Mount Sinai Beth Israel, New York, NY, USA.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Curr Pain Headache Rep. 2019 Jan 12;23(1):1. doi: 10.1007/s11916-019-0742-8.
Migraine is a common neurologic disorder. This article will discuss a few factors that influence migraine (mostly episodic) and its treatment, such as sleep, obstructive sleep apnea (OSA), obesity, and affective disorders, as well as autoimmune diseases. Practitioners must be aware of these coexisting conditions (comorbidities) as they affect treatment. It is noted in literature that both the quantity (too much or too few hours) and the quality (OSA related) of sleep may worsen migraine frequency. An associated risk factor for OSA, obesity also increases migraine frequency in episodic migraine cases. A bidirectional relationship with migraine along with depression and anxiety is debated in the literature. Retrospective cohort studies are undecided and lack statistical significance, but prospective studies do show promising results on treatment of anxiety and depression as a means of improving migraine control. Finally, we address the topic of autoimmune diseases and migraine. While few studies exist at this time, there are cohort study groups looking into the association between rheumatoid arthritis, hypothyroidism, and antiphospholipid antibody. There is also evidence for the link between migraine and vascular diseases, including coronary and cerebral diseases. We suggest that these comorbid conditions be taken into account and individualized for each patient along with their pharmaceutical regimen. Physicians should seek a multifactorial treatment plan including diet, exercise, and healthy living to reduce migraine frequency.
偏头痛是一种常见的神经系统疾病。本文将讨论一些影响偏头痛（主要是发作性偏头痛）及其治疗的因素，如睡眠、阻塞性睡眠呼吸暂停（OSA）、肥胖和情感障碍，以及自身免疫性疾病。医生必须意识到这些共存疾病（合并症），因为它们会影响治疗效果。文献中指出，睡眠的数量（过多或过少）和质量（与 OSA 相关）都可能使偏头痛发作的频率恶化。OSA 的一个相关危险因素——肥胖也会增加发作性偏头痛患者的偏头痛发作频率。偏头痛与抑郁和焦虑之间存在双向关系，这在文献中存在争议。回顾性队列研究尚无定论，缺乏统计学意义，但前瞻性研究确实显示出治疗焦虑和抑郁作为改善偏头痛控制手段的有前景的结果。最后，我们讨论了自身免疫性疾病和偏头痛的问题。尽管目前这方面的研究还很少，但有一些队列研究小组正在研究类风湿关节炎、甲状腺功能减退症和抗磷脂抗体之间的关联。偏头痛与包括冠心病和脑血管疾病在内的血管疾病之间也存在关联。我们建议考虑这些合并症，并根据每个患者的情况以及他们的药物治疗方案进行个体化治疗。医生应寻求包括饮食、运动和健康生活方式在内的多因素治疗方案，以降低偏头痛发作的频率。
