Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
Int J Environ Res Public Health. 2021 Dec 30;19(1):362. doi: 10.3390/ijerph19010362.
Migraine headaches can be provoked by surgical stress and vasoactive effects of anesthetics of general anesthesia in the perioperative period. However, it is unclear whether general anesthesia increases the migraine risk after major surgery. Incidence and risk factors of postoperative migraine are also largely unknown. We utilized reimbursement claims data of Taiwan's National Health Insurance and performed propensity score matching analyses to compare the risk of postoperative migraine in patients without migraine initially who underwent general or neuraxial anesthesia. Multivariable logistic regressions were applied to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI) for migraine risk. A total of 68,131 matched pairs were analyzed. The overall incidence of migraine was 9.82 per 1000 person-years. General anesthesia was not associated with a greater risk of migraine compared with neuraxial anesthesia (aORs: 0.93, 95% CI: 0.80-1.09). This finding was consistent across subgroups of different migraine subtypes, uses of migraine medications, and varying postoperative periods. Influential factors for postoperative migraine were age (aOR: 0.99), sex (male vs. female, aOR: 0.50), pre-existing anxiety disorder (aOR: 2.43) or depressive disorder (aOR: 2.29), concurrent uses of systemic corticosteroids (aOR: 1.45), ephedrine (aOR: 1.45), and theophylline (aOR: 1.40), and number of emergency room visits before surgery. There was no difference in the risk of postoperative migraine between surgical patients undergoing general and neuraxial anesthesia. This study identified the risk factors for postoperative migraine headaches, which may provide an implication in facilitating early diagnoses and treatment.
偏头痛可由手术应激和围手术期全身麻醉的血管活性作用引起。然而，全身麻醉是否会增加大手术后偏头痛的风险尚不清楚。术后偏头痛的发生率和危险因素也知之甚少。我们利用台湾全民健康保险的理赔数据，通过倾向评分匹配分析比较了最初无偏头痛且接受全身麻醉或脊麻的患者术后偏头痛的风险。多变量逻辑回归用于计算偏头痛风险的调整优势比（aOR）和 95%置信区间（CI）。共分析了 68131 对匹配的患者。偏头痛的总发生率为每 1000 人年 9.82 例。与脊麻相比，全身麻醉与偏头痛风险增加无关（aOR：0.93，95%CI：0.80-1.09）。这一发现与不同偏头痛亚型、偏头痛药物使用和不同术后时期的亚组一致。术后偏头痛的影响因素包括年龄（aOR：0.99）、性别（男性 vs. 女性，aOR：0.50）、先前存在的焦虑症（aOR：2.43）或抑郁症（aOR：2.29）、同时使用全身皮质类固醇（aOR：1.45）、麻黄碱（aOR：1.45）和茶碱（aOR：1.40）以及手术前急诊就诊次数。接受全身麻醉和脊麻的手术患者术后偏头痛的风险无差异。本研究确定了术后偏头痛的危险因素，这可能对早期诊断和治疗有一定的启示。
