今日の臨床サポート

緊張型頭痛

著者: 徳岡健太郎 東海大学医学部付属八王子病院

監修: 高橋裕秀 昭和大学藤が丘病院 脳神経内科

著者校正済:2021/10/27
現在監修レビュー中
参考ガイドライン:
  1. 日本頭痛学会:頭痛の診療ガイドライン2021
患者向け説明資料

概要・推奨   

  1. 緊張型頭痛の分類・診断は、国際頭痛分類第3版(The international classification of headache disorders; ICHD-3分類)に準拠して行う(推奨度1)。
  1. 緊張型頭痛の分類は、反復性と慢性に分けられ、さらに反復性は頭痛頻度により稀発型と頻発型に分けられる。さらに、それぞれのサブタイプには頭蓋周囲の圧痛の有無に細分化される(推奨度1)。
  1. 緊張型頭痛は、一次性頭痛の中で最も高い有病率であるが、病態や発症機序に関しては未だ不明である(推奨:該当なし)。
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となりま
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要とな
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となり
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要と
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧には
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
徳岡健太郎 : 特に申告事項無し[2021年]
監修:高橋裕秀 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行った。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 緊張型頭痛は、様々な調査で一般集団における生涯有病率は30-78%とされており、機能性頭痛のなかで最も頻度の高い頭痛である。
  1. 危険因子や誘因に確定したものはない。
  1. 病態や発症機序は未だ不明であるが、稀発反復性緊張型頭痛・頻発反復性緊張型頭痛は末梢性感作、慢性緊張型頭痛は中枢性感作の疼痛メカニズムの異常が考えられている。
  1. 診断は、国際頭痛分類第3版(The international classification of headache disorders; ICHD-3)の診断基準を用いる。
  1. 両側性にみられることが多く、性状は圧迫感もしくは締め付けられる感じがある(非拍動性)。
  1. 程度は、軽度から中等度である。
  1. 歩行や階段昇降などの日常的な動作により増悪しない。
  1. 悪心や光過敏、音過敏を伴うことはなく、あっても軽度である。
病歴・診察のポイント  
  1. 問診は、頭痛の診断において大変重要である。

今なら12か月分の料金で14ヶ月利用できます(個人契約、期間限定キャンペーン)

11月30日(火)までにお申込みいただくと、
通常12ヵ月の使用期間が2ヶ月延長となり、14ヵ月ご利用いただけるようになります。

詳しくはクリック
本サイトの知的財産権は全てエルゼビアまたはコンテンツのライセンサーに帰属します。私的利用及び別途規定されている場合を除き、本サイトの利用はいかなる許諾を与えるものでもありません。 本サイト、そのコンテンツ、製品およびサービスのご利用は、お客様ご自身の責任において行ってください。本サイトの利用に基づくいかなる損害についても、エルゼビアは一切の責任及び賠償義務を負いません。 また、本サイトの利用を以て、本サイト利用者は、本サイトの利用に基づき第三者に生じるいかなる損害についても、エルゼビアを免責することに合意したことになります。  本サイトを利用される医学・医療提供者は、独自の臨床的判断を行使するべきです。本サイト利用者の判断においてリスクを正当なものとして受け入れる用意がない限り、コンテンツにおいて提案されている検査または処置がなされるべきではありません。 医学の急速な進歩に鑑み、エルゼビアは、本サイト利用者が診断方法および投与量について、独自に検証を行うことを推奨いたします。

文献 

著者: H J Featherstone
雑誌名: Headache. 1985 Jun;25(4):194-8.
Abstract/Text
PMID 4019180  Headache. 1985 Jun;25(4):194-8.
著者: G C Manzoni, P Torelli
雑誌名: Neurol Sci. 2004 Oct;25 Suppl 3:S255-7. doi: 10.1007/s10072-004-0300-x.
Abstract/Text In most cases, diagnosis of the various headache subtypes is possible through the accurate collection of medical history data. However, sometimes serious problems of differential diagnosis may be encountered. Therefore, the distinction between migraine without aura and tension-type headache is not always easy, the relationship between chronic migraine and medication overuse headache is a complex one, and differentiation of chronic tension-type headache vs. new daily-persistent headache is often problematic. A clear knowledge of the distinctive clinical features of the various headache subtypes is necessary to establish a correct diagnosis in the group of unilateral headaches with short-lived attacks and in the group of headaches with nocturnal onset.

