Schumacher Leah, Wing Rena, Thomas J Graham, Pavlovic Jelena, Digre Kathleen, Farris Samantha, Steffen Kristine, Sarwer David, Bond Dale
Department of Psychiatry and Human Behavior Alpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research Center Providence Rhode Island USA.
Department of Neurology and the Montefiore Headache Center Albert Einstein College of Medicine/Montefiore Medical Center Bronx New York USA.
Obes Sci Pract. 2020 Sep 9;6(6):596-604. doi: 10.1002/osp4.443. eCollection 2020 Dec.
Despite plausibility of migraine headaches contributing to impaired sexual function among women, data are inconsistent and point to obesity as a potential confounder. Prospective studies that assess the relative importance of migraine improvements and weight loss in relation to sexual function could help elucidate associations among migraine, obesity and female sexual dysfunction (FSD).
To evaluate sexual function changes and predictors of improvement after behavioural weight loss (BWL) intervention for migraine or migraine education (ME).
Women with migraine and overweight/obesity were randomized to 16 weeks of BWL ( = 54) or ME ( = 56). Participants completed a 4-week smartphone headache diary and the Female Sexual Function Index (FSFI) at pre- and post-treatment. A validated FSFI total cut-off score defined FSD. We compared changes in FSFI scores and FSD rates between conditions and evaluated migraine improvements and weight loss as predictors of sexual functioning in the full sample.
Among treatment completers ( = 85), 56 (65.9%) participants who reported sexual activity at pre- and post-treatment were analysed. Migraine improvements were similar between conditions, whereas BWL had greater weight losses compared with ME. FSD rates did not change overall (48.2% to 44.6%, = .66) or by condition (BWL: 56.0% to 40.0% vs. ME: 41.9% to 48.4%, = .17). Similar patterns were observed for changes in FSFI total and subscale scores. Across conditions, larger weight losses predicted greater improvements in FSFI total and arousal subscale scores, whereas larger migraine headache frequency reductions predicted greater improvements in FSFI satisfaction subscale scores.
Sexual functioning did not improve with either BWL or ME despite migraine headache improvements in both conditions and weight loss after BWL. However, weight loss related to improvements in physiological components of the sexual response (i.e., arousal) and overall sexual functioning, whereas reduced headache frequency related to improved sexual satisfaction. Additional research with larger samples is needed.
尽管偏头痛可能导致女性性功能障碍，但相关数据并不一致，且表明肥胖是一个潜在的混杂因素。评估偏头痛改善和体重减轻对性功能相对重要性的前瞻性研究，有助于阐明偏头痛、肥胖与女性性功能障碍（FSD）之间的关联。
评估偏头痛行为减重（BWL）干预或偏头痛教育（ME）后性功能的变化及改善的预测因素。
患有偏头痛且超重/肥胖的女性被随机分为接受16周BWL（n = 54）或ME（n = 56）治疗。参与者在治疗前和治疗后完成了为期4周的智能手机头痛日记以及女性性功能指数（FSFI）。通过验证的FSFI总分临界值定义FSD。我们比较了不同治疗组间FSFI评分和FSD发生率的变化，并评估了偏头痛的改善情况和体重减轻作为整个样本性功能预测因素的作用。
在治疗完成者（n = 85）中，对56名（65.9%）在治疗前和治疗后均报告有性活动的参与者进行了分析。不同治疗组间偏头痛的改善情况相似，但与ME相比，BWL导致的体重减轻更多。FSD发生率总体上没有变化（从48.2%降至44.6%，P = 0.66），不同治疗组间也无差异（BWL组：从56.0%降至40.0%，ME组：从41.9%降至48.4%，P = 0.17）。FSFI总分和各子量表评分的变化也观察到类似模式。在所有治疗组中，体重减轻幅度越大，FSFI总分和性唤起子量表评分的改善就越大，而偏头痛发作频率降低幅度越大，FSFI满意度子量表评分的改善就越大。
尽管两种治疗组的偏头痛均有改善，且BWL后体重减轻，但BWL或ME均未改善性功能。然而，体重减轻与性反应的生理成分（即性唤起）及总体性功能的改善有关，而头痛频率降低与性满意度提高有关。需要进行更大样本量的进一步研究。
