阵发性偏头痛的流行病学和临床特征：系统评价和荟萃分析。

Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.

Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Headache. 2024 Jan;64(1):5-15. doi: 10.1111/head.14658. Epub 2024 Jan 11.

OBJECTIVE

To assess the prevalence or relative frequency of paroxysmal hemicrania and its clinical features in the adult general population and among adult patients evaluated for headache in tertiary care.

BACKGROUND

Paroxysmal hemicrania is a rare trigeminal autonomic cephalalgia with characteristic attacks of headache, associated cranial autonomic symptoms and signs, and an absolute response to indomethacin. Its epidemiological burden remains unknown in both the adult general population and among adult patients evaluated for headache in a tertiary care setting. Moreover, the frequencies of the clinical features associated with paroxysmal hemicrania have not been well established.

METHODS

A literature search of PubMed and Embase was conducted from January 1, 1988, to January 20, 2023. Eligible for inclusion were observational studies reporting the point prevalence or relative frequency of paroxysmal hemicrania or its clinical features in the adult general population or among adult patients evaluated for headache in tertiary care. Two independent investigators (M.J.H. and J.G.L.) performed the title, abstract, and full-text article screening. Each included study's risk of bias was critically appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Estimates of prevalence or relative frequency were calculated using a random-effects meta-analysis. The between-study heterogeneity was assessed using the I statistic and further explored with meta-regression. This study was pre-registered on PROSPERO (identifier: CRD42023391127).

RESULTS

A total of 17 clinic-based studies and one population-based study met the eligibility criteria. Importantly, an overall high risk of bias was observed across the eligible studies. The relative frequency of paroxysmal hemicrania was estimated to be 0.3% (95% CI, 0.2%-0.5%) among adult patients evaluated for headache in tertiary care with considerable heterogeneity (I = 76.4%). No cases with paroxysmal hemicrania were identified among 1,838 participants in a population-based sample. Moreover, the most prevalent cranial autonomic symptoms were lacrimation (77.3% [95% Cl, 62.7%-87.3%]), conjunctival injection (75.0% [95% Cl, 60.3%-85.6%]), and nasal congestion (47.7% [95% Cl, 33.6%-62.3%]).

CONCLUSIONS

Our findings suggest that paroxysmal hemicrania is a rare disorder among adults evaluated for headache in tertiary care, while its prevalence in the general population remains unknown. Further studies focusing on the clinical features of paroxysmal hemicrania are warranted.

目的

评估阵发性偏头痛在普通成年人群和三级护理头痛评估患者中的患病率或相对频率及其临床特征。

背景

阵发性偏头痛是一种罕见的三叉神经自主头痛，其特征性头痛发作伴有颅自主症状和体征，对吲哚美辛有绝对反应。其在普通成年人群和三级护理头痛评估患者中的流行病学负担尚不清楚。此外，与阵发性偏头痛相关的临床特征的频率尚未得到很好的确定。

方法

对 1988 年 1 月 1 日至 2023 年 1 月 20 日期间的 PubMed 和 Embase 文献进行了检索。纳入标准为报告普通成年人群或三级护理头痛评估患者中阵发性偏头痛或其临床特征的时点患病率或相对频率的观察性研究。两名独立的研究者（M.J.H.和 J.G.L.）进行了标题、摘要和全文文章筛选。使用 Joanna Briggs 研究所的患病率数据报告的关键性评估清单对每项纳入研究的偏倚风险进行了批判性评估。使用随机效应荟萃分析计算患病率或相对频率的估计值。使用 I 统计量评估研究间异质性，并进一步通过荟萃回归进行探索。本研究在 PROSPERO（标识符：CRD42023391127）上进行了预先注册。

结果

共有 17 项基于诊所的研究和一项基于人群的研究符合入选标准。重要的是，所有合格研究的偏倚风险总体较高。在三级护理头痛评估患者中，阵发性偏头痛的相对频率估计为 0.3%（95%CI，0.2%-0.5%），存在较大异质性（I 2 =76.4%）。在一项基于人群的样本中，1838 名参与者中未发现阵发性偏头痛病例。此外，最常见的颅自主症状是流泪（77.3%[95%Cl，62.7%-87.3%]）、结膜充血（75.0%[95%Cl，60.3%-85.6%]）和鼻塞（47.7%[95%Cl，33.6%-62.3%]）。