Linet M S, Stewart W F
Epidemiol Rev. 1984;6:107-39. doi: 10.1093/oxfordjournals.epirev.a036268.
Clinical and epidemiologic studies suggest that a number of factors are associated with the risk of migraine and precipitation of an attack. However, the degree to which causal associations can be inferred from reported studies is very limited and is a result of the methodological problems discussed throughout this review. The study of migraine in many ways parallels the pattern seen in early investigations of other conditions, such as rheumatoid arthritis and systemic lupus erythematosus, because a number of methodological problems had to be resolved in the study of these conditions before significant progress could be made. To achieve significant advances in the improvement of our understanding of the causes of migraine, a number of related issues must be addressed and resolved in future studies. Most noteworthy among these are Recognition of the probable heterogeneity of migraine, not merely in the manifestation of symptoms but, more importantly, in the existence of distinct etiologic subtypes. A number of findings suggest that some migraine subtypes are sensitive to certain precipitants, some appear to be a part of a more generalized constitutional disorder, and some are accompanied by a higher prevalence of migraine among family members. Efforts should be made in understanding the relationship between specific biochemical markers and traits (such as monoamine oxidase deficiency and tyramine sensitivity); precipitants related to the migraine attack; and epidemiologic characteristics such as age at onset and sex. Creation of a more precise, reliable, and practically useful definition of migraine. Without such a definition, it is difficult, if not impossible, to compare results between studies, to understand the relationship between risk factors and migraine subtypes, to understand properly associations identified in selected clinic populations, and, in general, to understand the epidemiology of migraine. More accurate characterization of the case group under study. More documentation of the age at onset, symptoms, frequency of attacks, and other characteristics related to migraine would be very useful to compare properly results between studies. Additional descriptive epidemiologic studies of migraine which would include reliable estimates of age-specific incidence, prevalence, remission rates, and natural history of the various migraine subtypes.(ABSTRACT TRUNCATED AT 400 WORDS)
临床和流行病学研究表明，许多因素与偏头痛风险及发作诱因相关。然而，从已报道的研究中能够推断出因果关联的程度非常有限，这是本综述中所讨论的方法学问题导致的结果。偏头痛的研究在许多方面与其他疾病（如类风湿关节炎和系统性红斑狼疮）早期研究中的模式相似，因为在这些疾病的研究中，必须解决一些方法学问题才能取得显著进展。为了在增进对偏头痛病因的理解方面取得重大进展，未来研究必须解决和处理一些相关问题。其中最值得注意的是认识到偏头痛可能存在异质性，不仅在症状表现方面，更重要的是在不同病因亚型的存在方面。一些研究结果表明，某些偏头痛亚型对特定诱因敏感，一些似乎是更普遍的体质性疾病的一部分，还有一些在家庭成员中偏头痛患病率更高。应努力了解特定生化标志物与特征（如单胺氧化酶缺乏和酪胺敏感性）之间的关系；与偏头痛发作相关的诱因；以及诸如发病年龄和性别等流行病学特征。创建一个更精确、可靠且实用的偏头痛定义。没有这样一个定义，就很难（如果不是不可能的话）比较不同研究结果，理解风险因素与偏头痛亚型之间的关系，正确理解在特定临床人群中发现的关联，以及总体上理解偏头痛的流行病学。更准确地描述所研究的病例组。更多关于发病年龄、症状、发作频率以及与偏头痛相关的其他特征的记录，对于恰当地比较不同研究结果非常有用。开展更多偏头痛的描述性流行病学研究，包括对不同偏头痛亚型按年龄特异性发病率、患病率、缓解率和自然史进行可靠估计。（摘要截断于400字）
