颅周肌肉A型肉毒素
紧张型头痛的发病机制尚不清楚，肌肉张力在紧张型头痛中发挥的作用充满争议。A型肉毒毒素可缓解面部肌肉张力，在A型肉毒毒素对紧张型头痛的试验性缓解中，这种现象发挥的作用较小。A型肉毒毒素已被证明可阻断谷氨酸、P物质和降钙素基因相关肽的释放，从而减少感觉性中枢神经系统传入，缓解疼痛。[24]Aoki KR. Evidence for the antinociceptive activity of the botulinum toxin type A in pain management. Headache. 2003 Jul-Aug;43(suppl 1):S9-15.http://www.ncbi.nlm.nih.gov/pubmed/12887389?tool=bestpractice.com 不同的双盲、安慰剂对照研究的结果并不一致，而且不推荐使用肉毒杆菌毒素治疗慢性紧张型头痛。[36]Simpson DM, Hallett M, Ashman EJ, et al. Practice guideline update summary: botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2016 May 10;86(19):1818-26.http://n.neurology.org/content/86/19/1818http://www.ncbi.nlm.nih.gov/pubmed/27164716?tool=bestpractice.com[37]Silberstein SD, Gobel H, Jensen R, et al. Botulinum toxin type A in the prophylactic treatment of chronic tension-type headache: a multicentre, double-blind, randomized, placebo-controlled, parallel-group study. Cephalalgia. 2006 Jul;26(7):790-800.http://www.ncbi.nlm.nih.gov/pubmed/16776693?tool=bestpractice.com[38]Karadaş O, Ipekdal IH, Ulaş UH, et al. Botulinum neuro-toxin aype-A in the treatment of chronic tension type headache associated with pericranial tenderness [in Turkish]. Agri. 2012;24(1):9-14.http://www.journalagent.com/pubmed/linkout.asp?ISSN=1300-0012&PMID=22399123http://www.ncbi.nlm.nih.gov/pubmed/22399123?tool=bestpractice.com
