Lipton Richard B
Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
Neurology. 2009 Feb 3;72(5 Suppl):S3-7. doi: 10.1212/WNL.0b013e3181974b19.
Migraine attacks sometimes increase in frequency over time. Headache experts conceptualize this process with a model that envisions transition into and out of four distinct states: no migraine, low-frequency episodic migraine (<10 headaches per month), high-frequency episodic migraine (10-14 headaches per month), and chronic migraine (CM, >or=15 headaches per month). Transitions may be in the direction of increasing or decreasing headache frequency and are influenced by specific risk factors. Overall, population studies estimate that patients who have low-frequency episodic migraine or high-frequency episodic migraine will transition to CM at the rate of about 2.5% per year. Two longitudinal population studies, the Frequent Headache Epidemiology study and the ongoing American Migraine Prevalence and Prevention (AMPP) study provide longitudinal population data that has defined the rates of and risk factors for transition. Launched in 2004, the AMPP study has followed a sample of >10,000 migraine sufferers annually for 4 years. Cross-sectional data from the Frequent Headache Epidemiology study and the AMPP study show that patients with chronic daily headaches have lower levels of education and household income. In addition, epidemiologic profiles show that CM sufferers tend to be older and have higher body mass indexes. These studies have also assessed a number of potential risk factors associated with the transition to CM. These include baseline high attack frequency, obesity, stressful life events, snoring, and overuse of certain classes of medication. In particular, opiate and barbiturate combination products contribute to migraine progression, and nonsteroidal anti-inflammatory agents are protective in patients with <10 headache days per month. The influence of medication is modified by both headache attack frequency and frequency of medication use. Although depression and anxiety are associated with an increased risk of new-onset CM, the influence of depression is accounted for by migraine disability assessment scale score, whereas the effect of anxiety may be independent of migraine disability assessment scale score. Emerging data on the longitudinal risk of CM suggest that, in a population at risk, CM may be a preventable disorder.
偏头痛发作的频率有时会随着时间的推移而增加。头痛专家用一个模型来描述这个过程，该模型设想了向四种不同状态的转变以及从这些状态中恢复：无偏头痛、低频发作性偏头痛（每月头痛少于10次）、高频发作性偏头痛（每月头痛10 - 14次）和慢性偏头痛（CM，每月头痛≥15次）。转变可能朝着头痛频率增加或减少的方向进行，并受到特定风险因素的影响。总体而言，人群研究估计，患有低频发作性偏头痛或高频发作性偏头痛的患者每年将以约2.5%的速度转变为慢性偏头痛。两项纵向人群研究，即频繁头痛流行病学研究和正在进行的美国偏头痛患病率与预防（AMPP）研究，提供了确定转变发生率和风险因素的纵向人群数据。AMPP研究于2004年启动，每年对超过10000名偏头痛患者进行为期4年的跟踪研究。频繁头痛流行病学研究和AMPP研究的横断面数据显示，患有慢性每日头痛的患者受教育程度和家庭收入较低。此外，流行病学资料表明，慢性偏头痛患者往往年龄较大且体重指数较高。这些研究还评估了一些与转变为慢性偏头痛相关的潜在风险因素。这些因素包括基线发作频率高、肥胖、生活压力事件、打鼾以及某些类别的药物过度使用。特别是，阿片类药物和巴比妥类药物组合产品会导致偏头痛病情进展，而对于每月头痛天数少于10天的患者，非甾体类抗炎药具有保护作用。药物的影响会因头痛发作频率和用药频率而有所改变。虽然抑郁和焦虑与新发慢性偏头痛的风险增加有关，但抑郁的影响可由偏头痛残疾评估量表评分来解释，而焦虑的影响可能独立于偏头痛残疾评估量表评分。关于慢性偏头痛纵向风险的新数据表明，在有风险的人群中，慢性偏头痛可能是一种可预防的疾病。