PMID 15549551  Neurol Sci. 2004 Oct;25 Suppl 3:S255-7. doi: 10.1007/s1・・・
著者: Headache Classification Subcommittee of the International Headache Society
雑誌名: Cephalalgia. 2004;24 Suppl 1:9-160.
Abstract/Text
PMID 14979299  Cephalalgia. 2004;24 Suppl 1:9-160.
著者: F N Kaynak Key, S Donmez, U Tuzun
雑誌名: Cephalalgia. 2004 Aug;24(8):669-74. doi: 10.1111/j.1468-2982.2004.00736.x.
Abstract/Text We investigated the prevalence and clinical characteristics of tension-type headache (TTH), psychosocial factors contributing to the onset and aggravation of headache and coping mechanisms of individuals in a young population in Turkey. The sample consisted of 2226 university students, aged 7 to 21 years old. A self-administered questionnaire inquiring about epidemiological and clinical features of headache was filled out by participants. TTH diagnosis was determined in accordance with the International Headache Society Criteria of 1988. The prevalence of TTH was 20.35% (25.54% for women and 14.25% for men). 43.7% of headache sufferers had one or more stressful life events before the onset of headache and stress was the most frequent aggravating factor of headache (52%). Resting (58.1%) was the most common coping style. In conclusion, TTH is not a rare condition in Turkish young people and psychosocial factors are always taken into consideration for diagnosis and treatment of TTH.

PMID 15265056  Cephalalgia. 2004 Aug;24(8):669-74. doi: 10.1111/j.1468・・・
著者: R Zivadinov, K Willheim, D Sepic-Grahovac, A Jurjevic, M Bucuk, O Brnabic-Razmilic, G Relja, M Zorzon
雑誌名: Cephalalgia. 2003 Jun;23(5):336-43.
Abstract/Text The careful monitoring of the trigger factors of headache could be an important step in treatment, because their avoidance may lessen the frequency and severity of attacks. Furthermore, they may provide a clue to the aetiology of headache. The aim of the present study was to estimate the prevalence of tension-type headache (TTH) and to establish the frequency of precipitating factors in subjects with migraine and TTH in the adult population of Bakar, County of the Coast and Gorski Kotar, Croatia. Another important purpose of the study was to examine the relationship of the precipitating factors with migraine and TTH, and with migraine subtypes: migraine with aura (MA) and migraine without aura (MO). We performed a population-based survey using a 'face-to-face door-to-door' interview method. The surveyed population consisted of 5173 residents aged between 15 and 65 years. The 3794 participants (73.3%) were screened for headache history according to the International Headache Society (IHS) criteria. Headache screen-positive responders, 2475 (65.2%), were interviewed by trained medical students with a structured detailed interview focused on the precipitating factors. The following precipitating factors in lifetime migraineurs and tension-type headachers have been assessed: stress, sleep disturbances, eating habits, menstrual cycle, oral contraceptives, food items, afferent stimulation, changes in weather conditions and temperature, frequent travelling and physical activity. A total of 720 lifetime migraineurs and 1319 tension-type headachers have been identified. The most common precipitants for both migraine and TTH were stress and frequent travelling. Stress (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.17, 1.69) was associated with migraine, whereas physical activity (OR 0.72, 95% CI 0.59, 0.87) was related to TTH. Considering MA and MO, frequent travelling (OR 2.2, 95% CI 1.59, 2.99), food items (OR 2.2, 95% CI 1.35, 3.51) and changes in weather conditions and temperature (OR 1.75, 95% CI 1.27, 2.41) exhibited a significant positive association with MA. The present study demonstrated that precipitant-dependent attacks are frequent among both migraineurs and tension-type headachers. Lifetime migraineurs experienced headache attacks preceded by triggering factors more frequently than tension-type headachers. MA was more frequently associated with precipitating factors than MO. We suggest that some triggering factors may contribute to the higher occurrence of precipitant-dependent headache attacks in susceptible individuals.

PMID 12780762  Cephalalgia. 2003 Jun;23(5):336-43.
著者: B P Schachtel, S A Furey, W R Thoden
雑誌名: J Clin Pharmacol. 1996 Dec;36(12):1120-5.
Abstract/Text A single-dose, double-blind, randomized clinical trial was conducted to examine the relative analgesic effectiveness of 400 mg of ibuprofen (n = 153), 1,000 mg of acetaminophen (n = 151), and placebo (n = 151) in volunteers with muscle contraction headache. At regular intervals during a 4-hour period, participants evaluated headache pain intensity on a 100-mm visual analog scale and headache pain relief on a six-category scale. Both active agents were significantly different from placebo at all time points and in reducing pain intensity and providing relief of headache overall. Similarly, ibuprofen at 400 mg differed significantly from acetaminophen at 1,000 mg on both rating scales. Participants receiving ibuprofen at 400 mg achieved complete relief of headache faster than those receiving acetaminophen at 1,000 mg or placebo, and more participants taking ibuprofen experienced complete relief of headache than those taking placebo or acetaminophen. Both ibuprofen at 400 mg and acetaminophen at 1,000 mg are efficacious analgesic agents for muscle contraction headache, and ibuprofen at 400 mg is significantly more effective than acetaminophen at 1,000 mg for treating this condition.

