Santos Itamar S, Brunoni André R, Goulart Alessandra C, Griep Rosane H, Lotufo Paulo A, Benseñor Isabela M
Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, Av, Dr, Enéas Carvalho de Aguiar, 155, 8o, andar, Bloco 3, Cerqueira César ZIP code 05403-000, São Paulo, Brazil.
BMC Public Health. 2014 Jul 3;14:678. doi: 10.1186/1471-2458-14-678.
Stress is a typical migraine trigger. However, the impact of negative life events on migraine activity is poorly studied. The aim of this study is to investigate the association between negative life events and migraine using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment.
ELSA-Brasil is a multicenter cohort study conducted in six Brazilian cities. Baseline assessment included validated questionnaires for headache classification and the occurrence of five pre-specified negative life events (financial hardship, hospitalization other than for childbirth, death of a close relative, robbery and end of a love relationship), focusing on a 12-month period before evaluation. We built crude and adjusted logistic regression models to study the association between the occurrences of negative life events and migraine diagnosis and activity.
We included 4,409 individuals with migraine and 4,457 participants without headache (reference). After adjustment for age, sex, race, income and educational level, we found that the occurrence of a negative life event (Odds ratio = 1.31; 95% confidence interval = 1.19-1.45) was associated with migraine. However, after stratifying with subgroup analyses, only financial hardship (Odds ratio = 1.65; 95% confidence interval = 1.47-1.87) and hospitalization (Odds ratio = 1.47; 95% confidence interval = 1.25-1.72) were independently associated with migraine. Further adjustment for a current major depression episode and report of religious activity did not significantly change the results. Considering migraine frequency as (a) less than once per month, (b) once per month to once per week, or (c) more than once per week, financial hardship and hospitalization remained significantly associated with migraine in all episode frequency strata, with higher odds ratios for higher frequencies in adjusted models. We also observed a significant association between the death of a close relative and the highest migraine frequency stratum (Odds ratio = 1.38; 95% confidence interval = 1.09-1.75) in full-adjusted model.
The occurrence of financial hardship and hospitalization had a direct and independent association with migraine diagnosis and frequency. The death of a close relative was also independently associated with the highest migraine frequency stratum.
压力是典型的偏头痛触发因素。然而，负面生活事件对偏头痛活动的影响研究较少。本研究旨在利用巴西成人健康纵向研究（ELSA - Brasil）基线评估数据，调查负面生活事件与偏头痛之间的关联。
ELSA - Brasil是在巴西六个城市进行的多中心队列研究。基线评估包括用于头痛分类的有效问卷以及五个预先指定的负面生活事件（经济困难、非分娩住院、近亲死亡、抢劫和恋爱关系结束）的发生情况，重点关注评估前12个月的时间段。我们构建了粗略和调整后的逻辑回归模型，以研究负面生活事件的发生与偏头痛诊断及活动之间的关联。
我们纳入了4409名偏头痛患者和4457名无头痛参与者（对照）。在对年龄、性别、种族、收入和教育水平进行调整后，我们发现负面生活事件的发生（比值比 = 1.31；95%置信区间 = 1.19 - 1.45）与偏头痛相关。然而，在进行亚组分析分层后，只有经济困难（比值比 = 1.65；95%置信区间 = 1.47 - 1.87）和住院（比值比 = 1.47；95%置信区间 = 1.25 - 1.72）与偏头痛独立相关。对当前重度抑郁发作和宗教活动报告进行进一步调整后，结果无显著变化。将偏头痛发作频率分为（a）每月少于一次、（b）每月一次至每周一次或（c）每周多于一次，在所有发作频率分层中，经济困难和住院与偏头痛仍显著相关，在调整模型中，频率越高比值比越高。在完全调整模型中，我们还观察到近亲死亡与最高偏头痛发作频率分层之间存在显著关联（比值比 = 1.38；95%置信区间 = 1.09 - 1.75）。
经济困难和住院的发生与偏头痛诊断及频率存在直接且独立的关联。近亲死亡也与最高偏头痛发作频率分层独立相关。
