美国明尼苏达州奥姆斯特德县的 Status Migrainosus 发生率：复发的特征和预测因素。

Incidence of Status Migrainosus in Olmsted County, Minnesota, United States: Characterization and Predictors of Recurrence.

机构信息

From the Departments of Neurology (J.H.V., K.M., A.A.M., D.G., R.B.H.S., J.H.S.) and Quantitative Health Sciences (R.J.B.), Mayo Clinic, Scottsdale, AZ; and Neurology Department (E.C.), Hospital Universitari Vall d'Hebron, Barcelona, Spain.

出版信息

Neurology. 2023 Jan 17;100(3):e255-e263. doi: 10.1212/WNL.0000000000201382. Epub 2022 Sep 29.

DOI:10.1212/WNL.0000000000201382

PMID:36175145

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10615570/

Abstract

BACKGROUND AND OBJECTIVES

SM is recognized as a complication of migraine in which pain and/or associated symptoms are unremitting and debilitating for more than 72 hours. The epidemiology of SM in the general population is not known. The aim of this study is to determine the incidence, recurrence rate, and clinical associations of status migrainosus (SM) in care-seeking residents of Olmsted County, Minnesota.

METHODS

The Rochester Epidemiology Project was used to identify the incident cases of SM according to the criteria and based on the first physician-encountered case in the record. The clinical characteristics of the incident cases were abstracted from the medical record. One-year recurrence-free survival was evaluated and compared between clinically relevant groups, including baseline demographics, migraine characteristics, and treatment exposures.

RESULTS

Between January 1, 2012, and December 31, 2017, 237 incident cases of SM were identified. The median age was 35 (IQR 26-47) years, and 210 (88.6%) were female. A history of chronic migraine was recorded in 82/226 (36.3%) and a history of aura in 76/213 (35.7%). At the time of the incident case, medication reconciliation included a triptan or ergotamine in 127/233 (53.6%) and/or an opioid-containing analgesic in 43/233 (18.5%). The overall age- and sex-adjusted incidence rate was 26.60 per 100,000 [95% CI, 23.21-29.97], with a peak incidence between ages 40 and 49 years. The median (95% CI) attack duration was 5 (4.48-5.42) days. The most frequent triggers were stress (40/237, 16.9%) and too much or too little sleep (27/237, 11.4%). Recurrence occurred in 35/237 (14.8%) at a median of 58 (IQR 23-130) days following the initial attack. In our age- and sex-adjusted multivariable model, too much or too little sleep as a trigger was associated with 12-month risk of recurrence (adjusted OR 3.59 [95% CI 1.58-8.14], = 0.0022).

DISCUSSION

Our study provides a population-based estimate of SM incidence. We identified aberrant sleep patterns as a potentially modifiable risk factor for 1-year SM recurrence.

摘要

背景与目的

SM 被认为是偏头痛的一种并发症，其疼痛和/或相关症状持续超过 72 小时，且使人衰弱。目前尚不清楚普通人群中 SM 的流行病学情况。本研究旨在确定明尼苏达州奥姆斯特德县寻求医疗护理的居民中，偏头痛持续状态（SM）的发生率、复发率和临床关联。

方法

根据记录中首次出现的医生就诊病例，利用罗切斯特流行病学项目来确定 SM 的新发病例。从病历中提取新发病例的临床特征。评估并比较临床相关组别的 1 年无复发生存情况，包括基线人口统计学特征、偏头痛特征和治疗暴露情况。

结果

2012 年 1 月 1 日至 2017 年 12 月 31 日，共确定了 237 例新发 SM 病例。患者中位年龄为 35（IQR 26-47）岁，210 例（88.6%）为女性。226 例（36.3%）有慢性偏头痛病史，213 例（35.7%）有先兆偏头痛病史。在新发病例时，药物调整包括 127/233（53.6%）例曲坦类或麦角胺和/或 43/233（18.5%）例含阿片类镇痛药。年龄和性别调整后的总发病率为 26.60/100,000[95%CI，23.21-29.97]，发病高峰在 40-49 岁年龄组。中位（95%CI）发作持续时间为 5（4.48-5.42）天。最常见的诱因是压力（40/237，16.9%）和睡眠过多或过少（27/237，11.4%）。在初始发作后中位 58（IQR 23-130）天，35/237（14.8%）例复发。在我们的年龄和性别调整后的多变量模型中，作为诱因的睡眠过多或过少与 12 个月的复发风险相关（调整后的 OR 3.59[95%CI 1.58-8.14]， = 0.0022）。