Department of Psychology, University of Mississippi, Oxford, Mississippi, USA.
University of Mississippi Medical Center, Jackson, Mississippi, USA.
Headache. 2024 Sep;64(8):931-938. doi: 10.1111/head.14796. Epub 2024 Aug 1.
To examine the unique role of migraine aura in predicting day-to-day levels of headache-related disability.
Migraine symptoms and psychological variables contribute to headache-related disability. Migraine aura may be associated with more severe symptom profiles and increased risk of psychiatric comorbidities, but the impact of aura on daily functioning is unknown. The present study sought to evaluate the role of migraine aura in predicting same-day and subsequent-day migraine-related disability while accounting for demographic, headache, and psychological variables.
This was an observational prospective cohort study among 554 adults with migraine. For each participant, data on migraine symptoms and psychological variables were collected daily for 90 days using the N-1 Headache™ digital app (N = 11,156 total migraine days). Analyses assessed whether the presence of aura predicted daily ratings of migraine-related disability independently of other headache and psychological variables. Given the number of predictors examined, statistical significance was set at p < 0.01.
The mean (standard deviation, range) patient-level Migraine Disability Assessment questionnaire score across days of the migraine episode was 1.18 (1.03, 0-3). Aura was significantly associated with higher disability ratings on all days of the migraine episode (odds ratio [OR] 1.40, 99% confidence interval [CI] 1.13-1.74; p < 0.001). This relationship remained unchanged after adjusting for patient-level variables (OR 1.40, 99% CI 1.13-1.73; p < 0.001) and day-level psychological variables (OR 1.39, 99% CI 1.12-1.73; p < 0.001) but was fully negated after controlling for day-level headache variables (OR 1.19, 99% CI 0.95-1.49; p = 0.039). Aura on the first day of the episode was associated with increased odds of allodynia (OR 1.87, 99% CI 1.22-2.86; p < 0.001), phonophobia (OR 1.62, 99% CI 1.17-2.25; p < 0.001), photophobia (OR 1.89, 99% CI 1.37-2.59; p < 0.001), and nausea/vomiting (OR 1.54, 99% CI 1.17-2.02; p < 0.001) on all days of the episode, but not episode duration (p = 0.171), peak severity (p = 0.098), or any examined psychological variables (sleep duration [p = 0.733], sleep quality [p = 0.186], stress [p = 0.110], anxiety [p = 0.102], or sadness [p = 0.743]).
The presence of aura is predictive of increased headache-related disability during migraine episodes, but this effect is attributable to associated non-pain symptoms of migraine.
探讨偏头痛先兆在预测日常头痛相关残疾中的独特作用。
偏头痛症状和心理变量会导致头痛相关残疾。偏头痛先兆可能与更严重的症状谱和更高的精神共病风险相关，但先兆对日常功能的影响尚不清楚。本研究旨在评估偏头痛先兆在预测偏头痛相关残疾方面的作用，同时考虑人口统计学、头痛和心理变量。
这是一项针对 554 名偏头痛患者的观察性前瞻性队列研究。对于每个参与者，使用 N-1 Headache™数字应用程序（N=11156 个偏头痛日），在偏头痛发作的 90 天内每天收集偏头痛症状和心理变量的数据。分析评估了先兆是否存在独立于其他头痛和心理变量预测日常偏头痛相关残疾的情况。由于研究了大量的预测因子，因此统计学意义设定为 p<0.01。
偏头痛发作期间患者偏头痛残疾评估问卷评分的平均值（标准差，范围）为 1.18（1.03，0-3）。先兆与偏头痛发作期间所有日子的残疾评分显著相关（比值比 [OR] 1.40，99%置信区间 [CI] 1.13-1.74；p<0.001）。调整患者水平变量（OR 1.40，99% CI 1.13-1.73；p<0.001）和每日心理变量（OR 1.39，99% CI 1.12-1.73；p<0.001）后，这种关系保持不变，但在控制每日头痛变量后，这种关系完全被否定（OR 1.19，99% CI 0.95-1.49；p=0.039）。发作第一天的先兆与以下情况的几率增加相关：感觉异常（OR 1.87，99% CI 1.22-2.86；p<0.001）、恐声症（OR 1.62，99% CI 1.17-2.25；p<0.001）、畏光症（OR 1.89，99% CI 1.37-2.59；p<0.001）和恶心/呕吐（OR 1.54，99% CI 1.17-2.02；p<0.001），但不包括发作持续时间（p=0.171）、峰值严重程度（p=0.098）或任何检查的心理变量（睡眠持续时间[p=0.733]、睡眠质量[p=0.186]、压力[p=0.110]、焦虑[p=0.102]或悲伤[p=0.743]）。
先兆的存在可预测偏头痛发作期间头痛相关残疾的增加，但这种影响归因于偏头痛的非疼痛相关症状。
