From the Saul B. Korey Department of Neurology (R.B.L., D.C.B., C.B.H., T.A.D., T.M.B., B.M.G., S.R.H.) and Department of Epidemiology and Population Health (R.B.L., C.B.H.), Albert Einstein College of Medicine, Bronx; Montefiore Headache Center (R.B.L., D.C.B., T.A.D., B.M.G.), Bronx, NY; and Department of Community Medicine (H.T.), University of Connecticut School of Medicine, Farmington, CT.
Neurology. 2014 Apr 22;82(16):1395-401. doi: 10.1212/WNL.0000000000000332. Epub 2014 Mar 26.
To test whether level of perceived stress and reductions in levels of perceived stress (i.e., "let-down") are associated with the onset of migraine attacks in persons with migraine.
Patients with migraine from a tertiary headache center were invited to participate in a 3-month electronic diary study. Participants entered data daily regarding migraine attack experience, subjective stress ratings, and other data. Stress was assessed using 2 measures: the Perceived Stress Scale and the Self-Reported Stress Scale. Logit-normal, random-effects models were used to estimate the odds ratio for migraine occurrence as a function of level of stress over several time frames.
Of 22 enrolled participants, 17 (median age 43.8 years) completed >30 days of diaries, yielding 2,011 diary entries including 110 eligible migraine attacks (median 5 attacks per person). Level of stress was not generally associated with migraine occurrence. However, decline in stress from one evening diary to the next was associated with increased migraine onset over the subsequent 6, 12, and 18 hours, with odds ratios ranging from 1.5 to 1.9 (all p values < 0.05) for the Perceived Stress Scale. Decline in stress was associated with migraine onset after controlling for level of stress for all time points. Findings were similar using the Self-Reported Stress Scale.
Reduction in stress from one day to the next is associated with migraine onset the next day. Decline in stress may be a marker for an impending migraine attack and may create opportunities for preemptive pharmacologic or behavioral interventions.
检验感知压力水平和感知压力降低（即“放松”）是否与偏头痛患者偏头痛发作的发生有关。
一家三级头痛中心的偏头痛患者受邀参加了为期 3 个月的电子日记研究。参与者每天记录偏头痛发作经历、主观压力评分和其他数据。使用 2 种量表评估压力：感知压力量表和自我报告压力量表。使用对数正态、随机效应模型，根据几个时间框架内的压力水平，估算偏头痛发生的优势比。
22 名入组参与者中，有 17 名（中位数年龄 43.8 岁）完成了 >30 天的日记，共记录了 2011 份日记条目，其中包括 110 次符合条件的偏头痛发作（中位数每人 5 次发作）。压力水平通常与偏头痛发作无关。然而，从一个晚上的日记到下一个晚上的压力下降与随后 6、12 和 18 小时内偏头痛发作的增加有关，使用感知压力量表的优势比范围为 1.5 至 1.9（所有 p 值均<0.05）。在考虑所有时间点的压力水平后，压力下降与偏头痛发作有关。使用自我报告压力量表也得出了类似的结果。
从一天到下一天的压力下降与第二天的偏头痛发作有关。压力下降可能是即将发生偏头痛发作的标志物，并可能为预防性药物或行为干预创造机会。
