Guillem E, Pelissolo A, Lepine J P
Service de Psychiatrie, Hôpital Fernand-Widal, Paris.
Encephale. 1999 Sep-Oct;25(5):436-42.
Epidemiologic studies in the general population, taking into account certain bias inherent to the clinical observation have confirmed the clinical impression reporting a higher psychiatric comorbidity with persons suffering from migraine than in persons without migraine. Persons with migraine are at increased risk for affective and anxiety disorders, personality traits disorders (neuroticism), suicide attempts, but not for alcohol or illicit drug abuse. The comorbidity is more important in migraine with aura than in migraine without aura. Concerning affective disorders, the lifetime prevalence of major depression is 34.4% in persons with migraine and 10.4% in persons without migraine. For bipolar I disorder, prevalence is 6.8% in migraine with aura versus 0.9% when no migraine. Compared to no migraine, the lifetime prevalence of anxiety disorders in migraine is significantly increased in: panic disorder (10.9% vs 1.8%); generalized anxiety disorder (10.2% vs 1.9%); obsessive-compulsive disorder (8.6% vs 1.8%); phobic disorder (39.8% vs 20.6%). In addition, no psychopathological, biological or genetic explanation seems to be meaningful for the comprehension of this comorbidity pattern. These results remain primarily descriptive but they justify a clinical investigation of affective and anxiety disorders, and suicide attempts, in all person with migraine, and it also justifies the treatment of pain associated with the treatment of eventual affective or anxiety disorders.
一般人群中的流行病学研究,考虑到临床观察中固有的某些偏差,证实了临床印象,即报告偏头痛患者的精神共病率高于无偏头痛者。偏头痛患者患情感和焦虑障碍、人格特质障碍(神经质)、自杀未遂的风险增加,但酒精或非法药物滥用风险未增加。有先兆偏头痛的共病比无先兆偏头痛更严重。关于情感障碍,偏头痛患者中重度抑郁症的终生患病率为34.4%,无偏头痛者为10.4%。对于双相I型障碍,有先兆偏头痛的患病率为6.8%,无偏头痛者为0.9%。与无偏头痛相比,偏头痛患者中焦虑障碍的终生患病率在以下疾病中显著增加:惊恐障碍(10.9%对1.8%);广泛性焦虑障碍(10.2%对1.9%);强迫症(8.6%对1.8%);恐惧症(39.8%对20.6%)。此外,对于理解这种共病模式,似乎没有任何心理病理学、生物学或遗传学解释有意义。这些结果主要仍是描述性的,但它们证明了对所有偏头痛患者进行情感和焦虑障碍以及自杀未遂的临床调查是合理的,也证明了在治疗最终的情感或焦虑障碍时对疼痛进行治疗是合理的。