Department of Neurology, University of Munich, Munich, 81377, Germany.
Headache. 2014 May;54(5):861-71. doi: 10.1111/head.12195. Epub 2013 Aug 23.
To investigate if a headache frequency of 15 days per month constitutes a turning point in the psychosocial impairment associated with migraine.
Migraine is differentiated into episodic and chronic forms based on a headache frequency criterion (< vs ≥15 headache days per month). It is presently not clear if this criterion represents a clinically and pathophysiologically meaningful turning point of the disease.
Six hundred and one migraine patients completed measures of pain-specific disability (Migraine Disability Assessment Scale, von Korff scale), health-related quality of life (Short Form-12 Health Survey), habitual well-being (Marburg questionnaire), and anxiety and depression (Hospital Anxiety and Depression Score).
A significant increase of psychosocial impairment with the number of headache days per month was found at lower headache frequencies, but leveled off at higher headache frequencies. Visual inspection and spline interpolation suggested that the turning point was not exactly at 15 headache days per month but rather around 13.3 (confidence interval: 8.9-17.7) days. Accordingly, significant correlations between headache days and psychosocial impairment were found in the group with ≤13 headache days per month (Spearman's rho = 0.25, P < .001) but not in the group with >13 headache days (rho = -0.02, n.s.).
These results suggest that a meaningful turning point in psychosocial impairment associated with migraine is located around 13.3 headache days per month, somewhat below the 15-headache days criterion that by definition separates chronic from episodic migraine. However, confidence intervals surrounding the turning point were large. Further studies will be needed to more exactly localize the turning point.
探讨每月头痛频率为 15 天是否构成偏头痛相关心理社会障碍的转折点。
偏头痛根据头痛频率标准（< vs ≥15 头痛天/月）分为发作性和慢性形式。目前尚不清楚该标准是否代表疾病的临床和病理生理有意义的转折点。
601 例偏头痛患者完成了疼痛特异性残疾（偏头痛残疾评估量表、von Korff 量表）、健康相关生活质量（简短形式-12 健康调查）、习惯性幸福感（马尔堡问卷）以及焦虑和抑郁（医院焦虑和抑郁量表）的评估。
在较低的头痛频率下，发现头痛天数与心理社会障碍呈显著正相关，但在较高的头痛频率下，相关性趋于平稳。直观检查和样条插值表明，转折点并不完全在每月 15 天头痛时，而是在每月 13.3 天左右（置信区间：8.9-17.7）。因此，在每月≤13 天头痛的组中发现头痛天数与心理社会障碍之间存在显著相关性（Spearman's rho=0.25，P<0.001），而在每月>13 天头痛的组中无相关性（rho=0.02，n.s.）。
这些结果表明，与偏头痛相关的心理社会障碍的一个有意义的转折点位于每月 13.3 天头痛左右，略低于定义慢性偏头痛与发作性偏头痛的每月 15 天头痛标准。然而，转折点的置信区间较大。需要进一步的研究来更准确地定位转折点。
