PDF(Pubmed)
Abstract：
BACKGROUND: Few reports have described multidisciplinary treatment, including extracorporeal shock wave therapy, for patients with refractory chronic tension-type headache. In this study, we conducted multidisciplinary treatment for a patient with chronic tension-type headache who suffered from chronic headache refractory to treatment.
METHODS: The patient was a 45-year-old Japanese male suffering from 20 years of headache. As his headache had worsened recently, he visited a local clinic. With the diagnosis of suspected tension-type headache, its treatment was unsuccessful and he was referred to our hospital. The neurology department confirmed the tension-type headache and prescribed another medication, but he showed no improvement. Then, the patient was referred to the rehabilitation medicine department for consultation. At the initial visit, we identified multiple myofascial trigger points in his bilateral posterior neck and upper back regions. At the initial visit, he was prescribed 10 mL of 1% lidocaine injected into the muscles in these areas. In addition, he received 2000 extracorporeal shock wave therapy into bilateral trapezius muscles, and was instructed to take oral Kakkonto extract granules, benfotiamine, pyridoxine hydrochloride, and cyanocobalamin. Cervical muscle and shoulder girdle stretches and exercises were also recommended. At follow-up treatment visits, we used extracorporeal shock wave therapy to bilateral trapezius muscles, which led to immediate pain relief. After 11 weeks, he was not taking any medication and his headache was subjectively improved and his medical treatment ended.
CONCLUSIONS: A patient with chronic tension-type headache refractory to regular treatment was successfully treated with a multimodal approach including extracorporeal shock wave therapy in addition to standard treatment. For patients with tension-type headache accompanied by myofascial trigger points, it may be recommended to promptly consider aggressive multimodal treatment that includes extracorporeal shock wave therapy.
METHODS: The patient was a 45-year-old Japanese male suffering from 20 years of headache. As his headache had worsened recently, he visited a local clinic. With the diagnosis of suspected tension-type headache, its treatment was unsuccessful and he was referred to our hospital. The neurology department confirmed the tension-type headache and prescribed another medication, but he showed no improvement. Then, the patient was referred to the rehabilitation medicine department for consultation. At the initial visit, we identified multiple myofascial trigger points in his bilateral posterior neck and upper back regions. At the initial visit, he was prescribed 10 mL of 1% lidocaine injected into the muscles in these areas. In addition, he received 2000 extracorporeal shock wave therapy into bilateral trapezius muscles, and was instructed to take oral Kakkonto extract granules, benfotiamine, pyridoxine hydrochloride, and cyanocobalamin. Cervical muscle and shoulder girdle stretches and exercises were also recommended. At follow-up treatment visits, we used extracorporeal shock wave therapy to bilateral trapezius muscles, which led to immediate pain relief. After 11 weeks, he was not taking any medication and his headache was subjectively improved and his medical treatment ended.
CONCLUSIONS: A patient with chronic tension-type headache refractory to regular treatment was successfully treated with a multimodal approach including extracorporeal shock wave therapy in addition to standard treatment. For patients with tension-type headache accompanied by myofascial trigger points, it may be recommended to promptly consider aggressive multimodal treatment that includes extracorporeal shock wave therapy.
摘要：
背景：很少有报道描述多学科治疗，包括体外冲击波疗法,用于难治性慢性紧张型头痛患者。在这项研究中,我们对一名慢性紧张型头痛患者进行了多学科治疗，该患者患有慢性头痛难以治疗。
方法：患者是一名45岁的日本男性，患有20年的头痛。由于他的头痛最近加重了，他参观了当地的诊所。诊断为疑似紧张型头痛，治疗不成功，他被转诊到我们医院。神经科证实了紧张型头痛，并开了另一种药物，但他没有任何改善.然后，病人被转介到康复医学科咨询。在初次访问时,我们在他的双侧后颈和上背部发现了多个肌筋膜触发点.在初次访问时,他被处方在这些区域的肌肉中注射10毫升1%利多卡因。此外,他接受了2000年体外冲击波治疗双侧斜方肌，并被指示口服Kakkonto提取物颗粒，benfotiamine,盐酸吡哆醇,和氰钴胺.还建议进行颈部肌肉和肩带伸展和锻炼。在后续治疗访问中，我们使用体外冲击波治疗双侧斜方肌，导致疼痛立即缓解。11周后,他没有服用任何药物，他的头痛主观上得到了改善，他的药物治疗结束了。
结论：一名常规治疗难以治疗的慢性紧张型头痛患者，除了标准治疗外，还采用包括体外冲击波治疗在内的多模式方法成功治疗。对于伴有肌筋膜触发点的紧张型头痛患者，建议及时考虑积极的多模式治疗,包括体外冲击波治疗.
方法：患者是一名45岁的日本男性，患有20年的头痛。由于他的头痛最近加重了，他参观了当地的诊所。诊断为疑似紧张型头痛，治疗不成功，他被转诊到我们医院。神经科证实了紧张型头痛，并开了另一种药物，但他没有任何改善.然后，病人被转介到康复医学科咨询。在初次访问时,我们在他的双侧后颈和上背部发现了多个肌筋膜触发点.在初次访问时,他被处方在这些区域的肌肉中注射10毫升1%利多卡因。此外,他接受了2000年体外冲击波治疗双侧斜方肌，并被指示口服Kakkonto提取物颗粒，benfotiamine,盐酸吡哆醇,和氰钴胺.还建议进行颈部肌肉和肩带伸展和锻炼。在后续治疗访问中，我们使用体外冲击波治疗双侧斜方肌，导致疼痛立即缓解。11周后,他没有服用任何药物，他的头痛主观上得到了改善，他的药物治疗结束了。
结论：一名常规治疗难以治疗的慢性紧张型头痛患者，除了标准治疗外，还采用包括体外冲击波治疗在内的多模式方法成功治疗。对于伴有肌筋膜触发点的紧张型头痛患者，建议及时考虑积极的多模式治疗,包括体外冲击波治疗.
