Radat F
Centre douleur chronique, CHU Pèllegrin, place Amelie-Raba-Léon, 33076 Bordeaux cedex, France.
Rev Neurol (Paris). 2013 May;169(5):406-12. doi: 10.1016/j.neurol.2012.11.008. Epub 2013 Apr 19.
The link between stress and migraine is complex. In its recent conception, stress is viewed as a transactional process between an individual and his-her environment in which the individual makes a response to an internal or external constraint. This paper reviews the evidence in favor of a relationship between stress and migraine. Many studies show that 50 to 80% of patients report stress as a precipitating factor for their migraine headaches. Many authors have suggested that acute stress can provoke biological modifications lowering the threshold of the individual's susceptibility to a migraine attack. It has also been shown that the incidence of migraine is higher when stress scores are higher in the previous year. This suggests that as well as being a precipitating factor of crisis, stress could also be a precipitating factor of illness in susceptible individuals. Moreover, stress can trigger migraine chronification. This has been shown in many retrospective studies and in one prospective study. Hyperalgesia and central sensitivity to pain induced by chronic stress can partly explain this phenomenon. Many retrospective studies also show that adverse events during childhood, like sexual and physical abuse, are more frequent in migraineurs than non-migraineurs. Nevertheless, there is no prospective study allowing considering a causal link between childhood abuse and migraine in adulthood. Another point that will be tackled is the comorbidity between stress related psychiatric disorders, such as post-traumatic stress disorder, and migraine. Here again, many studies conducted in huge samples from the general population are convincing. All that leads to propose stress management therapies to migraineurs. Randomized control trials and meta-analyses have shown that relaxation therapies, biofeedback and stress management cognitive behavioral therapies are effective in migraine prophylaxis, above all in children. The use of these therapies is of particular interest in association with pharmacological treatments in patients with frequent crises. However, the majority of the studies have poor methodological standards. Nevertheless, stress management therapies are proposed as prophylactic treatment in the French recommendations for migraine management.
压力与偏头痛之间的联系很复杂。在最近的概念中，压力被视为个体与其环境之间的一种交互过程，在此过程中个体对内部或外部限制做出反应。本文综述了支持压力与偏头痛之间存在关联的证据。许多研究表明，50%至80%的患者称压力是其偏头痛发作的诱发因素。许多作者认为，急性压力可引发生物变化，降低个体对偏头痛发作的易感性阈值。研究还表明，上一年压力得分较高时，偏头痛的发病率也较高。这表明，压力不仅是危机的诱发因素，在易感个体中也可能是疾病的诱发因素。此外，压力可引发偏头痛慢性化。这在许多回顾性研究和一项前瞻性研究中都得到了证实。慢性压力引起的痛觉过敏和中枢疼痛敏感性可部分解释这一现象。许多回顾性研究还表明，偏头痛患者童年时期遭受的不良事件，如性虐待和身体虐待，比非偏头痛患者更为常见。然而，尚无前瞻性研究能够证实童年期虐待与成年期偏头痛之间存在因果关系。另一个要探讨的问题是与压力相关的精神障碍，如创伤后应激障碍，与偏头痛之间的共病情况。同样，在来自普通人群的大量样本中进行的许多研究也很有说服力。所有这些都促使向偏头痛患者推荐压力管理疗法。随机对照试验和荟萃分析表明，放松疗法、生物反馈和压力管理认知行为疗法对偏头痛预防有效，尤其是对儿童。在频繁发作的患者中，将这些疗法与药物治疗联合使用特别有意义。然而，大多数研究的方法学标准较差。尽管如此，在法国偏头痛管理指南中，压力管理疗法被推荐作为预防性治疗方法。
