气喘似乎会使慢性偏头痛风险加倍


  【24drs.com】根据在线发表于11月19日头痛(Headache)期刊的一篇研究,对于曾发生偏头痛者而言,如果有气喘病史,可以预测慢性偏头痛。
  
  因为这两种状况都很常见—美国约有11.6%人口有偏头痛、7.5%有气喘—所以很可能会同时患有这两个疾病,但是,目前并未确认两者之间的风险关系。纽约布朗士阿尔伯特-爱因斯坦医学院神经科名誉教授、蒙特菲尔头痛中心主任Richard Lipton医师表示,曾有气喘和偏头痛之关联的报告,头痛医疗实务方面也发现,许多偏头痛患者同时也有气喘。
  
  起初,本研究的资深作者Lipton医师,以为他是看到患有这两种疾病病患的偏差样本,因为,是由一线照护医师不确定是否可处方propranolol给气喘患者预防偏头痛时而转介过来。但是,他后来发现其它线索,白三烯素抑制剂对于气喘和偏头痛有一些效果,而这两种疾病都与发炎情况改变、某些平滑肌的变化有关。在气喘方面,呼吸道平滑肌收缩和呼吸道内层发炎而引起支气管收缩。至于在偏头痛,是血管发炎、扩张与收缩。这些机械式关联认为这两个疾病之间可能有相关。
  
  Lipton医师已经进行了「美国偏头痛盛行率与预防(American Migraine Prevalence and Prevention[AMPP])」研究,所以他补充了气喘问题;他表示,那么,我们问气喘可以预测一段时间后的偏头痛恶化吗?你瞧,它可以。
  
  这次的研究中,第一作者、俄亥俄州辛辛那提大学神经科学研究中心、头痛与脸部疼痛计画共同主持人Vincent T. Martin医师等人假设,气喘是从偶发偏头痛变成慢性偏头痛(每个月发作15次以上)的一个风险因素,很少有慢性偏头痛是没有先发生偶发性偏头痛的。
  
  研究者使用来自2008和2009年的AMPP研究资料,纳入来自「欧洲社区呼吸道健康研究(European Community Respiratory Health Survey)」这项调查的一份有6个项目的气喘问卷,另外,为了探讨气喘情况比较严重时是否会增加演变成慢性偏头痛的可能性,研究者发展出一份「呼吸道症状严重度评分(Respiratory Symptom Severity Score)」量表,范围从不严重(没有阳性反应)到轻度严重(1-2个阳性反应)、中度严重(3-4个阳性反应)、高度严重(5-6个阳性反应);AMPP研究则是询问有关头痛时间与频率。
  
  曾有偶发性偏头痛的4,446人中,746人(16.8%)有气喘、3,700人(83.2%)没有。在2009年,这些人有2.9% (131/4446)新发生慢性偏头痛,这也是研究的主要终点。
  
  这组包括了5.4% (40/746)的气喘次组与2.5% (91/3700)的非气喘次组。校正社会人口统计学因素(包括年龄、身体质量指数、性别、收入)、头痛频率、使用偏头痛预防药物之后,有气喘的研究对象发生慢性偏头痛的风险,是没有气喘者的2倍以上(校正风险比[aOR]为2.1;95%信赖区间[CI]为1.4 - 3.1)。
  
  此外,这个风险会随著气喘症状的次数而增加,但是,与没有气喘者相比,只有气喘严重程度高的人,发生慢性偏头痛机会的增加情况才有达到统计上的显著差异(aOR, 3.3;95% CI, 1.7 - 6.2)。
  
  Lipton医师表示,如果严重气喘症状的发生频率增加时,会增加发生慢性偏头痛的风险,那么,很有可能是呼吸道症状扮演著致病作用。
  
  虽然我们发现有气喘者约有2倍的风险,呼吸道症状最严重者发生慢性偏头痛的风险则是没有气喘者的3倍以上。他指出,这个明显的剂量反应关系很像忧郁症,整体而言,忧郁使慢性偏头痛风险增加约将近2倍,但是,忧郁程度最严重者的风险则是3倍。
  
  其它共变项,包括药物滥用、头痛频率与使用预防性药物,都与新发生慢性偏头痛无关。慢性偏头痛的其它风险因素包括肥胖、异常疼痛、其它疼痛状况、滥用barbiturates和narcotics等药物。
  
  Lipton医师表示,让偶发偏头痛的气喘病患使用偏头痛预防药物的决定是复杂的,医师应评估偏头痛病程的整体风险因素资料,将这些纳入治疗决策考量,但是,我不认为有任何研究显示,如果你发现偏头痛病程风险高的患者时,使用偏头痛预防性药物可以预防病程进展。他也推测,如果发炎情形是关联所在时,使用可以降低发炎的药物治疗气喘时,对于偏头痛病程可能会有保护效果。
  
  作者们指出,研究限制包括,未知的干扰因素、90%的研究对象是白人、问卷采自我报告、时间只有1年。
  
  资料来源:http://www.24drs.com/
  
  Native link:Asthma Appears to Double Chronic Migraine Risk

Asthma Appears to Double Chronic Migraine Risk

By Ricki Lewis, PhD
Medscape Medical News

A history of asthma may predict chronic migraine in individuals who have episodic migraine, according to a study published online November 19 in Headache.

