目的:头痛障碍是全球残疾的主要原因之一。虽然有报道称不良的童年经历与原发性头痛之间存在关联,研究的汇总大小和关联途径尚不清楚.我们的目标是1)评估≥1次不良儿童期经历(ACE)对成年后原发性头痛疾病的综合影响,和2)检验以下假设:根据我们对ACE如何影响生命历程发展的叙事回顾中的选定理论,将ACE归类为“威胁”或“剥夺”对原发性头痛具有明显影响。
方法:PubMed,EMBASE,Medline,WebofScience,谷歌学者,生物精神病学,和灰色文献一直搜索到2023年3月16日(PROSPERO,CRD42020223403)。精选文章包括:1)比较组的观察性研究,2)18岁之前发生的ACE,3)原发性头痛,年龄≥21岁。使用多级线性随机效应模型计算集合赔率比(OR)。叙事回顾包括描述ACE如何在整个生命过程中影响人类发展和疾病的理论。我们从我们的叙述回顾中选择了一个理论,并根据该理论对ACEs进行了分类,以对点估计进行任何修改。
结果:我们的搜索确定了32项研究,其中28人符合荟萃分析的条件(n=154,739名参与者,19个国家)。≥1次不良儿童经历的发生与原发性头痛相关[汇总OR=1.48(95%CI1.36-1.61);高质量证据,134,696名参与者]。随着ACE数量的增加,原发性头痛的几率增加[范围:1ACEOR=1.24(95%CI1.14-1.35)至≥4ACEOR=2.09(1.83-2.38),趋势的p值<0.0001]。从叙事回顾来看,对将ACE分为威胁或剥夺的神经发育理论进行了测试,并且两者都与原发性头痛[威胁OR=1.46(95%CI:1.32-1.60)和剥夺OR=1.35(95%CI:1.23-1.49)独立相关,分别],考虑异质性(p=0.021)。
结论:本系统综述和荟萃分析证实ACEs是成年期原发性头痛障碍的重要危险因素。我们的发现提供了流行病学支持,将ACE归类为威胁和剥夺可能表现为早期逆境的不同途径。
OBJECTIVE: Headache disorders are among the leading causes of disability worldwide. While an association between adverse childhood experiences and primary headaches has been reported, the pooled magnitude across studies and pathways of the association are unknown. Our objectives were (1) to estimate the pooled effect of ≥1 adverse childhood experience (ACE) on primary headache disorders in adulthood and (2) to test the hypothesis that ACEs categorized as \"threat\" traumas or \"deprivation\" traumas have distinct effects on primary headaches based on a selected theory from our narrative
review of how ACEs affect human development along the life course.
METHODS: PubMed, EMBASE, MEDLINE, Web of Science, Google Scholar, Biological Psychiatry, and gray literature were searched up to March 16, 2023 (PROSPERO, CRD42020223403). Selected articles included (1) observational studies with a comparator group, (2) ACEs that occurred before 18 years of age, and (3) primary headaches occurring at or after 21 years of age. Pooled odds ratios (ORs) were calculated using multilevel linear random-effects modeling. The narrative
review included theories that describe how ACEs affect human development and disease across the life course. We selected a theory from our narrative
review and tested ACEs categorized according to this theory for any modification of point estimates.
RESULTS: Our search identified 32 studies, of which 28 were eligible for meta-analysis (n = 154,739 participants, 19 countries). The occurrence of ≥1 adverse childhood experience(s) was associated with primary headaches (pooled OR = 1.48 [95% CI 1.36-1.61]; high-quality evidence, 134,696 participants). As the number of ACEs increased, the odds of primary headaches increased (range: 1 ACE OR = 1.24 [95% CI 1.14-1.35] to ≥4 ACEs OR = 2.09 [95% CI 1.83-2.38], p for trend <0.0001). From the narrative
review, a neurodevelopmental theory that categorizes ACEs into threat or deprivation was tested, and both were independently associated with primary headaches (threat OR = 1.46 [95% CI 1.32-1.60] and deprivation OR = 1.35 [95% CI 1.23-1.49], respectively), accounting for heterogeneity (p = 0.021).
CONCLUSIONS: This systematic
review and meta-analysis confirm that ACEs are important risk factors of primary headache disorders in adulthood. Our findings provide epidemiologic support that ACEs categorized as threat and deprivation may manifest as distinct pathways of early adversity.