目的:研究偏头痛先兆在预测头痛相关残疾的日常水平方面的独特作用。
背景:偏头痛症状和心理变量导致头痛相关的残疾。偏头痛先兆可能与更严重的症状和精神合并症的风险增加有关。但是光环对日常功能的影响是未知的。本研究试图评估偏头痛先兆在预测当天和随后的偏头痛相关残疾中的作用,同时考虑人口统计学,头痛,和心理变量。
方法:这是一项观察性前瞻性队列研究,纳入554例偏头痛患者。对于每个参与者,使用N-1Headache™数字应用程序(N=11,156天,共收集90天的偏头痛症状和心理变量数据).分析评估了先兆的存在是否独立于其他头痛和心理变量预测偏头痛相关残疾的每日评级。鉴于所检查的预测因子的数量,统计学显著性设定为p<0.01。
结果:平均值(标准偏差,range)偏头痛发作天数的患者级偏头痛残疾评估问卷评分为1.18(1.03,0-3)。在偏头痛发作的所有日子中,Aura与较高的残疾评分显着相关(比值比[OR]1.40,99%置信区间[CI]1.13-1.74;p<0.001)。在调整患者水平变量(OR1.40,99%CI1.13-1.73;p<0.001)和日水平心理变量(OR1.39,99%CI1.12-1.73;p<0.001)后,这种关系保持不变,但在控制日水平头痛变量(OR1.19,99%CI0.95-1.49;p=0.039)后完全否定。发作第一天的光环与异常性疼痛的几率增加相关(OR1.87,99%CI1.22-2.86;p<0.001),恐惧症(OR1.62,99%CI1.17-2.25;p<0.001),畏光(OR1.89,99%CI1.37-2.59;p<0.001),和恶心/呕吐(OR1.54,99%CI1.17-2.02;p<0.001),但不是发作持续时间(p=0.171),峰值严重程度(p=0.098),或任何检查过的心理变量(睡眠持续时间[p=0.733],睡眠质量[p=0.186],应力[p=0.110],焦虑[p=0.102],或悲伤[p=0.743])。
结论:先兆的存在预示着偏头痛发作期间头痛相关残疾的增加,但这种效应可归因于偏头痛的相关非疼痛症状。
To examine the unique role of migraine
aura in predicting day-to-day levels of headache-related disability.
Migraine symptoms and psychological variables contribute to headache-related disability. Migraine aura may be associated with more severe symptom profiles and increased risk of psychiatric comorbidities, but the impact of
aura on daily functioning is unknown. The present study sought to evaluate the role of migraine
aura in predicting same-day and subsequent-day migraine-related disability while accounting for demographic, headache, and psychological variables.
This was an observational prospective cohort study among 554 adults with migraine. For each participant, data on migraine symptoms and psychological variables were collected daily for 90 days using the N-1 Headache™ digital app (N = 11,156 total migraine days). Analyses assessed whether the presence of
aura predicted daily ratings of migraine-related disability independently of other headache and psychological variables. Given the number of predictors examined, statistical significance was set at p < 0.01.
The mean (standard deviation, range) patient-level Migraine Disability Assessment questionnaire score across days of the migraine episode was 1.18 (1.03, 0-3).
Aura was significantly associated with higher disability ratings on all days of the migraine episode (odds ratio [OR] 1.40, 99% confidence interval [CI] 1.13-1.74; p < 0.001). This relationship remained unchanged after adjusting for patient-level variables (OR 1.40, 99% CI 1.13-1.73; p < 0.001) and day-level psychological variables (OR 1.39, 99% CI 1.12-1.73; p < 0.001) but was fully negated after controlling for day-level headache variables (OR 1.19, 99% CI 0.95-1.49; p = 0.039). Aura on the first day of the episode was associated with increased odds of allodynia (OR 1.87, 99% CI 1.22-2.86; p < 0.001), phonophobia (OR 1.62, 99% CI 1.17-2.25; p < 0.001), photophobia (OR 1.89, 99% CI 1.37-2.59; p < 0.001), and nausea/vomiting (OR 1.54, 99% CI 1.17-2.02; p < 0.001) on all days of the episode, but not episode duration (p = 0.171), peak severity (p = 0.098), or any examined psychological variables (sleep duration [p = 0.733], sleep quality [p = 0.186], stress [p = 0.110], anxiety [p = 0.102], or sadness [p = 0.743]).
The presence of aura is predictive of increased headache-related disability during migraine episodes, but this effect is attributable to associated non-pain symptoms of migraine.