偏頭痛會增加抽菸者的中風風險


  【24drs.com】新研究顯示,偏頭痛與抽菸者的中風風險增加有關,非抽菸者則無。
  
  這些來自人口基礎多種族世代中風發生率研究的結果,線上登載於7月22日神經學期刊,作者是佛羅里達州邁阿密大學醫學院頭痛小組主任、臨床神經學助理教授Teshamae S. Monteith醫師等人。
  
  研究對象是1,292名40歲以上的人(平均年齡68歲),20% (n = 262人)有偏頭痛,平均11年的追蹤期間內,偏頭痛(有先兆或沒有先兆)與中風或其他血管事件之間並無整體關係,不過,198名目前有抽菸習慣者中,18%(n = 35人)有偏頭痛者的中風發生率增加3倍。
  
  Monteith醫師表示,這些研究結果有點令人驚訝,我們發現偏頭痛和傳統血管風險因素之間的關聯,還發現偏頭痛和中風/心血管事件的關聯。
  
  她表示,需要後續研究,以確認抽菸偏頭痛患者之中風風險增加的生物機轉;但在此期間,已知偏頭痛與血管風險因素增加有關,偏頭痛患者應該知道,如果他們有抽菸,則會面臨中風風險增加的情況,但戒菸永遠不嫌遲。
  
  新罕布夏Lebanon Dartmouth學院Geisel醫學院神經科教授Thomas N. Ward醫師受邀對這些研究結果發表評論時表示,這篇研究確認抽菸與偏頭痛是不好的組合,而且,如果病患有使用外源性雌激素時,情況會更糟糕。
  
  至於偏頭痛和中風之間缺乏整體關聯,Ward醫師表示,相較於比較中風和心臟病發作風險與偏頭痛關聯之其他研究,這篇研究相對較小且只有年長族群,因此,它可能無法發現大型研究才能察覺的一些比較小的徵兆。
  
  偏頭痛者比較可能有高血壓(81% vs. 73%;P = .0094)與高膽固醇血症(68% vs. 60%;P = .0184),且比較不會進行中等到繁重的運動(4% vs 8%;P = .0215)。
  
  在平均追蹤11年間,有114例中風、94例心肌梗塞、178例血管原因死亡。
  
  控制社經與血險風險因素之後,有偏頭痛者相較於無偏頭痛者的中風風險比,目前有抽菸者為3.17、以前有抽菸者為0.87、未曾抽菸者為0.49;若合併血管事件,有偏頭痛者相較於無偏頭痛者的風險比,目前有抽菸者為1.83、目前無抽菸者為0.63。
  
  Monteith 醫師表示,有趣的是,我們這些有偏頭痛但沒有抽菸的世代中,比較少有血管事件;還不清楚這是這些沒抽菸偏頭痛患者有比較健康生活型態的結果,還是因為報告時的偏差。
  
  Ward醫師指出,以前的研究顯示,相較於無偏頭痛者,偏頭痛患者比較可能會抽菸,但是比較不會喝酒。他表示,這篇研究的作者們充分說明了他們的研究限制,或許是因此而得到略有不同的研究結果。
  
  資料來源:http://www.24drs.com/
  
  Native link:Migraine Ups Stroke Risk, but Only in Smokers

Migraine Ups Stroke Risk, but Only in Smokers

By Miriam E. Tucker
Medscape Medical News

Migraine is associated with an increased risk for stroke among active smokers, but not nonsmokers, new research shows.

The findings, from a population-based multiethnic cohort study of stroke incidence, were published online July 22 in Neurology by Teshamae S. Monteith, MD, assistant professor of clinical neurology and chief of the Headache Division at the University of Miami's Miller School of Medicine, Florida, and colleagues.

Among the 1292 participants older than 40 years (mean age, 68 years), including 20% (n = 262) with migraine, there was no overall relationship between migraine (with or without aura) and stroke or other vascular events at an average of 11 years' follow up. However, among the 198 current smokers, the 18% with migraine (n = 35) had a 3-fold increased risk for stroke.

The findings were somewhat surprising, Dr Monteith told Medscape Medical News. "We found a relationship with migraine and traditional vascular risk factors but also expected to see an association between migraine and stroke/cardiovascular events."

Further work is needed to determine the biological mechanisms underlying the increased risk for stroke in patients with migraine who smoke, she said. But in the meantime, "Already, migraine is associated with increased vascular risk factors. Migraineurs should be aware that they place themselves at a greater risk for stroke and combined vascular events if they smoke. It is never too late to quit smoking."

Asked to comment on the findings, Thomas N. Ward, MD, professor of neurology at the Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, said that the study "does confirm that smoking and migraine is a bad combination, and already known to be even worse if the patient is taking exogenous estrogen."

As for the lack of overall relationship between migraine and stroke, Dr Ward said, "Compared to some of the other studies relating stroke and heart attack risk to migraine this was a relatively small study with an older population. It therefore may not have been able to detect the abnormality where some of the very large studies may have found the presumably smaller signal."

Those with migraine were more likely to have hypertension (81% vs. 73%; P = .0094) and hypercholesterolemia (68% vs. 60%; P = .0184) and were also less likely to engage in moderate to heavy physical activity (4% vs 8%; P = .0215).

Over the mean of 11 years, there were 114 strokes, 94 myocardial infarctions, and 178 vascular deaths.

The hazard ratios for stroke for migraine vs no migraine were 3.17 among current smokers, 0.87 in former smokers, and 0.49 in those who never smoked (after controlling for socioeconomic and vascular risk factors). For combined vascular events, the hazard ratios for migraine vs no migraine were 1.83 among current smokers and 0.63 among current nonsmokers.

"Interestingly, our cohort of nonsmokers with migraines appeared to have fewer vascular events. It was not clear if this was a consequence of healthier lifestyles of nonsmoking migraine subjects or due to reporting biases," Dr Monteith told Medscape Medical News.

Previous studies have shown that migraineurs are more likely to smoke but less likely to drink alcohol than nonmigraineurs, Dr Ward pointed out.

"The authors in this study do a nice job of addressing the limitations of their study and perhaps why the findings are a bit different," he said.

This study was funded by the National Institute of Neurological Disorders and Stroke. The authors have disclosed no relevant financial relationships. Dr Ward is the editor-in-chief of the American Headache Society's journal Headache. He has disclosed no relevant financial relationships.

Neurology. Published online July 22, 2015.

    
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