緊張型頭痛病人之症狀、生理病理機制、及心理社會因素探討

The Symptomatology, Pathophysiology, and Psychosocial Factors of Tension-type Headache

頭痛是一般人最常見的慢性疼痛症狀之一，繄張型頭痛尤佔頭痛病人的大部分。本研究之目的在釐清本土緊張型頭痛症狀之基本臨床現象，進而以生物心理社會模式，探討其生理病理機制，及相關心理行為與社會因素，以提供臨床診斷與治療之參考依據。本研究歷時三年，以頭痛評估調查表對58名頭痛患者進行訪談，收集緊張型頭痛症狀之基本臨床現象資料。在生理病理機制方面，本研究驗證肌肉緊縮和自主神經系統過度活躍兩個假設。在心理與社會因素方面，本研究在門診病人中，建立緊張型頭痛個案組29名，並配對無頭痛控制組21名。比較兩組患者理學檢查、生理迴饋檢查、情緒反應、與社會資源之差異。依生物心理社會模式，探討其生理病理機轉，與心理社會相關因素。結果顯示，緊張型頭痛患者在生理病理方面，其肌肉緊縮之假設與自主神經系統過度活躍之假設皆未得支持。雖然上述兩種假設未得支持，但依然無法排除有其他生理病理成因之可能性。在心理方面，頭痛組有較高的焦慮情緒反應；在社會資源方面，頭痛組主觀上所獲得之情感資源和實質資源皆低於無頭痛控制組。由本研究結果可以得知，緊張型頭痛病理成因是多因性的。除了可能有的生理成因外，情緒反應與社會支持不足，皆是影響病人症狀表現的重要因素。

The purpose of this study is, through a comprehensive biopsychosocial assessment, history taking, physical and biofeedback evaluation to clarify the basic clinical symptomatology of tension-type headache, then to probe into the pathophysiology mechanism and psychosocial factors about this disease. We hope that the results can be provided for an empirical foundation for clinical assessment and treatment work. This study took three years. We have recruited 58 patients with tension-type headache. We interviewed them with headache evaluation scale to collect basic clinical symptomatology. And, we tested two pathophysiological hypotheses, the muscle contraction hypothesis and the oversensitivity of autonomic nervous system hypothesis. Then, we matched 29 tension-type headache patients as headache group with 21 non-headache adults as control group, and compared the differences of physical and biofeedback evaluation, emotional response, and social resources between the two groups. About symptomatology, pulsating pain, which is used as an exclusive criterion, was found in our chronic tension-type headache patients. Although the results didn’t support the muscle contraction hypothesis and the oversensitivity of autonomic nervous system hypothesis, we can not rule out other probable pathophysiological mechanism. On psychological reaction, the anxiety emotion of headache group is higher then that of control group. On social resources, both subjectively received affective resources and material resources of headache group are lesser then those of control group. In other words, besides probable pathophysiological mechanism, higher emotional response and lesser social resources would contribute to the symptom.