Ⅲ- 8 AF

Ⅲ－8	緊張型頭痛の治療法で薬物療法以外にどのようなものがあるか

3) Stetter F, Kupper S . Autogenic training: a meta-analysis of clinical 　 outcome studies. Appl Psychophysiol Biofeedback 2002 　 Mar;27(1):45-98
論文抄録	Autogenic training (AT) is a self-relaxation procedure by which a psychophysiological determined relaxation response is elicited. A meta-analysis was performed to evaluate the clinical effectiveness of AT. Seventy-three controlled outcome studies were found (published 1952-99). Sixty studies (35 randomized controlled trials [RCT]) qualified for inclusion in the meta-analysis. Medium-to-large effect sizes (ES) occurred for pre-post comparisons of disease-specific AT-effects, with the RCTs showing larger ES. When AT was compared to real control conditions, medium ES were found. Comparisons of AT versus other psychological treatment mostly resulted in no effects or small negative ES. This pattern of results was stable at follow-up. Unspecific AT-effects (i.e., effects on mood, cognitive performance, quality of life, and physiological variables) tended to be even larger than main effects. Separate meta-analyses for different disorders revealed a significant reduction of the heterogeneity of ES. Positive effects (medium range) of AT and of AT versus control in the meta-analysis of at least 3 studies were found for tension headache/migraine, mild-to-moderate essential hypertension, coronary heart disease, asthma bronchiale, somatoform pain disorder (unspecified type), Raynaud's disease, anxiety disorders, mild-to-moderate depression/dysthymia, and functional sleep disorders.
文献 PubMed － ID	PMID: 12001885
文献タイトル ( 日本語 )	自律訓練法（ AT ）の臨床的効果のメタアナライシス
文献タイトル（英語）	Autogenic training: a meta-analysis of clinical outcome studies.
エビデンスレベル	Ib
著者名	Stetter F, Kupper S
雑誌名 , 出版年巻 : 頁	Appl Psychophysiol Biofeedback 2002 Mar;27(1):45-98
目的	自律訓練法（ AT ）臨床的効果の検討
研究デザイン	メタアナリシス 77 の比較試験が存在したが（ 1952 年～ 1999 年に公表）， 66 をメタアナリシスに採用（無作為化比較試験は 35[RCT] ）した
研究施設	77 の比較試験
研究期間	N/A
対象患者	N/A
介入	自律訓練法（ AT ）
主要評価項目とそれに用いた統計学的手法	effect size
結果	疾患を特定した AT 効果の前 - 後比較において中～大の effect size （ ES ）が生じ， RCT において最大の ES が示された． AT が実際に対照群と比較された場合は中程度の ES になっている． AT と他の精神的治療の比較では概ね効果なしあるいは Negative の ES が若干出る．この結果パターンはフォローアップにおいても変化がない．非特定 AT 効果（すなわち雰囲気，意識的振る舞い， QOL ，精神的変化などへの効果）が主たる効果より大きく出る傾向が見られた．これとは別の他の疾患に対するメタアナリシスでは ES の不均一性が有意に減少していた．メタアナリシスにおいて，緊張型頭痛 / 片頭痛，軽度～中等度の高血圧，冠動脈疾患，気管支喘息，身体表現性疼痛疾患（非特定タイプ）， Raynaud's 病，不安障害，軽度～中等度のうつ / 気分変調および機能的睡眠障害について， AT の陽性効果（平均幅）および AT とコントロール群との比較における陽性効果が最低 3 試験で示されていた．
結論	メタアナリシスにおいて，緊張型頭痛にも自律訓練法（ AT ）の臨床的効果が認められる．
コメント	緊張型頭痛における自律訓練法（ AT ）の臨床的効果をメタアナリシスにおいて照明した検討．
備考	Publication Types: Meta-Analysis MeSH Terms: Affect Anxiety Disorders/therapy Autogenic Training* Cognition Depression/therapy Humans Hypertension/therapy Quality of Life Randomized Controlled Trials Relaxation Techniques Severity of Illness Index Sleep Disorders/therapy Somatoform Disorders/therapy Tension Headache/therapy *Treatment Outcome
作成者	平田幸一

5) Bove G, Nilsson N. Spinal manipulation in the treatment of episodic 　 tension-type headache: a randomized controlled trial. JAMA. 1998 　 Nov 11;280(18):1576-9.
