Eidlitz-Markus Tal, Haimi-Cohen Yishai, Zeharia Avraham
Pediatric Headache Clinic, Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Headache. 2017 Jun;57(6):899-907. doi: 10.1111/head.13109. Epub 2017 May 7.
OBJECTIVE/BACKGROUND: To investigate the characteristics of vomiting in pediatric migraineurs and the relationship of vomiting with other migraine-related parameters.
The cohort included children and adolescents with migraine attending a headache clinic of a tertiary pediatric medical center from 2010 to 2016. Patients were identified by a retrospective database search. Data were collected from medical files. The presence of vomiting was associated with background and headache-related parameters.
The study group included 453 patients, 210 boys (46.4%) and 243 girls (53.6%), of mean age 11.3 ± 3.7 years. Vomiting was reported by 161 patients (35.5%). On comparison of patients with and without vomiting, vomiting was found to be significantly associated with male gender (54% vs 42.1%, P < .018), younger age at migraine onset (8.0 ± 3. years vs 9.6 ± 3.7 years, P < .001), younger age at clinic admission (10.5 ± 3. years vs 11.6 ± 3.6 years, P = .002), higher rate of awakening headache (64.1% vs 38.7%, P < .001), lower headache frequency (10.5 ± 10.3 headaches/month vs 15.0 ± 11.7 headaches/month, P < .001), higher rate of episodic vs chronic migraine (67% vs 58.7%, P < .001), and higher rates of paternal migraine (24.1% vs 10.1%, P < .001), migraine in both parents (9.3% vs 3.1%, P = .007), and migraine in either parent (57.5% vs 45.5%, P = .02).
The higher rate of vomiting in the younger patients and the patients with awakening pain may be explained by a common underlying pathogenetic mechanism of vomiting and migraine involving autonomic nerve dysfunction/immaturity. The association of vomiting with parental migraine points to a genetic component of vomiting and migraine. It should be noted that some of the findings may simply reflect referral patterns in the tertiary clinic.
目的/背景：研究小儿偏头痛患者呕吐的特征以及呕吐与其他偏头痛相关参数的关系。
该队列研究纳入了2010年至2016年在一家三级儿科医疗中心头痛门诊就诊的偏头痛儿童和青少年。通过回顾性数据库搜索识别患者。从病历中收集数据。呕吐的存在与背景及头痛相关参数相关。
研究组包括453例患者，其中210例男孩（46.4%），243例女孩（53.6%），平均年龄11.3±3.7岁。161例患者（35.5%）报告有呕吐症状。在有呕吐和无呕吐的患者比较中，发现呕吐与男性性别（54%对42.1%，P<0.018）、偏头痛发作时年龄较小（8.0±3.0岁对9.6±3.7岁，P<0.001）、门诊入院时年龄较小（10.5±3.0岁对11.6±3.6岁，P=0.002）、觉醒性头痛发生率较高（64.1%对38.7%，P<0.001）、头痛频率较低（10.5±10.3次/月对15.0±11.7次/月，P<0.001）、发作性偏头痛与慢性偏头痛发生率较高（67%对58.7%，P<0.001）以及父亲患偏头痛的发生率较高（24.1%对10.1%，P<0.001）、父母双方均患偏头痛（9.3%对3.1%，P=0.007）和父母一方患偏头痛（57.5%对45.5%，P=0.02）显著相关。
年龄较小的患者以及有觉醒性疼痛的患者呕吐发生率较高，这可能是由于呕吐和偏头痛存在共同的潜在发病机制，涉及自主神经功能障碍/不成熟。呕吐与父母患偏头痛之间的关联表明呕吐和偏头痛存在遗传因素。需要注意的是，部分研究结果可能仅仅反映了三级诊所的转诊模式。
