, Advil®）等等，可用以缓解由紧张性头痛引起的程度较轻的疼痛。医生可能还会推荐患者在颈部肌肉紧张处采用“湿热疗法”或做一些力度较为轻柔的“按摩”。

可能有益的生活方式

　　紧张性头痛在经历几次精神压力或情感压力后，通常发作次数会越来越频繁，症状会越来越严重。[4, 5 ,6]若干项对照研究发现，相比较于非头痛患者，紧张性头痛患者经常觉得自己压力较大。[7, 8, 9]另外，他们的抑郁水平、焦虑水平、被压抑的愤怒感[13]、肌肉紧张度[14 ,15]也明显较高。医生一般推荐紧张性头痛患者尽量减少压力，保持充分睡眠，并进行有规律的锻炼。但是，目前尚无研究对这些生活方式的改变所带来的效果进行调查。一项以“肌肉收缩性头痛”和其它类型头痛患者为受试者的对照研究显示，相比较于非吸烟者，吸烟者患头痛病后，病情一般更为严重。[16]虽然其它研究尚未发现头痛与吸烟之间存在相关性，但是无论如何，大家一定要记住，戒烟永远是保持健康的好方法。

可能有益的营养补充剂

　　左旋5-羟色胺（5-HTP）可能对紧张性头痛有所帮助。最近一项双盲研究发现，患有慢性紧张性头痛的成年人每日服用300毫克5-羟色胺，可使头痛发作天数降低36％，但是这个结果与安慰剂组的29％相比，并没有显著差异。[17]一般来说，即使仅给予无活性的安慰剂，头痛通常也会得到显著改善。[18]因此，研究者认为，在“头痛缓解程度”这一方面，5-羟色胺与安慰剂的疗效差不多。但是，在“头痛发作时患者对镇痛剂的需求度”这一点上，5-羟色胺比安慰剂显示出显著优势。以前也有一些双盲试验对5-羟色胺在各种类型的头痛患者（包括一些紧张性头痛患者）中的作用进行了研究。这些研究结果同样发现，成人每日服用400毫克，儿童每日服用100毫克5-羟色胺，确实对头痛患者有一定效果，但是与安慰剂组比较后，发现其效果并不显著。[20]

有无副作用及药物之间相互作用？

请参考各种草药的副作用及相互作用。

可能有益的草药

　　一份初步报告表明，“薄荷油”具有放松和缓解疼痛的功效，可作为一种局部使用的药物用于紧张性头痛的治疗。[21]如果在太阳穴处抹10％薄荷油溶剂，每日3次，每次持续30分钟，结果显示，它比安慰剂组的镇痛效果更为显著，但与退热净的效果等同。[22]另外还有一种使用方法类似的药膏，内含“薄荷脑”和其它与薄荷油相关的药油。该药膏与镇痛药的疗效等同，但比安慰剂的效果更佳。[23]

有无副作用及药物之间相互作用？

请参考各种草药的副作用及相互作用。

可能有益的整体疗法

针灸治疗

　　在关于针灸治疗紧张性头痛的研究中，结果较不统一。[24]在两项有关针灸的对照试验中，有一项试验显示，真针灸比“假”针灸具有更显著镇痛效果，[25]而另一项显示两种治疗方法之间并无显著差异。[26]比较针灸和传统物理疗法（包括放松法、自我按摩法、冷疗法、经皮神经电刺激[TENS]、拉伸和预防教育）对于紧张性头痛的疗效，发现两种治疗对患者的改善效果相似。[27, 28]以各种类型的头痛患者（包括紧张性头痛）为受试者，采用各种疗法对他们进行治疗。部分试验表明，“针灸”的效果更为显著，[29 ,30]但并不是所有结果都是如此。[31]

　　两项初步研究表明，[32, 33]在特定的针灸穴位上加“指压”（即“针压法”），可缓解部分紧张性头痛患者的疼痛感。但是，目前尚无该疗法的相关研究。

整脊疗法

　　“整脊疗法”可能对某些紧张性头痛患者有所帮助。若干项初步研究表明，整脊疗法可降低紧张性头痛的发作频率，并减轻头痛的严重程度。[34, 35, 36 ,37 ,38, 39]一项对照试验比较了“整脊疗法”和“药物疗法”对于紧张性头痛患者的疗效。[40]在治疗期间，两治疗组均有同等程度的改善，虽然“整脊疗法组”的副作用远远少于“药物治疗组”。但是在治疗结束一个月后，只有“整脊疗法组”的患者继续保持疗效。另一项对照试验显示，相比较于“按摩法”，“整脊疗法”可更有效地减少患者的每日头痛发作时间，减少对止痛药的依赖性，并减轻每次发作时的剧痛感。[41]另外，带有“肌肉按摩”的整脊疗法与按摩加假激光疗法的疗效等同，从而说明“整脊疗法”也并没有提供其它新的疗效。[42]

物理疗法

　　根据以上所提到的两项对照研究发现，“物理疗法”（放松法、自我按摩法、冷疗法、经皮神经电刺激、拉伸和/或预防教育）与“针灸疗法”一样，可显著减轻头部疼痛感以及头痛发作次数。[43 ,44]一项初步研究也发现，“物理疗法”，包括形态课、居家锻炼、按摩、颈部肌肉拉伸等，均可显著改善紧张性头痛，并且效果可持续至治疗结束后一年。[45]另一项初步研究显示，“按摩”（包括深层穿透技术）可显著减轻慢性紧张性头痛患者的疼痛感。[46]另外，颈部及肩部肌肉痉挛的头痛患者在进行物理治疗（由暖袋、按摩和超声组成）的同时，加入“经皮神经电刺激”，结果显示，相比较于单独使用物理疗法，其头痛症状的减轻速度和减轻程度更为显著。[47]

肌电图——生物反馈疗法

　　“肌电图（EMG）—生物反馈疗法”，可以教人如何在精神上放松颈部及头部肌肉群，无论对于成人[48, 49,50 ,51 ,52]，还是儿童和青少年，[53 ,54]该疗法均可使大约50％的紧张性头痛患者得到改善。“进行性肌肉放松”是另一种肌肉放松方法，在成人[55, 56]或是儿童和青少年[57. 58]的对照研究表明，该疗法可显著减轻紧张性头痛。

放松疗法

　　对于慢性紧张性头痛患者，“放松疗法”比“药物疗法”更能有效缓解压力。[59]但是，在放松治疗结束后，其中有一半受试者仍会继续头痛发作，大约每周发作3至4天。

　　另外，研究者还将“放松疗法”（包括进行性肌肉放松，催眠疗法，认知心理疗法）与“肌电图－生物反馈疗法”进行比较，发现后者对慢性紧张性头痛患者更有效，可更显著减轻头痛程度以及头痛发作频率。[61]

催眠疗法

　　一项大规模的研究显示，“催眠疗法”可显著减轻慢性紧张性头痛患者的头痛剧烈程度和持续时间。[60]

接触性治疗

　　一项对照试验显示，“接触性治疗”可显著减轻紧张性头痛患者的头部疼痛感，持续时间可延长至治疗结束后4小时。[62]但是目前尚无此种疗法的深入研究结果。

足部放射疗法

　　“足部放射疗法”是另外一种较为特殊的疗法，即在足底的各个放射区进行按摩，目前仅有一项初步试验对其疗效进行研究。[63]在该研究中进行治疗的大部分患者得到了一定程度的改善。

激素疗法

　　研究者对包括紧张性头痛在内的头痛患者进行“激素疗法”，结果并未发现“激素疗法”对头痛具有显著疗效。[64]

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