論文抄録	CONTEXT: Episodic tension-type headache is common and is often treated using manual therapies. Few data exist for the efficacy of these interventions. OBJECTIVE: To determine the effects of spinal manipulation therapy on adults with episodic tension-type headache. DESIGN: Randomized controlled trial lasting 19 weeks. SETTING: Outpatient facility of a National Health Service-funded chiropractic research institution in Denmark . PARTICIPANTS: Volunteer sample of 26 men and 49 women aged 20 to 59 years who met the diagnostic criteria for episodic tension-type headache as defined by the International Headache Society. INTERVENTION: Participants were randomized into 2 groups, 1 receiving soft tissue therapy and spinal manipulation (the manipulation group), and the other receiving soft tissue therapy and a placebo laser treatment (the control group). All participants received 8 treatments over 4 weeks; all treatments were performed by the same chiropractor. MAIN OUTCOME MEASURES: Daily hours of headache, pain intensity per episode, and daily analgesic use, as recorded in diaries. RESULTS: Based on intent-to-treat analysis, no significant differences between the manipulation and control groups were observed in any of the 3 outcome measures. However, by week 7, each group experienced significant reductions in mean daily headache hours (manipulation group, reduction from 2.8 to 1.5 hours; control group, reduction from 3.4 to 1.9 hours) and mean number of analgesics per day (manipulation group, reduction from 0.66 to 0.38; control group, reduction from 0.82 to 0.59). These changes were maintained through the observation period. Headache pain intensity was unchanged for the duration of the trial. CONCLUSION: As an isolated intervention, spinal manipulation does not seem to have a positive effect on episodic tension-type headache.
文献 PubMed － ID	PMID:9820258
エビデンスレベル	Ib
文献タイトル ( 日本語 )	発作性緊張型頭痛 (ETTH) における指圧効果：無作為対照試験
目的	ETTH における脊椎指圧の有効性を検証すること
研究デザイン	無作為プラセボ対照試験（ Randomized, placebo-controlled study ）
研究施設	National Health Service-funded chiropractic research institution in Denmark
研究期間	N/A
対象患者	75 人の ETTH 患者（月に 5 回以上 15 回以下， 0 から 100 の visual analogue scale で頭痛強度が 25 から 85 の間にある ETTH ）
介入	指圧師によるマッサージと上部頚髄指圧を受ける指圧治療群とマッサージと低出力レザー光線照射をうける対照群の 2 群にわけて検討した． 4 週間にわたり合計 8 回の治療を行い，治療前後で 19 週にわたる臨床試験である．
主要評価項目とそれに用いた統計学的手法	主要項目は，１日あたりの頭痛持続時間，発作毎の平均頭痛強度，日々の鎮痛剤使用回数である． ITT 解析を行った，
結果	指圧群と対照群の間には有意差はなかった．
結論	指圧自体に，単独治療として ETTH の有効性があるとは言い難い．
備考	Publication Types: * Clinical Trial * Randomized Controlled Trial MeSH Terms: * Adult * Female * Humans * Male * Manipulation, Spinal* * Middle Aged * Research Support, Non-U.S. Gov't * Tension Headache/therapy* * Treatment Outcome
作成者	飯塚高浩

6) Xue CC, Dong L, Polus B, English RA, Zheng Z, Da Costa C, Li CG, 　 Story DF . Electroacupuncture for tension-type headache on distal 　 acupoints only: a randomized, controlled, crossover trial. Headache 　 2004 Apr;44(4):333-41
論文抄録	OBJECTIVE: To investigate the efficacy of electroacupuncture, applied to distal acupoints only, for tension-type headache. BACKGROUND: Electroacupuncture is commonly used for tension-type headache, but when applied to distal acupoints only, evidence of its efficacy is lacking. DESIGN: A randomized, single-blinded, sham-controlled, crossover clinical trial. Methods.-The trial had 5 stages: baseline (2 weeks), phases I and II (each 4 weeks), washout period (2 weeks), and follow-up (3 months after phase II). Forty patients were randomly assigned to either group A or group B. Group A received real electroacupuncture during phase I, then sham electroacupuncture in phase II. Group B received the treatments in reverse order. Outcome measures were headache frequency and duration, pain intensity using a visual analog scale, mechanical pain threshold, headache disability, and sickness impact. Data were analyzed by univariate 2-way analysis of variance. RESULTS: Thirty-seven patients completed the trial. There were no significant differences between the 2 groups at baseline. At the end of phase I, group A, but not group B, demonstrated significant improvement in mean (standard error of the mean [SEM]) headache frequency (3.0 per month [0.3] versus 12.0 per month [1.7]), duration (13.3 hours [3.5] versus 32.0 hours [6.2]), pain intensity (32.8 mm [4.1] versus 47.5 mm [2.7]), pain threshold (right side, 2.9 kg/second [0.1] versus 0.9 kg/second [0.1]; left side, 2.4 kg/second [0.1] versus 1.1 kg/second [0.1]), headache disability score (6.0 [1.0] versus 16.3 [1.6]), and sickness impact score (288.7 [48.0] versus 687.1 [77.2]). For each parameter, significant differences also were demonstrated for both groups between baseline and phase II, and baseline and follow-up. There were no significant differences between the groups at the end of follow-up (P >.05). CONCLUSION: Electroacupuncture to distal points alone is effective for short-term symptomatic relief of tension-type headache.
