Institute of Public Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
J Headache Pain. 2023 Jul 11;24(1):83. doi: 10.1186/s10194-023-01624-y.
Migraine is a very common headache disorder on the population level, characterized by symptomatic attacks (activity). For many people with migraine, the migraine symptoms intermittently or permanently cease during their lifetime (inactive migraine). The current diagnostic classification of migraine considers two states: active migraine (having migraine symptoms within the last year) and not having active migraine (including both individuals with inactive migraine and those who never had migraine). Defining a state of inactive migraine that has gone into remission may better capture the trajectories of migraine across the lifespan and contribute to a better understanding of its biological processes. We aimed to quantify the prevalence of never, active, and inactive migraine separately, using modern prevalence and incidence estimation methodology to better describe the complexity of migraine trajectories at the population level.
Using a multistate modeling approach, data from the Global Burden of Disease (GBD) study, and results from a population-based study, we estimated the transition rates by which individuals moved between migraine disease states and estimated prevalences of never, active and inactive migraine. We used data from the GBD project and a hypothetical cohort of 100,000 people with a starting age of 30 and 30 years of follow-up, both in Germany and globally, stratified by sex.
In Germany, the estimated rate of transition from active to inactive migraine (remission rate) increased after the age of 22.5 in women and 27.5 in men. The pattern for men in Germany was similar to the one observed on the global level. The prevalence of inactive migraine among women reaches 25.7% in Germany and 16.5% globally at age 60. For men, the inactive migraine prevalence estimates at the same age were 10.4% in Germany and 7.1% globally.
Considering an inactive migraine state explicitly reflects a different epidemiological picture of migraine across the lifecourse. We have demonstrated that many women of older ages may be in an inactive migraine state. Many pressing research questions can only be answered if population-based cohort studies collect information not only on active migraine but also on inactive migraine states.
偏头痛是一种非常常见的人群头痛障碍，其特征是出现症状性发作（活动期）。对于许多偏头痛患者来说，其偏头痛症状在一生中会间歇性或永久性停止（非活跃性偏头痛）。目前的偏头痛诊断分类考虑了两种状态：活跃性偏头痛（在过去一年中出现偏头痛症状）和非活跃性偏头痛（包括非活跃性偏头痛患者和从未患有偏头痛的患者）。定义进入缓解期的非活跃性偏头痛状态可能更能捕捉偏头痛在整个生命周期中的轨迹，并有助于更好地了解其生物学过程。我们旨在使用现代患病率和发病率估计方法分别量化从未患有、活跃性和非活跃性偏头痛的患病率，以便更好地描述人群水平上偏头痛轨迹的复杂性。
我们使用多状态建模方法，结合全球疾病负担（GBD）研究的数据和一项基于人群的研究结果，估计了个体在偏头痛疾病状态之间转移的转移率，并估计了从未患有、活跃性和非活跃性偏头痛的患病率。我们使用 GBD 项目的数据和德国及全球的一个 10 万人的假想队列数据进行分析，队列起始年龄为 30 岁，随访 30 年，队列按性别分层。
在德国，女性的活跃性偏头痛向非活跃性偏头痛（缓解率）的转移率在 22.5 岁后增加，男性在 27.5 岁后增加。德国男性的模式与全球观察到的模式相似。60 岁时，德国女性的非活跃性偏头痛患病率达到 25.7%，全球为 16.5%。而在同一年龄，德国男性的非活跃性偏头痛患病率估计值为 10.4%，全球为 7.1%。
明确考虑非活跃性偏头痛状态反映了偏头痛在整个生命周期中的不同流行病学特征。我们已经证明，许多年龄较大的女性可能处于非活跃性偏头痛状态。如果基于人群的队列研究不仅收集活跃性偏头痛的信息，而且还收集非活跃性偏头痛状态的信息，那么许多紧迫的研究问题才能够得到解答。
