Tzourio C, Kittner S J, Bousser M G, Alpérovitch A
INSERM U360 Recherches Epidémiologiques en Neurologie et Psychopathologie, Hôpital de la Salpêtrière, Paris, France.
Cephalalgia. 2000 Apr;20(3):190-9. doi: 10.1046/j.1468-2982.2000.00041.x.
In this paper we review the evidence that migraine is associated with ischaemic stroke in young women, emphasizing potential biases, factors that may influence the association, potential mechanisms, and potential public health impact. Consistency of case-control findings from several countries and supporting evidence from prospective data suggest that the association is not an artifact of study design or execution, although, due to methodological limitations, none of the studies mentioned can be considered definite proof of the association. However, it is less clear whether migraine without aura is associated with stroke or whether the association is restricted to migraine with aura. Similarly, there are few data examining the magnitude of the association among nonusers of oral contraceptives compared with those who use low oestrogen oral contraceptives. As a consequence, there is a lack of data concurrently stratifying both by the presence vs. the absence of aura and by the use of low oestrogen oral contraceptives vs. non-use of oral contraceptives. Moreover, there is still no convincing evidence on the mechanisms that would be implied and on the groups of migraineurs really at risk of ischaemic stroke. Despite the considerable advances in our understanding of the relationship between migraine and stroke, there are many gaps in the data needed for public health recommendations.
在本文中，我们回顾了偏头痛与年轻女性缺血性卒中相关的证据，重点关注潜在偏倚、可能影响这种关联的因素、潜在机制以及潜在的公共卫生影响。来自多个国家的病例对照研究结果具有一致性，前瞻性数据也提供了支持证据，这表明这种关联并非研究设计或实施过程中的人为因素所致。不过，由于方法学上的局限性，上述提及的研究均不能被视为这种关联的确凿证据。然而，无先兆偏头痛是否与卒中相关，或者这种关联是否仅限于有先兆偏头痛，目前尚不清楚。同样，与使用低雌激素口服避孕药的人群相比，关于未使用口服避孕药人群中这种关联程度的数据也很少。因此，缺乏同时按有无先兆以及使用低雌激素口服避孕药与否进行分层的数据。此外，对于其中所涉及的机制以及真正有缺血性卒中风险的偏头痛患者群体，仍然没有令人信服的证据。尽管我们对偏头痛与卒中之间关系的理解有了相当大的进展，但在制定公共卫生建议所需的数据方面仍存在许多空白。
