From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Neurology. 2024 Feb 27;102(4):e208102. doi: 10.1212/WNL.0000000000208102. Epub 2024 Jan 24.
The aim of this study was to examine the diurnal links between average and changes in average levels of prospectively rated mood, sleep, energy, and stress as predictors of incident headache in a community-based sample.
This observational study included structured clinical diagnostic assessment of both headache syndromes and mental disorders and electronic diaries that were administered 4 times per day for 2 weeks yielding a total of 4,974 assessments. The chief outcomes were incident morning (am) and later-day (pm) headaches. Generalized linear mixed-effects models were used to evaluate the average and lagged values of predictors including subjectively rated mood, anxiety, energy, stress, and sleep quality and objectively measured sleep duration and efficiency on incident am and pm headaches.
The sample included 477 participants (61% female), aged 7 through 84 years. After adjusting for demographic and clinical covariates and emotional states, incident am headache was associated with lower average (ß = -0.206*; confidence intervals: -0.397 to -0.017) and a decrease in average sleep quality on the prior day (ß = -0.172*; confidence interval: -0.305, -0.039). Average stress and changes in subjective energy levels on the prior day were associated with incident headaches but with different valence for am (decrease) (ß = -0.145* confidence interval: -0.286, -0.005) and pm (increase) (ß = 0.157*; confidence interval: 0.032, 0.281) headache. Mood and anxiety disorders were not significantly associated with incident headache after controlling for history of a diagnosis of migraine.
Both persistent and acute changes in arousal states manifest by subjective sleep quality and energy are salient precursors of incident headaches. Whereas poorer sleep quality and decreased energy on the prior day were associated with incident morning headache, an increase in energy and greater average stress were associated with headache onsets later in the day. Different patterns of predictors of morning and later-day incident headache highlight the role of circadian rhythms in the manifestations of headache. These findings may provide insight into the pathophysiologic processes underlying migraine and inform clinical intervention and prevention. Tracking these systems in real time with mobile technology provides a valuable ancillary tool to traditional clinical assessments.
本研究旨在检验日间平均情绪、睡眠、精力和压力水平的变化与社区样本中头痛发作的关系，以评估其作为头痛发作的预测因子。
本观察性研究对头痛综合征和精神障碍进行了结构化的临床诊断评估，并通过电子日记进行了 2 周内 4 次/天的管理，共获得了 4974 次评估。主要结局为晨发性（上午）和晚发性（下午）头痛。使用广义线性混合效应模型评估了预测因子的平均和滞后值，包括主观评估的情绪、焦虑、精力、压力和睡眠质量，以及客观测量的睡眠时间和效率。
研究样本包括 477 名参与者（61%为女性），年龄 7 至 84 岁。在调整了人口统计学和临床协变量以及情绪状态后，晨发性头痛与较低的平均（ß = -0.206*；置信区间：-0.397 至-0.017）和前一天平均睡眠质量下降（ß = -0.172*；置信区间：-0.305，-0.039）有关。前一天的平均压力和主观精力水平的变化与头痛发作有关，但对上午（减少）（ß = -0.145置信区间：-0.286，-0.005）和下午（增加）（ß = 0.157；置信区间：0.032，0.281）头痛的影响不同。控制偏头痛病史后，情绪和焦虑障碍与头痛发作之间没有显著关联。
由主观睡眠质量和精力表现出的持续性和急性唤醒状态的变化是头痛发作的显著前兆。前一天睡眠质量较差和精力下降与晨发性头痛有关，而精力增加和平均压力增加与当天晚些时候的头痛发作有关。晨发性和晚发性头痛的预测因子的不同模式突出了昼夜节律在头痛表现中的作用。这些发现可能为偏头痛的病理生理过程提供了一些见解，并为临床干预和预防提供了信息。使用移动技术实时跟踪这些系统为传统临床评估提供了有价值的辅助工具。
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