Department of Neurology, University Hospital of Essen, Essen, Germany Department of Neurology, St. Joseph Hospital, Ruhr-University of Bochum, Bochum, Germany Allergan, Inc, Irvine, CA, USA Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany.
Pain. 2013 Mar;154(3):484-492. doi: 10.1016/j.pain.2012.12.010. Epub 2012 Dec 28.
The objective of this study was to evaluate the association between low and frequent low back pain and chronic migraine (CM) and chronic tension-type headache (CTTH) in a large, German population-based sample. Headaches were diagnosed according to International Classification of Headache Disorders-2 criteria and categorized according to frequency (episodic 1-14 days/month or chronic ≤15 days/month) and headache type (migraine or TTH). We defined frequent low back pain as self-reported low back pain on ≥15 days/month. We calculated odds ratios and 95% confidence intervals (CI) using logistic regression analyses, adjusting for sociodemographic covariates. There were 5605 respondents who reported headache in the previous year, of whom 255 (4.5%) had Chronic Headache. Migraine was diagnosed in 2933 respondents, of whom 182 (6.2%) had CM. TTH was diagnosed in 1253 respondents, of whom 50 (4.0%) had CTTH. Among 9944 respondents, 6030 reported low back pain, of whom 1267 (21.0%) reported frequent low back pain. In adjusted models, the odds of having frequent low back pain were between 2.1 (95% CI 1.7-2.6) and 2.7 (95% CI 2.3-3.2) times higher in all episodic headache subtypes when compared to No Headache. The odds of having frequent low back pain were between 13.7 (95% CI 7.4-25.3) and 18.3 (95% CI 11.9-28.0) times higher in all chronic headache subtypes when compared to No Headache. Low and frequent low back pain was associated with CM and CTTH. Multiple explanations may contribute to the association of headache and back pain, including the notion that the neurobiology of chronic headache, independent of primary headache type, not only involves the trigeminal pain pathway, but is also a part of abnormal general pain processing.
本研究旨在评估在德国大型人群样本中，低频率和高频率腰痛与慢性偏头痛（CM）和慢性紧张型头痛（CTTH）之间的关联。头痛的诊断依据为国际头痛疾病分类第 2 版（ICHD-2）标准，并根据频率（发作性 1-14 天/月或慢性头痛≤15 天/月）和头痛类型（偏头痛或 TTH）进行分类。我们将高频率腰痛定义为报告每月腰痛≥15 天。我们使用逻辑回归分析计算了比值比（OR）和 95%置信区间（CI），并调整了社会人口学协变量。在过去一年中报告有头痛的 5605 名受访者中，有 255 名（4.5%）患有慢性头痛。在报告有偏头痛的 2933 名受访者中，有 182 名（6.2%）患有 CM。在报告有 TTH 的 1253 名受访者中，有 50 名（4.0%）患有 CTTH。在 9944 名受访者中，有 6030 名报告有腰痛，其中 1267 名（21.0%）报告有高频率腰痛。在调整后的模型中，与无头痛相比，所有发作性头痛亚型的高频率腰痛的 OR 均在 2.1（95%CI 1.7-2.6）和 2.7（95%CI 2.3-3.2）倍之间。与无头痛相比，所有慢性头痛亚型的高频率腰痛的 OR 均在 13.7（95%CI 7.4-25.3）和 18.3（95%CI 11.9-28.0）倍之间。低频率和高频率腰痛与 CM 和 CTTH 相关。许多解释可能导致头痛和腰痛之间的关联，包括这样一种观点，即慢性头痛的神经生物学，独立于原发性头痛类型，不仅涉及三叉神经疼痛通路，而且还是异常的一般疼痛处理的一部分。