文献 PubMed － ID	PMID: 15109358
エビデンスレベル	Ib
文献タイトル ( 日本語 )	遠位鍼点に限定した電気鍼の緊張型頭痛への使用：無作為比較交差試験
目的	遠位鍼点のみに施術した電気鍼の緊張型頭痛に対する効果の検討
研究デザイン	無作為比較交差試験（ randomised, controlled, crossover study ） 40 名の患者をグループ A または B に無作為に割付し，グループ A には PhaseI において実際に電気鍼で治療し， PhaseII で偽電気鍼を用いた．グループ B ではその逆の方法で検討した．
研究施設	RMIT Chinese Medicine Research Group, RMIT University , Bundoora , Victoria , Australia .
研究期間	ベースライン（ 2 週間）， PhaseI および PhaseII （各 4 週間），離脱期間（ 2 週間）およびフォローアップ（ PhaseII 後 3 ヶ月）
対象患者	40 名の緊張型頭痛患者
主要評価項目とそれに用いた統計学的手法	頭痛頻度と持続時間， VAS を使っての痛みの強度，機能的な痛みの閾値，頭痛による支障および影響度を測定．解析方法：単一変量 2 方向分析
結果	37 名の患者が試験を完了し，ベースラインにおいては 2 群に有意差は無く， PhaseI 終了時にはグループ A において平均の頭痛頻度（ 3 回 / 月対 12 回 / 月），持続時間（ 13.3 時間対 32 時間），痛みの強度（ 32.8mm 対 47.4mm ），痛みの閾値（右側， 2.9kg/ 秒対 0.9kg/ 秒；左側， 2.4kg/ 秒対 1.1kg/ 秒），頭痛支障度スコア（ 6.0 対 16.3 ），および影響度（ 288.7 対 687.1 ）は有意な改善を示したが，グループ B では示されなかった．各パラメーターにおいて，ベースラインと PhaseII およびベースラインとフォローアップの間では両群に有意差を認めた．フォローアップ終了後は両群に有意差を認めなかった．（ P>.05 ）
結論	遠位鍼点に対する電気鍼は緊張型頭痛の短期対症療法としては効果的である．
コメント	対象は少ないが，電気鍼と偽電気鍼使用したしったりとした RCT
備考	Publication Types: Clinical Trial Randomized Controlled Trial MeSH Terms: Acupuncture Points Adult Cross-Over Studies Electroacupuncture/methods Extremities Female Humans Male Single-Blind Method Tension Headache/therapy* Time Factors Treatment Outcome
作成者	平田幸一

7) Hansen PE , Hansen JH. Acupuncture treatment of chronic tension 　 headache--a controlled cross-over trial. Cephalalgia. 1985 　 Sep;5(3):137-42.
論文抄録	In a controlled trial the effect of traditional Chinese acupuncture v. placebo acupuncture was evaluated in 18 patients with chronic tension headache (mean disease duration 15 years). All patients suffered from daily or frequently recurring headache, the intensity of which was recorded by the patient over a period of 15 weeks. Each patient was treated by traditional Chinese acupuncture as well as by placebo acupuncture in a cross-over design following randomization. Each period of treatment comprised six treatments. Traditional Chinese acupuncture was found to be significantly more pain-relieving than placebo acupuncture, according to the pain registration of the patients themselves. The pain reduction was 31%. Acupuncture is therefore found to be a reasonable treatment for chronic tension headache.
