偏头痛触发因素的地形定位及其与头痛频率和严重程度的关系。

Topographic localization of migraine triggers and its association with headache frequency and severity.

机构信息

Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226014, India.

Department of Neurology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi 110 029, India.

出版信息

Clin Neurol Neurosurg. 2023 Jul;230:107794. doi: 10.1016/j.clineuro.2023.107794. Epub 2023 May 19.

DOI:10.1016/j.clineuro.2023.107794

PMID:37229952

Abstract

OBJECTIVE

Internal biological rhythm with or without external trigger may precipitate migraine. Classifying exogenous and endogenous triggers to a topographic localization may help in understanding the migraine. We report topographic localization of migraine triggers and its influence on headache frequency and severity.

METHODS

588 migraineurs, aged 16-69 years were included. Various endogenous and exogenous triggers were categorized to topographic localization- hypothalamic, pituitary, auditory, visual, somato-sensory, olfactory and gustatory. The relationship of topographic localization of triggers with episodic versus chronic migraine, and moderate versus severe headache were analyzed using univariate followed by multivariate analysis.

RESULTS

All migraineurs had triggers 584(99.9%) except 4(0.1%) patients. Presence of multiple triggers (99.4%), and combination of both endogenous and exogenous triggers (97.7%) was the rule. On topographic localization, hypothalamic trigger was the commonest (98.1%) followed by visual (84.1%), auditory (82.1%), somatosensory (76.1%), olfactory (26.2%), pituitary (24.1%), and gustatory (6.6%). 98.6% patients had combination of hypothalamic with pituitary triggers. Hypothalamic [Adjusted odds ratio (AOR) 4.50] and auditory triggers (AOR 0.34) independently predicted chronic migraine, and auditory (AOR 0.55) and gustatory (AOR 2.41) triggers predicted severity of headache.

CONCLUSION

Hypothalamic triggers are the commonest suggesting an innate susceptibility of migraine. Auditory trigger may precipitate frequent and severe headache.

摘要

目的

内源性生物节律或受外源性触发因素影响都可能导致偏头痛发作。对偏头痛的触发因素进行定位分类，有助于我们更好地理解偏头痛。我们报告偏头痛触发因素的定位分类及其对头痛频率和严重程度的影响。

方法

纳入 588 名年龄在 16-69 岁之间的偏头痛患者。将各种内源性和外源性触发因素分类为下丘脑、垂体、听觉、视觉、躯体感觉、嗅觉和味觉定位。使用单变量和多变量分析来分析触发因素的定位与发作性偏头痛与慢性偏头痛、中重度头痛之间的关系。

结果

除 4 名（0.1%）患者外，所有偏头痛患者均有触发因素（584 名，99.9%）。存在多种触发因素（99.4%），且内源性和外源性触发因素组合（97.7%）是常见情况。在定位方面，下丘脑触发因素最常见（98.1%），其次是视觉（84.1%）、听觉（82.1%）、躯体感觉（76.1%）、嗅觉（26.2%）、垂体（24.1%）和味觉（6.6%）。98.6%的患者存在下丘脑和垂体触发因素的组合。下丘脑（调整优势比[OR]4.50）和听觉触发因素（OR 0.34）独立预测慢性偏头痛，而听觉（OR 0.55）和味觉触发因素（OR 2.41）预测头痛的严重程度。