Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Headache. 2022 Jan;62(1):57-64. doi: 10.1111/head.14251.
The purpose of this study was to examine overall and site-specific cancer risk among individuals diagnosed with migraine compared with the general population.
Current evidence regarding migraine and risk of cancer is sparse and inconclusive.
We conducted a nationwide population-based cohort study with data collected routinely and prospectively from Danish population-based registries from 1995 to 2017. We computed the age- and sex-standardized incidence ratio (SIR) as the ratio of observed to expected cancers among patients diagnosed with migraine in the study population overall, and by encounter type of first diagnosis (inpatient, outpatient specialty clinic, and emergency department). Site-specific cancers were grouped according to etiology.
We identified 72,826 patients with a first-time hospital migraine diagnosis. There were 3090 observed overall cancer cases among individuals diagnosed with migraine as compared with 3108 expected cases (SIR 0.99, 95% confidence interval [CI]: 0.96-1.03). The cumulative incidence of all cancers combined from 1995 to 2017 among those with a first-time migraine diagnosis was 9.47% (95% CI: 9.08-9.87). The SIRs for most cancers were consistent with absence of an association: 1.00 (95% CI: 0.94-1.06) for hormone-related cancers, 0.96 (95% CI: 0.88-1.03) for smoking-related cancers, 1.10 (95% CI: 0.98-1.24) for hematologic cancers, and 0.95 (95% CI: 0.85-1.06) for immune-related cancers. Exceptions were SIRs for gastrointestinal cancers (0.78, 95% CI: 0.70-0.87) and for cancers of neurological origin (1.57, 95% CI: 1.40-1.76).
For most cancer groups, our results did not support an association with migraine. The exceptions were an increased risk for cancers of neurological origin and a decreased risk for gastrointestinal cancers. These findings may reflect a true difference in risk among individuals with migraine, or more plausibly they reflect other forces, such as differences in medication use, detection bias and reverse causation, or shared risk factors.
本研究旨在考察与普通人群相比，偏头痛患者的总体和特定部位癌症风险。
目前关于偏头痛与癌症风险的证据有限且尚无定论。
我们进行了一项全国性基于人群的队列研究，数据来自丹麦基于人群的登记处，收集于 1995 年至 2017 年期间。我们计算了年龄和性别标准化发病率比（SIR），即研究人群中偏头痛患者的观察到的癌症与预期癌症之比，以及首次诊断的就诊类型（住院、专科门诊和急诊）。根据病因对特定部位的癌症进行了分组。
我们确定了 72826 名首次诊断为偏头痛的患者。与预期病例相比，偏头痛患者中有 3090 例观察到总体癌症病例（SIR 0.99，95%置信区间[CI]：0.96-1.03）。从 1995 年至 2017 年，首次诊断为偏头痛患者的所有癌症的累积发病率为 9.47%（95%CI：9.08-9.87）。大多数癌症的 SIR 与无关联一致：激素相关癌症为 1.00（95%CI：0.94-1.06），吸烟相关癌症为 0.96（95%CI：0.88-1.03），血液系统癌症为 1.10（95%CI：0.98-1.24），免疫相关癌症为 0.95（95%CI：0.85-1.06）。胃肠道癌症（0.78，95%CI：0.70-0.87）和神经起源癌症（1.57，95%CI：1.40-1.76）的 SIR 除外。
对于大多数癌症组，我们的结果不支持偏头痛与癌症之间存在关联。例外的是神经起源癌症的风险增加和胃肠道癌症的风险降低。这些发现可能反映了偏头痛患者风险的真正差异，或者更可能反映了其他因素，例如药物使用、检测偏差和反向因果关系或共同的风险因素的差异。