PMID 9013368  J Clin Pharmacol. 1996 Dec;36(12):1120-5.
著者: Florian Kubitzek, Gabrielle Ziegler, Morris S Gold, Jiun-Min H Liu, Elisabeta Ionescu
雑誌名: Eur J Pain. 2003;7(2):155-62. doi: 10.1016/S1090-3801(02)00094-0.
Abstract/Text BACKGROUND: Several clinical trials have demonstrated that low doses of non-steroidal anti-inflammatory drugs relieve episodic tension-type headache (ETH).
AIMS: The aims of this placebo-controlled study were to determine whether single doses of diclofenac-K 12.5 and 25mg effectively relieve ETH in adults and to compare it to ibuprofen 400mg.
METHODS: A single-dose multicentre, randomised, double-blind, double-dummy, clinical trial was conducted at 22 primary care centres in Germany. All subjects had a history of ETH according to the classification of the International Headache Society. Of 684 subjects randomised, 620 used the study drugs for an episode of tension headache occurring within one month after enrolment: diclofenac-K 12.5mg (n=160), diclofenac-K 25mg (n=156), ibuprofen 400mg (n=151) and placebo (n=153). The primary efficacy variable was total pain relief, calculated as the time-weighted sum of the pain relief assessments from baseline to the 3h evaluation time (TOTPAR-3).
RESULTS: For TOTPAR-3, all active treatments were superior to placebo; no statistically significant difference between the three active treatments could be detected. A similar pattern was also observed with regard to TOTPAR-6 (6h evaluation time), > or =50%maxTOTPAR at 3 and 6h, weighted pain intensity difference at 3 and 6h (SPID-3; SPID-6), percentage of patients with complete headache relief at 2h, end of study global evaluation and time to rescue medication. The number-needed-to-treat (NNT) at 6h was 4.5 (2.9-9.2) in the ibuprofen 400mg group, 4.0 (2.8-7.3) in the diclofenac-K 12.5mg group and 3.9 (2.7-7.1) in the diclofenac-K 25mg group. These differences were not statistically significant.
CONCLUSION: Diclofenac-K, administered as single doses of 12.5 and 25mg effectively relieves ETH and is comparable to ibuprofen 400mg.

PMID 12600797  Eur J Pain. 2003;7(2):155-62. doi: 10.1016/S1090-3801(0・・・
著者: M J Prior, K M Cooper, L G May, D L Bowen
雑誌名: Cephalalgia. 2002 Nov;22(9):740-8.
Abstract/Text The objective of this study was to evaluate and compare the efficacy and safety of single doses of acetaminophen (paracetamol) 1000 mg and naproxen 375 mg vs. placebo over a six-hour period in the treatment of tension-type headache. The treatments were compared in a randomized, double-blind, multicentre, placebo-controlled study. Efficacy was evaluated using four standard analgesic summary endpoints (the sum of pain intensity differences from baseline, the maximum pain intensity from baseline, the sum of the pain relief scores, and the maximum pain relief score). Both acetaminophen 1000 mg and naproxen 375 mg were significantly superior to placebo (Por=0.498) for these four endpoints. For example, the mean sum of pain intensity differences from baseline was 9.14+/-0.34 for acetaminophen 1000 mg and 8.81+/-0.35 for naproxen 375 mg compared with 7.42+/-0.34 for placebo. Other efficacy endpoints (percentage of responders (pain reduced to none) at two hours, onset of meaningful relief, time to use of rescue medication and subject's overall impression of study medication) showed similar trends. A significantly larger mean pain intensity difference from baseline was observed for acetaminophen 1000 mg (1.13) than for naproxen 375 mg (0.95) (P=0.036) at one hour after treatment. There was no significant difference among the treatment groups in the incidence of adverse events (P=0.730). In summary, the results of this well-controlled, double-blind study demonstrate that over-the-counter acetaminophen 1000 mg and prescription naproxen 375 mg are effective and well tolerated in the treatment of tough (moderate-to-severe) tension-type headache.

PMID 12421160  Cephalalgia. 2002 Nov;22(9):740-8.
著者: R Cerbo, P Barbanti, G Fabbrini, M P Pascali, T Catarci
雑誌名: Headache. 1998 Jun;38(6):453-7.
Abstract/Text The tricyclic antidepressant, amitriptyline, is an effective drug for the treatment of chronic tension-type headache and for other chronic pain syndromes, but it is also effective in the prophylaxis of an episodic type of headache such as migraine. However, its efficacy in episodic tension-type headache has not yet been clarified. We compared the efficacy of amitriptyline (25 mg/day) in 82 nondepressed patients with either chronic or episodic tension-type headache in an open-label study. Amitriptyline significantly reduced (P < 0.05) frequency and duration of headache as well as analgesic consumption in chronic, but not in episodic, tension-type headache. Further placebo-controlled trials, possibly with higher doses of amitriptyline, might confirm if the different pattern of response to amitriptyline can be explained in terms of different involvement of central nociception and of peripheral myofascial factors in the chronic and in the episodic forms of tension-type headache.

PMID 9664750  Headache. 1998 Jun;38(6):453-7.

ページ上部に戻る

戻る

さらなるご利用にはご登録が必要です。

こちらよりご契約または優待日間無料トライアルお申込みをお願いします。

(※トライアルご登録は1名様につき、一度となります)


ご契約の場合はご招待された方だけのご優待特典があります。

以下の優待コードを入力いただくと、

契約期間が通常12ヵ月のところ、14ヵ月ご利用いただけます。

優待コード: (利用期限:まで)

ご契約はこちらから