Because both conditions are prevalent — about 11.6% of the US population has migraine and 7.5% has asthma — comorbidity is likely, but a risk relationship has not been established. "Links between asthma and migraine had been reported, and people who practice headache medicine have noticed that a lot of patients with migraine also have asthma," Richard Lipton, MD, director of the Montefiore Headache Center and the Edwin S. Lowe Chair in Neurology, Albert Einstein College of Medicine, Bronx, New York, told Medscape Medical News.

At first, Dr Lipton, who is senior author on the paper, thought he was seeing a skewed sample of patients with both disorders who had been referred by primary care physicians uncertain of whether to prescribe propranolol to prevent migraine to patients with asthma. But then he noted other clues: "Leukotriene inhibitors have some effect in asthma and migraine, and both disorders involve inflammatory changes and changes in smooth muscle. In asthma, bronchoconstriction is caused by contractility of smooth muscle in the airways and inflammation of the airway linings. And in migraine there's inflammation, and dilation and constriction of blood vessels. These mechanistic links suggested that the two conditions might be associated."

Dr Lipton was already conducting the American Migraine Prevalence and Prevention (AMPP) study, so he added asthma questions. "Then we asked, 'Does asthma predict worsening of migraine over time?' Lo and behold, it did," he said.

Link Apparent in Large Study

For the current study, lead author Vincent T. Martin, MD, codirector of the Headache and Facial Pain Program at the University of Cincinnati Neuroscience Institute in Ohio, and colleagues hypothesized that asthma is a risk factor for the transition from episodic to chronic migraine (15 or more headaches a month). Chronic migraine rarely occurs without episodic migraine first.

The researchers used data from the AMPP for 2008 and 2009. The instrument included a six-item asthma questionnaire from the European Community Respiratory Health Survey. Also, to investigate whether more severe asthma increased the likelihood of progressing to chronic migraine, the researchers developed a Respiratory Symptom Severity Score, ranging from no severity (zero positive responses), to low severity (one to two positive responses), moderate severity (three to four positive responses), and high severity (five to six positive responses). The AMPP asked about headache duration and frequency.

Of 4446 participants who had episodic migraine, 746 (16.8%) had asthma and 3700 (83.2%) did not. In 2009, new-onset chronic migraine developed in 2.9% (131/4446) of the cohort, which was the primary endpoint.

This group included 5.4% (40/746) of the asthma subgroup and 2.5% (91/3700) of the nonasthma subgroup. Participants with asthma had a greater than twofold risk for progression to chronic migraine compared with those without asthma, after adjusting for sociodemographic factors (including age, body mass index, sex, and income), headache frequency, and migraine preventive medication use (adjusted odds ratio [aOR], 2.1; 95% confidence interval [CI], 1.4 - 3.1).

Moreover, the risk appeared to increase as the number of asthma symptoms increased, but only those in the high asthma severity group exhibited a statistically significant increase in the odds of chronic migraine onset compared with those without asthma (aOR, 3.3; 95% CI, 1.7 - 6.2).

"If increasingly severe asthma symptoms increase the risk of progression to chronic migraine, then it is more likely that respiratory symptoms play a causal role," Dr Lipton said. "While we found that overall presence of asthma about doubles the risk, the group with the most severe respiratory symptoms was more than three times as likely to develop chronic migraine as people free of asthma." The apparent dose-response is similar to that for depression, he added. "Overall, depression a little less than doubles the risk of chronic migraine, but the highest depression triples risk."

The other covariates, including medication overuse, headache frequency, and preventative medication use, were not associated with new-onset chronic migraine. Other risk factors for chronic migraine are obesity, allodynia, other pain disorders, and overuse of barbiturates and narcotics.

The decision to use migraine preventive medication in patients with asthma with episodic migraine is complex, Dr Lipton said. "Physicians should assess the overall profiles of risk factors for migraine progression and take them into account in treatment decisions. But I don't think any studies have shown that if you identify people at high risk for migraine progression that treatment with migraine preventive medication prevents progression." He also speculates that treating asthma with drugs that reduce inflammation may have a protective effect against migraine progression, if inflammation is the link.

The authors note several study limitations including unknown confounders, the fact that 90% of the participants were Caucasian, self-reporting on questionnaires, and the 1-year duration.

McNeil-Janssen Scientific Affairs LLC funded The AMPP study and donated the resulting database to the National Headache Foundation. The authors have disclosed no relevant financial relationships.

Headache. Published online November 19, 2015.

    
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