Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA.
American Migraine Foundation (AMF), Mount Royal, NJ, USA.
Headache. 2021 Jul;61(7):992-1003. doi: 10.1111/head.14154. Epub 2021 Jun 3.
To evaluate whether the 15-day threshold of headache days per month adequately reflects substantial differences in disability across the full spectrum of migraine.
The monthly frequency of headache days defines migraine subtypes and has crucial implications for epidemiological and clinical research as well as access to care.
The patients with migraine (N = 836) who participated in the American Registry for Migraine Research, which is a multicenter, longitudinal patient registry, between February 2016 and March 2020, were divided into four groups based on monthly headache frequency: Group 1 (0-7 headache days/month, n = 286), Group 2 (8-14 headache days/month, n = 180), Group 3 (15-23 headache days/month, n = 153), Group 4 (≥24 headache days/month, n = 217). Disability (MIDAS), Pain intensity (NRS), Work Productivity and Activity Impairment (WPAI), Pain Interference (PROMIS-PI), Patient Health Questionnaire-4 (PHQ-4), and General Anxiety Disorder-7 (GAD-7) scores were compared.
Mean (standard deviation [SD]) age was 46 (13) years (87.9% [735/836] female). The proportion of patients in each group was as follows: Group 1 (34.2% [286/836]), Group 2 (21.5% [180/836]), Group 3 (18.3% [153/836]), and Group 4 (26.0% [217/836]). There were significant relationships with increasing disability, lost productive time, and pain interference in higher headache frequency categories. There were no significant differences between Group 2 and Group 3 for most measures (NRS, all WPAI scores, PROMIS-PI, GAD-7, and PHQ-4), although MIDAS scores differed (median [interquartile range (IQR)]; 38 [20-58] vs. 55 [30-90], p < 0.001). Patients in Group 1 had significantly lower MIDAS (median [IQR];16 [7-30], p < 0.001), WPAI-% total active impairment (mean (SD): Group 1 [30.9 (26.8)] vs. Group 2 [39.2 (24.5), p = 0.017], vs. Group 3 [45.9 (24.1), p < 0.001], vs. Group 4 [55.3 (23.0), p < 0.001], and PROMIS-PI-T score (Group 1 [60.3 (7.3)] vs. Group 2 [62.6 (6.4), p = 0.008], vs. Group 3 [64.6 (5.6), p < 0.001], vs. Group 4 [66.8 (5.9), p < 0.001]) compared to all other groups. Patients in Group 4 had significantly higher MIDAS (median (IQR): Group 4 [90 (52-138)] vs. Group 1 [16 (7-30), p < 0.001], vs. Group 2 [38 (20-58), p < 0.001], vs. Group 3 [55 (30-90), p < 0.001], WPAI-%Presenteeism (Group 4 [50.4 (24.4)] vs. Group 1 [28.8 (24.9), p < 0.001], vs. Group 2 [34.9 (22.3), p < 0.001], vs. Group 3 [40.9 (22.3), p = 0.048], WPAI-% total work productivity impairment (Group 4 [55.9 (26.1)] vs. Group 1 [32.1 (37.6), p < 0.001], vs. Group 2 [38.3 (24.0), p < 0.001], vs. Group 3 [44.6 (24.4), p = 0.019]), and WPAI-%Total activity impairment (Group 4 [55.3 (23.0)] vs. Group 1 [30.9 (26.8), p < 0.001], vs. Group 2 [39.2 (24.5), p < 0.001], vs. Group 3 [45.9 (24.1), p = 0.025]) scores compared with all other groups.
Our data suggest that the use of a 15 headache day/month threshold to distinguish episodic and chronic migraine does not capture the burden of illness nor reflect the treatment needs of patients. These results have important implications for future refinements in the classification of migraine.
评估每月头痛日数的 15 天阈值是否能充分反映偏头痛全谱中残疾的实质性差异。
头痛日数的每月频率定义了偏头痛亚型，对流行病学和临床研究以及获得治疗具有至关重要的意义。
2016 年 2 月至 2020 年 3 月期间，参加美国偏头痛研究登记处的偏头痛患者（N=836）被分为四组，根据每月头痛频率：第 1 组（0-7 头痛日/月，n=286）、第 2 组（8-14 头痛日/月，n=180）、第 3 组（15-23 头痛日/月，n=153）和第 4 组（≥24 头痛日/月，n=217）。比较残疾（MIDAS）、疼痛强度（NRS）、工作生产力和活动障碍（WPAI）、疼痛干扰（PROMIS-PI）、患者健康问卷-4（PHQ-4）和广泛性焦虑障碍-7（GAD-7）评分。
平均（标准差[SD]）年龄为 46（13）岁（87.9%[735/836]为女性）。每组患者的比例如下：第 1 组（34.2%[286/836]）、第 2 组（21.5%[180/836]）、第 3 组（18.3%[153/836]）和第 4 组（26.0%[217/836]）。在更高的头痛频率类别中，与残疾、丧失生产时间和疼痛干扰的关系呈上升趋势。在大多数测量指标中（NRS、所有 WPAI 评分、PROMIS-PI、GAD-7 和 PHQ-4），第 2 组和第 3 组之间没有显著差异，尽管 MIDAS 评分有所不同（中位数[四分位距（IQR）]；38[20-58]vs.55[30-90]，p<0.001）。第 1 组的 MIDAS 评分明显较低（中位数[IQR]；16[7-30]，p<0.001）、WPAI-%总活动障碍（平均值（SD）：第 1 组[30.9（26.8）]vs.第 2 组[39.2（24.5）]，p=0.017，vs.第 3 组[45.9（24.1）]，p<0.001，vs.第 4 组[55.3（23.0）]，p<0.001]，以及 PROMIS-PI-T 评分（第 1 组[60.3（7.3）]vs.第 2 组[62.6（6.4）]，p=0.008，vs.第 3 组[64.6（5.6）]，p<0.001，vs.第 4 组[66.8（5.9）]，p<0.001）与其他所有组相比。第 4 组的 MIDAS 评分明显较高（中位数[IQR]；第 4 组[90（52-138）]vs.第 1 组[16（7-30）]，p<0.001，vs.第 2 组[38（20-58）]，p<0.001，vs.第 3 组[55（30-90）]，p<0.001]，WPAI-%出席率（第 4 组[50.4（24.4）]vs.第 1 组[28.8（24.9）]，p<0.001，vs.第 2 组[34.9（22.3）]，p<0.001，vs.第 3 组[40.9（22.3）]，p=0.048），WPAI-%总工作生产力障碍（第 4 组[55.9（26.1）]vs.第 1 组[32.1（37.6）]，p<0.001，vs.第 2 组[38.3（24.0）]，p<0.001，vs.第 3 组[44.6（24.4）]，p=0.019），以及 WPAI-%总活动障碍（第 4 组[55.3（23.0）]vs.第 1 组[30.9（26.8）]，p<0.001，vs.第 2 组[39.2（24.5）]，p<0.001，vs.第 3 组[45.9（24.1）]，p=0.025）与所有其他组相比。
我们的数据表明，使用每月 15 天头痛日的阈值来区分发作性和慢性偏头痛并不能捕捉疾病的负担，也不能反映患者的治疗需求。这些结果对偏头痛分类的未来改进具有重要意义。
