1 Alpert Medical School of Brown University, Providence, RI, USA.
2 The Miriam Hospital, Centers for Preventative and Behavioral Medicine, Providence, RI, USA.
Cephalalgia. 2018 Oct;38(11):1707-1715. doi: 10.1177/0333102417747231. Epub 2017 Dec 13.
Background Migraine is a neurological disease involving recurrent attacks of moderate-to-severe and disabling head pain. Worsening of pain with routine physical activity during attacks is a principal migraine symptom; however, the frequency, individual consistency, and correlates of this symptom are unknown. Given the potential of this symptom to undermine participation in daily physical activity, an effective migraine prevention strategy, further research is warranted. This study is the first to prospectively evaluate (a) frequency and individual consistency of physical activity-related pain worsening during migraine attacks, and (b) potential correlates, including other migraine symptoms, anthropometric characteristics, psychological symptoms, and daily physical activity. Methods Participants were women (n = 132) aged 18-50 years with neurologist-confirmed migraine and overweight/obesity seeking weight loss treatment in the Women's Health and Migraine trial. At baseline, participants used a smartphone diary to record migraine attack occurrence, severity, and symptoms for 28 days. Participants also completed questionnaires and 7 days of objective physical activity monitoring before and after diary completion, respectively. Patterning of the effect of physical activity on pain was summarized within-subject by calculating the proportion (%) of attacks in which physical activity worsened, improved, or had no effect on pain. Results Participants reported 5.5 ± 2.8 (mean ± standard deviation) migraine attacks over 28 days. The intraclass correlation (coefficient = 0.71) indicated high consistency in participants' reports of activity-related pain worsening or not. On average, activity worsened pain in 34.8 ± 35.6% of attacks, had no effect on pain in 61.8 ± 34.6% of attacks and improved pain in 3.4 ± 12.7% of attacks. Few participants (9.8%) reported activity-related pain worsening in all attacks. A higher percentage of attacks where physical activity worsened pain demonstrated small-sized correlations with more severe nausea, photophobia, phonophobia, and allodynia (r = 0.18 - 0.22, p < 0.05). Pain worsening due to physical activity was not related to psychological symptoms or total daily physical activity. Conclusions There is large variability in the effect of physical activity on pain during migraine attacks that can be accounted for by individual differences. For a minority of participants, physical activity consistently contributed to pain worsening. More frequent physical activity-related pain worsening was related to greater severity of other migraine symptoms and pain sensitivity, which supports the validity of this diagnostic feature. Study protocol ClinicalTrials.govIdentifier: NCT01197196.
背景 偏头痛是一种涉及反复发作的中度至重度和致残性头痛的神经系统疾病。在发作期间，常规体力活动会加重疼痛，这是偏头痛的主要症状之一；然而，这种症状的频率、个体一致性和相关性尚不清楚。鉴于这种症状有可能破坏日常体力活动的参与，因此需要制定有效的偏头痛预防策略，进一步的研究是必要的。这项研究首次前瞻性评估了（a）偏头痛发作期间与体力活动相关的疼痛加重的频率和个体一致性，以及（b）潜在的相关性，包括其他偏头痛症状、人体测量特征、心理症状和日常体力活动。 方法 参与者为年龄在 18-50 岁之间的女性（n=132），经神经病学家确诊患有偏头痛和超重/肥胖症，正在参加妇女健康和偏头痛试验以寻求减肥治疗。在基线时，参与者使用智能手机日记记录 28 天内偏头痛发作的发生、严重程度和症状。参与者还分别在完成日记前后完成了问卷调查和 7 天的客观体力活动监测。通过计算疼痛加重、改善或无影响的攻击比例（%），对体力活动对疼痛的影响进行了个体内总结。 结果 参与者报告了 28 天内 5.5±2.8（均值±标准差）次偏头痛发作。个体内相关性（系数=0.71）表明参与者报告的与活动相关的疼痛加重或不加重具有高度一致性。平均而言，活动使 34.8±35.6%的发作中的疼痛加重，使 61.8±34.6%的发作中的疼痛无变化，使 3.4±12.7%的发作中的疼痛改善。少数参与者（9.8%）报告在所有发作中均有与活动相关的疼痛加重。活动加重疼痛的发作比例较高与更严重的恶心、畏光、畏声和痛觉过敏呈小到中度相关（r=0.18-0.22，p<0.05）。体力活动引起的疼痛加重与心理症状或总日常体力活动无关。 结论 偏头痛发作期间体力活动对疼痛的影响存在很大差异，这可以归因于个体差异。对于少数参与者而言，体力活动始终会导致疼痛加重。更频繁的与体力活动相关的疼痛加重与其他偏头痛症状的严重程度和疼痛敏感性相关，这支持了该诊断特征的有效性。 研究方案 ClinicalTrials.gov 标识符：NCT01197196。
