Department of Neurology, The Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington, DC; Pediatric Specialists of Virginia, Woodbridge, VA; Genetic Epidemiology Branch, National Institute of Mental Health, Bethesda, MD.
Genetic Epidemiology Branch, National Institute of Mental Health, Bethesda, MD.
J Pediatr. 2019 Feb;205:210-217. doi: 10.1016/j.jpeds.2018.09.033. Epub 2018 Oct 29.
To examine the associations between headaches and migraine with physical and mental disorders in a large pediatric registry.
In total, 9329 youth aged 8-21 years from the Philadelphia Neurodevelopmental Cohort were included. Physical conditions, including headache, were ascertained from electronic medical records and in-person interviews. Modified International Classification of Headache Disorders (ICHD-II) criteria were used to classify migraine symptoms. Forty-two other physical conditions were classified into 14 classes of medical disorders. Mental disorders were assessed using an abbreviated version of the Kiddie-Schedule for Affective Disorders and Schizophrenia.
Lifetime prevalence of any headache was 45.5%, and of migraine was 22.6%. Any headache was associated with a broad range of physical disorders, attention-deficit/hyperactivity disorder (OR 1.2 [95% CI 1.1-1.4]), and behavior disorders (1.3 [1.1-1.5]). Youth with migraine had greater odds of specific physical conditions and mental disorders, including respiratory, neurologic/central nervous system, developmental, anxiety, behavior, and mood disorders than those with nonmigraine headache (OR ranged from 1.3 to 1.9).
Comorbidity between headaches with a range of physical conditions that have been associated with adult migraine demonstrates that multimorbidity occurs early in development. Comorbidity may be an important index of heterogeneity of migraine that can guide clinical management, genetic investigation, and future research on shared pathophysiology with other disorders.
在一个大型儿科注册研究中，研究头痛和偏头痛与身体和精神障碍之间的关联。
共纳入了来自费城神经发育队列的 9329 名 8-21 岁的青少年。身体状况（包括头痛）是从电子病历和面对面访谈中确定的。使用改良的头痛国际分类（ICHD-II）标准来分类偏头痛症状。其他 42 种身体状况被分为 14 类医学疾病。精神障碍使用儿童情感障碍和精神分裂症日程表的简化版进行评估。
终生任何头痛的患病率为 45.5%，偏头痛的患病率为 22.6%。任何头痛都与广泛的身体疾病相关，包括注意缺陷/多动障碍（OR 1.2 [95% CI 1.1-1.4]）和行为障碍（1.3 [1.1-1.5]）。偏头痛患者比非偏头痛头痛患者更有可能出现特定的身体疾病和精神障碍，包括呼吸系统、神经/中枢神经系统、发育障碍、焦虑症、行为障碍和情绪障碍（OR 范围从 1.3 到 1.9）。
头痛与一系列与成人偏头痛相关的身体疾病的共病表明，共病在发育早期就发生了。共病可能是偏头痛异质性的一个重要指标，可以指导临床管理、遗传研究以及未来对与其他疾病共享病理生理学的研究。
