Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
JAMA Otolaryngol Head Neck Surg. 2018 Aug 1;144(8):712-717. doi: 10.1001/jamaoto.2018.0939.
A headache is a symptom of a migraine, but not all patients with migraine have headaches. It is still unclear whether a migraine might increase the risk of cochlear disorders, even though a migraine does not occur concurrently with cochlear disorders.
To investigate the risk of cochlear disorders for patients with a history of migraines.
DESIGN, SETTING, AND PARTICIPANTS: This study used claims data from the Taiwan Longitudinal Health Insurance Database 2005 to identify 1056 patients with migraines diagnosed between January 1, 1996, and December 31, 2012. A total of 4224 controls were also identified from the same database based on propensity score matching. Statistical analysis was performed from January 23, 1996, to December 28, 2012.
The incidence rate of cochlear disorders (tinnitus, sensorineural hearing impairment, and/or sudden deafness) was compared between the cohorts by use of the Kaplan-Meier method. The Cox proportional hazards regression model was also used to examine the association of cochlear disorders with migraines.
Of the 1056 patients with migraines, 672 were women and 384 were men, and the mean (SD) age was 36.7 (15.3) years. Compared with the nonmigraine cohort, the crude hazard ratio for cochlear disorders in the migraine cohort was 2.83 (95% CI, 2.01-3.99), and the adjusted hazard ratio was 2.71 (95% CI, 1.86-3.93). The incidence rates of cochlear disorders were 81.4 (95% CI, 81.1-81.8) per 1 million person-years for the migraine cohort and 29.4 (95% CI, 29.2-29.7) per 1 million person-years for the nonmigraine cohort. The cumulative incidence of cochlear disorders in the migraine cohort (12.2%) was significantly higher than that in the matched nonmigraine cohort (5.5%). Subgroup analysis showed that, compared with the nonmigraine cohort, the adjusted hazard ratios in the migraine cohort were 3.30 (95% CI, 2.17-5.00) for tinnitus, 1.03 (95% CI, 0.17-6.41) for sensorineural hearing impairment, and 1.22 (95% CI, 0.53-2.83) for sudden deafness.
In this population-based study, the risk of cochlear disorders, especially for tinnitus, was found to be significantly higher among patients with a history of migraines. This finding may support the presence and/or concept of "cochlear migraine."
头痛是偏头痛的一种症状，但并非所有偏头痛患者都有头痛。尽管偏头痛不会同时发生，但偏头痛是否会增加耳蜗疾病的风险仍不清楚。
调查有偏头痛病史的患者发生耳蜗疾病的风险。
设计、地点和参与者：本研究使用 1996 年 1 月 1 日至 2012 年 12 月 31 日期间来自台湾纵向健康保险数据库的索赔数据，从该数据库中确定了 1056 例偏头痛诊断患者。还根据倾向评分匹配从同一数据库中确定了 4224 名对照。统计分析于 1996 年 1 月 23 日至 2012 年 12 月 28 日进行。
使用 Kaplan-Meier 方法比较队列之间耳蜗疾病（耳鸣、感音神经性听力障碍和/或突发性聋）的发生率。还使用 Cox 比例风险回归模型检查耳蜗疾病与偏头痛之间的关联。
在 1056 例偏头痛患者中，672 例为女性，384 例为男性，平均（SD）年龄为 36.7（15.3）岁。与非偏头痛队列相比，偏头痛队列中耳蜗疾病的粗危险比为 2.83（95%CI，2.01-3.99），调整后的危险比为 2.71（95%CI，1.86-3.93）。耳蜗疾病的发生率为偏头痛队列为每 100 万人年 81.4（95%CI，81.1-81.8），非偏头痛队列为每 100 万人年 29.4（95%CI，29.2-29.7）。偏头痛队列的耳蜗疾病累积发生率（12.2%）明显高于匹配的非偏头痛队列（5.5%）。亚组分析显示，与非偏头痛队列相比，偏头痛队列中耳鸣的调整后危险比为 3.30（95%CI，2.17-5.00），感音神经性听力障碍为 1.03（95%CI，0.17-6.41），突发性聋为 1.22（95%CI，0.53-2.83）。
在这项基于人群的研究中，发现有偏头痛病史的患者耳蜗疾病的风险，特别是耳鸣的风险明显更高。这一发现可能支持“耳蜗偏头痛”的存在和/或概念。
