运动相关脑震荡后不良预后的易患因素——伤前偏头痛的系统评价
Systematic Review of Pre-injury Migraines as a Vulnerability Factor for Worse Outcome Following Sport-Related Concussion.
作者信息
Terry Douglas P, Büttner Fionn, Huebschmann Nathan A, Gardner Andrew J, Cook Nathan E, Iverson Grant L
机构信息
Vanderbilt Sports Concussion Center, Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, United States.
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
出版信息
Front Neurol. 2022 Jun 20;13:915357. doi: 10.3389/fneur.2022.915357. eCollection 2022.
BACKGROUND
Individuals with migraine disorders may be affected differently by concussions compared to individuals without migraine disorders. Prior studies on this topic have had mixed results. The purpose of this study was to systematically examine clinical outcomes following a sport-related concussion in athletes who have a pre-injury history of migraines.
METHODS
All studies published prior to 15 May 2021 that examined pre-injury migraines as a possible predictor of clinical recovery from concussion were included. The search included (i) sport/athlete-related terms, (ii) concussion-related terms, and (iii) diverse predictor/modifier terms. After removing duplicates, 5,118 abstracts were screened, 538 full-text articles were reviewed, and 27 articles were included for narrative synthesis without meta-analysis ( = 25 with unique samples). Risk of bias was assessed using the domain-based Quality In Prognosis Studies (QUIPS) tool.
RESULTS
Most studies did not find pre-injury migraines to be associated with concussion outcome, but several of these studies had small or very small sample sizes, as well as other methodological weaknesses. Risk of bias varied greatly across studies. Some of the larger, better-designed studies suggested pre-injury migraines may be a risk factor for worse concussion outcome. Most articles examined pre-injury migraines as an exploratory/secondary predictor of concussion outcome; very few were designed to examine migraine as the primary focus of the study. Migraine history was predominantly based on self-report and studies included minimal information about migraine (e.g., age of onset, frequency/severity, past treatment). Effect sizes were usually not reported or able to be calculated from reported study data.
CONCLUSION
There is some evidence to suggest that pre-injury migraines may be a vulnerability factor for a worse outcome following concussion, with studies having the lowest risk of bias reporting a positive association. Future studies should focus on improving methodological quality when assessing the relationship between pre-injury migraines and concussion outcome and better characterizing pre-injury migraine status.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019128292, identifier: PROSPERO 2019 CRD42019128292.
背景
与无偏头痛疾病的个体相比，患有偏头痛疾病的个体可能受到脑震荡的影响有所不同。此前关于该主题的研究结果不一。本研究的目的是系统地检查有偏头痛损伤前病史的运动员在与运动相关的脑震荡后的临床结果。
方法
纳入2021年5月15日前发表的所有将损伤前偏头痛作为脑震荡临床恢复可能预测因素的研究。检索词包括：(i) 与运动/运动员相关的术语，(ii) 与脑震荡相关的术语，以及(iii) 各种预测/修饰词。去除重复项后，筛选了5118篇摘要，审查了538篇全文文章，纳入27篇文章进行叙述性综合分析（无荟萃分析）（n = 25个具有独特样本）。使用基于领域的预预后研究质量（QUIPS）工具评估偏倚风险。
结果
大多数研究未发现损伤前偏头痛与脑震荡结果相关，但其中几项研究的样本量较小或非常小，且存在其他方法学缺陷。不同研究的偏倚风险差异很大。一些规模较大、设计较好的研究表明，损伤前偏头痛可能是脑震荡结果较差的一个危险因素。大多数文章将损伤前偏头痛作为脑震荡结果的探索性/次要预测因素；很少有研究将偏头痛作为主要研究重点。偏头痛病史主要基于自我报告，研究中关于偏头痛的信息极少（例如，发病年龄、频率/严重程度、既往治疗）。效应量通常未报告，或无法从报告的研究数据中计算得出。
结论
有证据表明，损伤前偏头痛可能是脑震荡后结果较差的一个易患因素，偏倚风险最低的研究报告了两者之间的正相关关系。未来的研究应侧重于提高评估损伤前偏头痛与脑震荡结果之间关系时的方法学质量，并更好地描述损伤前偏头痛状态。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019128292，标识符：PROSPERO 2019 CRD42019128292
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