Divison of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Headache. 2024 Nov-Dec;64(10):1230-1243. doi: 10.1111/head.14859. Epub 2024 Oct 27.
To conduct a retrospective cross-sectional multicenter study to validate the relationships between migraine-associated symptoms.
Symptoms associated with headache-photophobia and phonophobia, nausea, and/or vomiting-are required criteria for migraine diagnosis based on the International Classification of Headache Disorders-Third Edition (ICHD-3). However, individuals with migraine report high rates of other symptoms (e.g., lightheadedness, difficulty thinking). We recently completed a single-center study assessing the relationships between an expanded set of migraine-associated symptoms.
A pre-registered cross-sectional multicenter retrospective analysis was conducted on standardized questionnaire data of youth ages 6-17 years from two headache registries at pediatric tertiary care centers. Cluster Analysis of Migraine-associated Symptoms (CAMS) was implemented to assess associations between 11 migraine-associated symptoms. We explored differences between the two centers, and how CAMS was associated with demographics, including sex and age, and headache burden.
There were 10,721 participants who were 66.5% female and had a median (interquartile range) age of 13 (10-15) years. The first three CAMS dimensions accounted for 46.5% of the variance and were consistent across sites. The first dimension indicated those reporting any migraine-associated symptoms were likely to report multiple. The second dimension separated symptoms into those included in ICHD-3 migraine diagnostic criteria and non-ICHD symptoms (e.g., lightheadedness, difficulty thinking). The third dimension separated sensory hypersensitivity and vestibular symptoms. An abundance of migraine-associated symptoms correlated with greater headache severity (Spearman's ρ = 0.18, 95% confidence interval [CI] 0.17-0.20; small effect size) and disability (ρ = 0.26, 95% CI 0.25-0.28; small effect size). We also observed differences in associated symptoms across age and sex.
Associations between an expanded set of migraine-associated symptoms are informative for headache burden and reveal intriguing changes across child development and sex. We were able to replicate findings across two centers, indicating that these symptom clusters are inherent to migraine.
进行回顾性横断面多中心研究，以验证偏头痛相关症状之间的关系。
根据《国际头痛疾病分类第三版》（ICHD-3），头痛相关症状（畏光和畏声、恶心和/或呕吐）是偏头痛诊断的必需标准。然而，偏头痛患者报告存在较高比例的其他症状（如头晕、思维困难）。我们最近完成了一项单中心研究，评估了一组扩展的偏头痛相关症状之间的关系。
对来自两家儿科三级护理中心头痛登记处的 6-17 岁青少年的标准化问卷数据进行了预先注册的横断面多中心回顾性分析。采用偏头痛相关症状聚类分析（CAMS）评估 11 种偏头痛相关症状之间的关联。我们探索了两个中心之间的差异，以及 CAMS 与人口统计学因素（包括性别和年龄）和头痛负担的关系。
共有 10721 名参与者，其中 66.5%为女性，中位数（四分位距）年龄为 13（10-15）岁。前三个 CAMS 维度占总方差的 46.5%，且在两个中心均一致。第一个维度表明，报告任何偏头痛相关症状的人很可能报告多种症状。第二个维度将症状分为 ICHD-3 偏头痛诊断标准中的症状和非 ICHD 症状（如头晕、思维困难）。第三个维度将感觉过敏和前庭症状分开。偏头痛相关症状越多与头痛严重程度（Spearman's ρ=0.18，95%置信区间[CI] 0.17-0.20；小效应量）和残疾（ρ=0.26，95%CI 0.25-0.28；小效应量）呈正相关。我们还观察到不同年龄和性别的相关症状存在差异。
扩展的偏头痛相关症状之间的关联对于头痛负担具有信息性，并揭示了儿童发育和性别过程中的有趣变化。我们能够在两个中心复制发现，表明这些症状群是偏头痛固有的。
