Crowe H M, Sampson L, Purdue-Smithe A C, Rexrode K M, Koenen K C, Rich-Edwards J W
Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Epidemiol Psychiatr Sci. 2024 Dec 11;33:e76. doi: 10.1017/S2045796024000799.
Migraine and post-traumatic stress disorder (PTSD) are both twice as common in women as men. Cross-sectional studies have shown associations between migraine and several psychiatric conditions, including PTSD. PTSD is disproportionally common among patients in headache clinics, and individuals with migraine and PTSD report greater disability from migraines and more frequent medication use. To further clarify the nature of the relationship between PTSD and migraine, we conducted bidirectional analyses of the association between (1) migraine and incident PTSD and (2) PTSD and incident migraine.
We used longitudinal data from 1989-2020 among the 33,327 Nurses' Health Study II respondents to the 2018 stress questionnaire. We used log-binomial models to estimate the relative risk of developing PTSD among women with migraine and the relative risk of developing migraine among individuals with PTSD, trauma-exposed individuals without PTSD, and individuals unexposed to trauma, adjusting for race, education, marital status, high blood pressure, high cholesterol, alcohol intake, smoking, and body mass index.
Overall, 48% of respondents reported ever experiencing migraine, 82% reported experiencing trauma and 9% met the Diagnostic and Statistical Manual of Mental Disorders-5 criteria for PTSD. Of those reporting migraine and trauma, 67% reported trauma before migraine onset, 2% reported trauma and migraine onset in the same year and 31% reported trauma after migraine onset. We found that migraine was associated with incident PTSD (adjusted relative risk [RR]: 1.26, 95% confidence interval [CI]: 1.14-1.39). PTSD, but not trauma without PTSD, was associated with incident migraine (adjusted RR: 1.20, 95% CI: 1.14-1.27). Findings were consistently stronger in both directions among those experiencing migraine with aura.
Our study provides further evidence that migraine and PTSD are strongly comorbid and found associations of similar magnitude between migraine and incident PTSD and PTSD and incident migraine.
偏头痛和创伤后应激障碍（PTSD）在女性中的发病率均是男性的两倍。横断面研究表明偏头痛与包括PTSD在内的几种精神疾病之间存在关联。PTSD在头痛门诊患者中极为常见，患有偏头痛和PTSD的个体偏头痛导致的残疾更严重，用药也更频繁。为进一步阐明PTSD与偏头痛之间关系的本质，我们对以下两者之间的关联进行了双向分析：（1）偏头痛与新发PTSD；（2）PTSD与新发偏头痛。
我们使用了1989年至2020年间33327名参与护士健康研究II的受访者对2018年压力问卷的纵向数据。我们使用对数二项式模型来估计偏头痛女性患PTSD的相对风险，以及PTSD患者、暴露于创伤但无PTSD的个体和未暴露于创伤的个体患偏头痛的相对风险，并对种族、教育程度、婚姻状况、高血压、高胆固醇、酒精摄入量、吸烟情况和体重指数进行了调整。
总体而言，48%的受访者表示曾患偏头痛，82%表示曾经历过创伤，9%符合《精神疾病诊断与统计手册》第5版PTSD的诊断标准。在报告有偏头痛和创伤经历的人群中，67%表示在偏头痛发作前经历过创伤，2%表示创伤和偏头痛在同一年发作，31%表示在偏头痛发作后经历过创伤。我们发现偏头痛与新发PTSD相关（调整后的相对风险[RR]：1.26，95%置信区间[CI]：1.14 - 1.39）。PTSD（而非无PTSD的创伤）与新发偏头痛相关（调整后的RR：1.20，95%CI：1.14 - 1.27）。在有先兆偏头痛的人群中，两个方向的研究结果始终更强。
我们的研究进一步证明偏头痛和PTSD强烈共病，并发现偏头痛与新发PTSD以及PTSD与新发偏头痛之间存在相似程度的关联。
Zotero 插件