Ng-Mak Daisy S, Cady Roger, Chen Ya-Ting, Ma Larry, Bell Christopher F, Hu X Henry
Outcomes Research and Management, Merck & Co., Inc., West Point, PA, USA.
Headache. 2007 May;47(5):645-53. doi: 10.1111/j.1526-4610.2007.00783.x.
While treating migraine early when the headache is mild is believed to link to improved treatment outcomes, it is not clear whether patients can correctly self-identify a headache as a migraine at onset in real-world settings.
This study aims to assess the likelihood that patients can correctly self-identify a headache as a migraine at onset, and to evaluate cues that patients use to correctly identify migraine attacks.
Adult migraineurs were recruited from 14 headache clinics across the United States. Patients recorded their headache experiences via an electronic diary daily over a period of 30 days. On days when they experienced headaches, patients were asked to recall the types of headache they experienced at both onset and peak. Patients also identified cues for deciding whether the headache was a migraine or not. Using identification of migraine at headache peak as the criterion, we examined the sensitivity and specificity of migraine identification at onset. We employed generalized estimating equation (GEE) to evaluate factors identified at headache onset that predicted migraine identified at headache peak.
Of the 192 enrolled patients, 182 patients recorded a total of 1197 headache episodes over 30 days. At headache onset, 888 episodes were deemed by patients as migraine and 309 episodes not migraine; a majority (92%) of these early migraine identifications were confirmed at headache peak. Sensitivity and specificity of self-identification of migraine at onset were 91% and 97%, respectively. A number of factors at headache onset were predictive of a migraine identified at peak: sensitivity to light (OR = 3.1, 95% CI: 1.9-5.0), headache severity (OR = 2.0, 95% CI: 1.4-2.8), nausea symptoms (OR = 2.6, 95% CI: 1.5-4.5), and visual disturbance (OR = 2.3, 95% CI: 1.1-4.9). Patients who ruled out tension-type headache at onset were twice (OR = 2.0, 95% CI: 1.5-2.8) as likely to conclude a migraine at peak.
Most migraineurs in tertiary care settings can correctly self-identify a headache as a migraine at onset. Factors such as headache severity, presence of nausea, visual disturbance, sensitivity to light, and no tension-type headache, appeared to augment the correct identification.
虽然人们认为在头痛症状较轻时尽早治疗偏头痛与改善治疗效果相关，但在现实环境中，患者是否能够在头痛发作之初就正确地自我识别为偏头痛尚不清楚。
本研究旨在评估患者在头痛发作之初就能正确自我识别为偏头痛的可能性，并评估患者用于正确识别偏头痛发作的线索。
从美国14家头痛诊所招募成年偏头痛患者。患者在30天的时间里每天通过电子日记记录其头痛经历。在经历头痛的日子里，要求患者回忆头痛发作之初和高峰期所经历的头痛类型。患者还需确定判断头痛是否为偏头痛的线索。以头痛高峰期偏头痛的识别情况作为标准，我们检验了头痛发作之初偏头痛识别的敏感性和特异性。我们采用广义估计方程（GEE）来评估在头痛发作之初确定的、能够预测头痛高峰期偏头痛识别情况的因素。
在192名登记患者中，182名患者在30天内共记录了1197次头痛发作。在头痛发作之初，患者认为888次发作为偏头痛，309次发作不是偏头痛；这些早期偏头痛识别中，大多数（92%）在头痛高峰期得到了证实。头痛发作之初偏头痛自我识别的敏感性和特异性分别为91%和97%。头痛发作之初的一些因素能够预测高峰期识别为偏头痛：对光敏感（比值比[OR]=3.1，95%置信区间[CI]：1.9 - 5.0）、头痛严重程度（OR = 2.0，95% CI：1.4 - 2.8）、恶心症状（OR = 2.6，95% CI：1.5 - 4.5）以及视觉障碍（OR = 2.3，95% CI：1.1 - 4.9）。在发作之初排除紧张型头痛的患者在高峰期判定为偏头痛的可能性是其他人的两倍（OR = 2.0，95% CI：1.5 - 2.8）。
三级医疗环境中的大多数偏头痛患者能够在头痛发作之初正确地自我识别为偏头痛。头痛严重程度、恶心的存在、视觉障碍、对光敏感以及无紧张型头痛等因素似乎有助于正确识别。
