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成人紧张型头痛：急性治疗

Author
Frederick R Taylor, MD
Section Editor
Jerry W Swanson, MD, MHPE
Deputy Editor
John F Dashe, MD, PhD

引言

紧张型头痛(tension-type headache, TTH)是一般人群中最普遍存在的头痛，也是人们购买非处方镇痛药的最常见原因之一。尽管TTH的发生率高，以及由这种原发性头痛造成的失能的社会负担大，但是治疗更多的是依据个案佐证和口头共识而不是临床治疗试验。造成这种情况的原因或许是TTH的性质通常为轻度，以致具有这种类型头痛的患者通常自己诊断并自己治疗，除非他们同时存在偏头痛或发生慢性TTH。

理解TTH的病理生理学可能是制订机制健全的、最佳的治疗计划的关键。不幸的是，对TTH的科学认识滞后于对偏头痛的认识，并且被提出的TTH机制仅产生有限的治疗线索。(参见“成人紧张型头痛的病理生理学、临床特征和诊断”，关于‘病理生理学’一节)

本专题将总结成人TTH的急性治疗。TTH的预防性治疗将在别处总结。(参见“成人紧张型头痛：预防性治疗”)

TTH的其他方面将单独讨论。(参见“成人紧张型头痛的病理生理学、临床特征和诊断”)

治疗方法

TTH的急性治疗或对症治疗的范围从非药物治疗至单纯和复方镇痛药治疗。在大多数情况下，TTH的治疗主要是采用非处方药物进行没有获得医务人员的任何意见的自我治疗。一些一般原则与TTH的药物治疗有关：

              

