Baldacci Filippo, Lucchesi Cinzia, Cafalli Martina, Poletti Michele, Ulivi Martina, Vedovello Marcella, Giuntini Martina, Mazzucchi Sonia, Del Prete Eleonora, Vergallo Andrea, Nuti Angelo, Gori Sara
Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy.
Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy.
Clin Neurol Neurosurg. 2015 May;132:74-8. doi: 10.1016/j.clineuro.2015.02.017. Epub 2015 Mar 10.
Migraine, anxiety and depression often coexist. A "neurolimbic" model of migraine has been recently proposed accounting for a dynamic influence of pain, mood and anxiety on the migraine disease. However, very few data exist concerning clinical migraine features in patients reporting anxiety-depression symptoms.
Aim of our study was to test differences in clinical migraine features between migraineurs with anxiety-depression symptoms and migraineurs without ones.
We recruited 200 consecutive migraineurs. Other primary headaches comorbidity and migraine prophylaxis were exclusion criteria. Each patient was interviewed following a structured questionnaire including general features about migraine, triggers, allodynia. Anxiety and depression symptoms were evaluated in each patient by two brief self-reported scales: the generalized anxiety disorder 7-item scale (GAD-7) and the Patient Health Questionnaire 9-item scale (PHQ-9). A cut-off of 5 in both the GAD-7 and the PHQ-9 was considered positive for the presence of anxiety-depressive symptoms.
One hundred and one patients (51.5%) had anxiety-depression symptoms (GAD-7 and PHQ-9 ≥ 5). They reported a more headaches/month (p = 0.004), higher number of triggers (p < 0.001), and were more allodynic (p = 0.005). In a binary logistic regression model triggers and allodynia made a unique statistical contribution on reporting anxiety-depression symptoms.
Our results showed that the presence of anxiety-depression symptoms affects migraine clinical presentation. They are associated with enhanced migraine triggers susceptibility, more ictal allodynic symptoms as well as more headaches/month. An altered sensation in migraineurs with anxiety-depression symptoms could be a result of a lower pain threshold and an increased cortical excitability in a broader context of a neurolimbic dysfunction.
偏头痛、焦虑和抑郁常常并存。最近有人提出一种偏头痛的“神经边缘”模型，用以解释疼痛、情绪和焦虑对偏头痛疾病的动态影响。然而，关于报告有焦虑抑郁症状的患者的临床偏头痛特征的数据非常少。
我们研究的目的是测试有焦虑抑郁症状的偏头痛患者与没有这些症状的偏头痛患者在临床偏头痛特征上的差异。
我们连续招募了200名偏头痛患者。其他原发性头痛合并症和偏头痛预防性治疗为排除标准。按照一份结构化问卷对每位患者进行访谈，问卷包括偏头痛的一般特征、诱发因素、痛觉过敏。通过两个简短的自我报告量表对每位患者的焦虑和抑郁症状进行评估：广泛性焦虑障碍7项量表（GAD - 7）和患者健康问卷9项量表（PHQ - 9）。GAD - 7和PHQ - 9中任何一项得分≥5被视为存在焦虑抑郁症状。
101名患者（51.5%）有焦虑抑郁症状（GAD - 7和PHQ - 9≥5）。他们每月头痛次数更多（p = 0.004），诱发因素数量更多（p < 0.001），痛觉过敏更明显（p = 0.005）。在二元逻辑回归模型中，诱发因素和痛觉过敏对报告焦虑抑郁症状有独特的统计学贡献。
我们的结果表明，焦虑抑郁症状的存在会影响偏头痛的临床表现。它们与偏头痛诱发因素易感性增强、发作期痛觉过敏症状增多以及每月头痛次数增多有关。有焦虑抑郁症状的偏头痛患者感觉改变可能是在神经边缘功能障碍这一更广泛背景下疼痛阈值降低和皮质兴奋性增加的结果。