文献 PubMed － ID	PMID:3899369
エビデンスレベル	Ib
文献タイトル ( 日本語 )	慢性緊張型頭痛における鍼灸治療：プラセボ対照交差試験
目的	伝統的中国式鍼灸の有効性を検証する．
研究デザイン	無作為二重盲検プラセボ対照交差試験（ Randomized, double-blind, placebo-controlled crossover study ）
研究期間	1981 年３月から１２月
対象患者	１年以上の罹病期間を有する慢性筋収縮性頭痛患者 18 人
介入	伝統的中国式の鍼灸治療とプラセボ鍼灸治療をそれぞれ３週間ずつ行い，有効性について評価した．
主要評価項目とそれに用いた統計学的手法	頭痛の全くない日数，通常の頭痛より軽い頭痛を認める日数，通常の頭痛を認める日数，通常より高度な頭痛を認める日数をもとに， period index(PI) を算出し評価した．
結果	伝統的中国式の鍼灸治療群はプラセボ群に比べ有意に改善した．
結論	伝統的中国式の鍼灸治療群は有効な治療法である．
コメント -1	プラセボを用いた鍼灸法は妥当か？　頭痛評価法は妥当か？
コメント -2	症例数も少ない．
備考	Publication Types: * Clinical Trial * Randomized Controlled Trial MeSH Terms: * Acupuncture Therapy* * Chronic Disease * Clinical Trials * Headache/therapy* * Humans
作成者	飯塚高浩

8) Torelli P, Jensen R, Ol . Physiotherapy for tension-type headache: 　 a controlled study. Cephalalgia 2004 Jan;24(1):29-36
論文抄録	The role of non-pharmacological therapies in the preventive treatment of tension-type headache (TTH) is still an object of debate. The primary aim of this study was therefore to investigate the therapeutic effect of physiotherapy in properly classified patients with TTH in a controlled trial. Fifty patients with TTH, 26 with episodic, frequent (ETTH) and 24 with chronic TTH (CTTH) fulfilling the International Headache Society classification criteria were included in the study. After a 4-week run-in period, they were randomized to either an 8-week period of standardized physiotherapy (group 1) or to an 8-week observation period followed by an identical course of physiotherapy (group 2); after the physiotherapy all patients were followed for a 12-week follow-up period. We then evaluated the number of days with headache, severity and duration of the headache attacks, and drug consumption for symptomatic treatment before and after the course of physiotherapy. Forty-eight patients completed the study. The average number of days with headache per 4-week period was reduced from 16.3 days at baseline to 12.3 days in the last 4 weeks of treatment [from 14.5 days to 10.5 days (P < 0.001) in group 1 and from 18.1 days to 14.1 days (P < 0.001) in group 2]. Severity and duration of headache as well as drug consumption were unchanged throughout the study. Analysing the response to treatment separately in the various subgroups, we found that the number of responders was significantly higher among patients with CTTH vs. patients with ETTH (P < 0.002) and in females vs. males (P < 0.02). No differences were found between patients with and without disorder of pericranial muscles. We conclude that a standardized physiotherapy programme has a good therapeutic effect, albeit on a restricted group of patients.
文献 PubMed － ID	PMID: 14687010
エビデンスレベル	Ib
文献タイトル ( 日本語 )	緊張型頭痛に対する理学療法：比較試験
目的	比較試験において正しく TTH と診断された患者における理学療法の治療効果の検討
研究デザイン	比較試験 controlled study
研究施設	Headache Centre, Unit of Neurology, Department of Neuroscience, University of Parma
研究期間	12 週間
対象患者	IHS 国際分類を満たす TTH50 名の患者（ ETTH 26 名， CTTH24 名）
介入	理学療法
主要評価項目とそれに用いた統計学的手法	頭痛日数，頭痛重症度，頭痛発作時間，頓服薬の服用について理学療法コースの前後で評価
結果	4 週間の平均頭痛日数はベースラインで 16.3 日から治療最終の 4 週間では 12.3 日に減少した． [ グループ１では１４ . ５日から１０ . ５日へ（ P<0.001 ），グループ 2 では 18.1 日から 14.1 日に（ P<0.001 ）に減少． ] 　頭痛の重症度と持続時間は頓服薬服用同様試験期間中に変化なし．様々なサブグループにおいて治療への反応を別途解析した結果，治療反応は ETTH より CTTH で有意に高く（ P<0.002 ），女性が男性より優位に高かった（ P<0.02 ）．頭蓋周囲筋の疾病の有無で変化は無かった．
結論	標準化した理学療法は限定した患者層ではあったが，治療効果がみられた．
コメント	対象者はさほど多くないが良くデザインされた研究．
備考	Publication Types: Clinical Trial Randomized Controlled Trial MeSH Terms: Adult Chronic Disease Cluster Headache/diagnosis Cluster Headache/therapy Female Humans Male Middle Aged Patient Selection Physical Therapy Techniques/methods* Prognosis Severity of Illness Index Sex Factors Statistics Tension Headache/diagnosis Tension Headache/therapy *Treatment Outcome
作成者	平田幸一