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Literature review current through: 2017-07 . | This topic last updated: 2017-01-24.
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References
Top
  1. Lampl C, Voelker M, Steiner TJ. Aspirin is first-line treatment for migraine and episodic tension-type headache regardless of headache intensity. Headache 2012; 52:48.
  2. Rasmussen BK. Epidemiology of headache. Cephalalgia 1995; 15:45.
  3. Dowson AJ, Tepper SJ, Baos V, et al. Identifying patients who require a change in their current acute migraine treatment: the Migraine Assessment of Current Therapy (Migraine-ACT) questionnaire. Curr Med Res Opin 2004; 20:1125.
  4. Bendtsen L, Evers S, Linde M, et al. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol 2010; 17:1318.
  5. Lenaerts ME. Pharmacotherapy of tension-type headache (TTH). Expert Opin Pharmacother 2009; 10:1261.
  6. Verhagen AP, Damen L, Berger MY, et al. [Treatment of tension type headache: paracetamol and NSAIDs work: a systematic review]. Ned Tijdschr Geneeskd 2010; 154:A1924.
  7. Bigal ME, Rapoport AM, Sheftell FD, et al. Transformed migraine and medication overuse in a tertiary headache centre--clinical characteristics and treatment outcomes. Cephalalgia 2004; 24:483.
  8. Martínez-Martín P, Raffaelli E Jr, Titus F, et al. Efficacy and safety of metamizol vs. acetylsalicylic acid in patients with moderate episodic tension-type headache: a randomized, double-blind, placebo- and active-controlled, multicentre study. Cephalalgia 2001; 21:604.
  9. Lange R, Lentz R. Comparison ketoprofen, ibuprofen and naproxen sodium in the treatment of tension-type headache. Drugs Exp Clin Res 1995; 21:89.
  10. Diamond S. Ibuprofen versus aspirin and placebo in the treatment of muscle contraction headache. Headache 1983; 23:206.
  11. van Gerven JM, Schoemaker RC, Jacobs LD, et al. Self-medication of a single headache episode with ketoprofen, ibuprofen or placebo, home-monitored with an electronic patient diary. Br J Clin Pharmacol 1996; 42:475.
  12. Kubitzek F, Ziegler G, Gold MS, et al. Low-dose diclofenac potassium in the treatment of episodic tension-type headache. Eur J Pain 2003; 7:155.
  13. Packman E, Packman B, Thurston H, Tseng L. Lumiracoxib is effective in the treatment of episodic tension-type headache. Headache 2005; 45:1163.
  14. Schachtel BP, Furey SA, Thoden WR. Nonprescription ibuprofen and acetaminophen in the treatment of tension-type headache. J Clin Pharmacol 1996; 36:1120.
  15. Packman B, Packman E, Doyle G, et al. Solubilized ibuprofen: evaluation of onset, relief, and safety of a novel formulation in the treatment of episodic tension-type headache. Headache 2000; 40:561.
  16. Mehlisch DR, Weaver M, Fladung B. Ketoprofen, acetaminophen, and placebo in the treatment of tension headache. Headache 1998; 38:579.
  17. Dahlöf CG, Jacobs LD. Ketoprofen, paracetamol and placebo in the treatment of episodic tension-type headache. Cephalalgia 1996; 16:117.
  18. Miller DS, Talbot CA, Simpson W, Korey A. A comparison of naproxen sodium, acetaminophen and placebo in the treatment of muscle contraction headache. Headache 1987; 27:392.
  19. Steiner TJ, Lange R, Voelker M. Aspirin in episodic tension-type headache: placebo-controlled dose-ranging comparison with paracetamol. Cephalalgia 2003; 23:59.
  20. Prior MJ, Cooper KM, May LG, Bowen DL. Efficacy and safety of acetaminophen and naproxen in the treatment of tension-type headache. A randomized, double-blind, placebo-controlled trial. Cephalalgia 2002; 22:740.
  21. Steiner TJ, Lange R. Ketoprofen (25 mg) in the symptomatic treatment of episodic tension-type headache: double-blind placebo-controlled comparison with acetaminophen (1000 mg). Cephalalgia 1998; 18:38.
  22. Harden RN, Rogers D, Fink K, Gracely RH. Controlled trial of ketorolac in tension-type headache. Neurology 1998; 50:507.
  23. von Graffenried B, Nüesch E. Non-migrainous headache for the evaluation of oral analgesics. Br J Clin Pharmacol 1980; 10 Suppl 2:225S.
  24. Langemark M, Olesen J. Effervescent ASA versus solid ASA in the treatment of tension headache. A double-blind, placebo controlled study. Headache 1987; 27:90.
  25. Haag G, Diener HC, May A, et al. Self-medication of migraine and tension-type headache: summary of the evidence-based recommendations of the Deutsche Migräne und Kopfschmerzgesellschaft (DMKG), the Deutsche Gesellschaft für Neurologie (DGN), the Österreichische Kopfschmerzgesellschaft (ÖKSG) and the Schweizerische Kopfwehgesellschaft (SKG). J Headache Pain 2011; 12:201.
  26. Schachtel BP, Thoden WR, Konerman JP, et al. Headache pain model for assessing and comparing the efficacy of over-the-counter analgesic agents. Clin Pharmacol Ther 1991; 50:322.
  27. Diamond S, Freitag FG. The use of ibuprofen plus caffeine to treat tension-type headache. Curr Pain Headache Rep 2001; 5:472.
  28. Migliardi JR, Armellino JJ, Friedman M, et al. Caffeine as an analgesic adjuvant in tension headache. Clin Pharmacol Ther 1994; 56:576.
  29. Diener HC, Pfaffenrath V, Pageler L, et al. The fixed combination of acetylsalicylic acid, paracetamol and caffeine is more effective than single substances and dual combination for the treatment of headache: a multicentre, randomized, double-blind, single-dose, placebo-controlled parallel group study. Cephalalgia 2005; 25:776.
  30. Cerbo R, Centonze V, Grazioli I, et al. Efficacy of a fixed combination of indomethacin, prochlorperazine, and caffeine in the treatment of episodic tension-type headache: a double-blind, randomized, nimesulide-controlled, parallel group, multicentre trial. Eur J Neurol 2005; 12:759.
  31. Kaniecki RG. Tension-type headache. Continuum (Minneap Minn) 2012; 18:823.
  32. Lenaerts ME, Newman LC. Tension-type headache. In: Wolff's Headache and Other Head Pain, Silberstein SD, Lipton RB, Dodick DW (Eds), Oxford University Press, New York 2008. p.303.
  33. Scher AI, Lipton RB, Stewart WF, Bigal M. Patterns of medication use by chronic and episodic headache sufferers in the general population: results from the frequent headache epidemiology study. Cephalalgia 2010; 30:321.
  34. Cady RK, Gutterman D, Saiers JA, Beach ME. Responsiveness of non-IHS migraine and tension-type headache to sumatriptan. Cephalalgia 1997; 17:588.
  35. Lipton RB, Cady RK, Stewart WF, et al. Diagnostic lessons from the spectrum study. Neurology 2002; 58:S27.
  36. Brennum J, Kjeldsen M, Olesen J. The 5-HT1-like agonist sumatriptan has a significant effect in chronic tension-type headache. Cephalalgia 1992; 12:375.
  37. Brennum J, Brinck T, Schriver L. Sumatriptan has no clinically relevant effect in the treatment of episodic tension-type headache. Eur J Neurol 1996; 3:23.