紧张型头痛睡眠情绪共病及rTMS研究进展

Research Progress on Sleep and Emotional Comorbidities and Repetitive Transcranial Magnetic Stimulation (rTMS) in Tension-Type Headache

摘要: 紧张型头痛(tension-type headache, TTH)是最常见的原发性头痛类型之一，但其临床重视程度长期低于实际疾病负担。近年来研究表明，TTH并非单纯的疼痛性疾病，而是与睡眠障碍、焦虑抑郁等情绪问题密切相关的复杂综合征。睡眠质量下降、昼夜节律紊乱及情绪负担增加不仅常见于TTH患者，还可能通过中枢敏化、下行疼痛调控异常、下丘脑–垂体–肾上腺轴功能紊乱、单胺递质失衡及脑网络异常等机制共同促进症状加重和疾病慢性化。重复经颅磁刺激(repetitive transcranial magnetic stimulation, rTMS)作为一种非侵入性神经调控技术，在慢性TTH中的应用逐渐受到关注，现有研究提示其可能在缓解头痛症状的同时改善睡眠和情绪共病。本文综述TTH的流行病学与疾病负担、TTH与睡眠障碍及情绪障碍的临床关联、三者的共享神经生物学机制、rTMS的潜在治疗价值以及真实世界研究在该领域中的应用与挑战，以期为TTH的共病整合管理和精准干预提供参考。

Abstract: Tension-type headache (TTH) is the most common primary headache disorder, yet its clinical significance has long been underestimated relative to its actual disease burden. Recent studies suggest that TTH is not merely a pain disorder, but a complex syndrome closely associated with sleep disturbances and emotional problems such as anxiety and depression. Poor sleep quality, circadian rhythm disruption, and increased emotional burden are common in patients with TTH, and may jointly contribute to symptom aggravation and headache chronification through mechanisms including central sensitization, impaired descending pain modulation, hypothalamic-pituitary-adrenal axis dysfunction, monoaminergic imbalance, and brain network abnormalities. Repetitive transcranial magnetic stimulation (rTMS), as a noninvasive neuromodulation technique, has gained increasing attention in chronic TTH, and current evidence suggests that it may alleviate headache symptoms while also improving sleep and emotional comorbidities. This review summarizes the epidemiology and disease burden of TTH, the clinical associations of TTH with sleep disturbances and emotional disorders, the shared neurobiological mechanisms underlying these interactions, the potential therapeutic value of rTMS, and the application and challenges of real-world research in this field, with the aim of providing a reference for integrated comorbidity management and precision intervention in TTH.