偏頭痛可能不會影響認知衰退


  【24drs.com】February 5, 2010 — 「Maastrict Aging Study」研究結果認為,不論是偏頭痛或者是偏頭痛相關藥物,都不會影響認知表現。
  
  荷蘭Maastricht大學心智健康與神經科學院的Maria A. E. Baars醫師等人結論表示,此外,沒有發現證據證明它們是認知功能不佳或認知隨著時間惡化的風險因素或預測因素。
  
  Baars醫師向Medscape Neurology表示,偏頭痛是一種常見的狀況,它對於每天生活功能的影響相當大,有關偏頭痛和認知功能的研究獲得了一些矛盾的結果,我們認為有必要以大範圍、縱向、流行病學等級的資料來研究此議題。
  
  這項結果登載於2月份的頭痛(Headache)期刊。
  
  【過去的研究有著各種結果】
  研究作者們報告指出,雖然之前的研究結果各異,磁振造影研究認為偏頭痛與認知功能不佳有關,偏頭痛患者出現較多的白質病灶。
  
  不過,「Baltimore Epidemiologic Catchment Area Study」研究結果認為,偏頭痛病患,特別是先兆型患者,比沒有偏頭痛者較少出現認知隨著時間衰退(Kalaydjian A等人,Neurology. 2007;68:1417-1424)。
  
  至於本研究,研究者試圖探討偏頭痛對於一個認知範圍的縱向影響。
  
  Baars醫師表示,我們希望將偏頭痛和認知表現之間的關聯查清楚,以幫助解答此一問題:「相較於非偏頭痛患者,這些病患隨著時間是否有不同的認知表現模式?」
  
  他們也希望評估藥物的效果,包括特定用於偏頭痛的藥物以及一般的頭痛藥物對於認知能力的影響。
  
  Baars醫師等人評估了「Maastrict Aging Study」研究的1823名病患,在開始時進行認知檢測,99名病患有偏頭痛(偏頭痛患者;64%為女性;平均年紀,47.1歲),以及1724名沒有偏頭痛者(健康對照組;49.1%為女性;平均年紀,51.8歲)。總共有1376名病患在6年後再度檢測,包括了71%的偏頭痛患者。
  
  研究者使用迷你心智狀態檢查,進行立即與延遲回憶檢測、簡單與複雜速度檢測,然後比較兩組的分數。
  
  【沒有發現認知差異】
  結果顯示,兩組在任何認知測量都沒有顯著差異,研究作者寫道,此外,不論是使用特定或非特定藥物,都不會改變偏頭痛和認知功能之間的關係。
  
  他們指出,雖然此研究聚焦在目前的偏頭痛隨著時間對於認知衰退的影響,事後分析也顯示,有偏頭痛病史者與健康對照組之間的衰退模式沒有差異。
  
  研究作者們寫道,有關本研究結果,最直接了當的解釋是,偏頭痛對於認知表現或改變,並沒有實際的負面的或正面的影響。
  
  他們推測,只有半數偏頭痛患者報告有使用偏頭痛藥物,這可能代表著這一組研究對象的偏頭痛嚴重度相對較低,此外,因為長期使用精神異常治療藥物者被排除,可能使那些使用這類藥物來治療偏頭痛的偏頭痛患者被排除於研究之外。
  
  研究作者們指出,他們也沒有關於病患先兆的資訊,因此,可以用這個差異來解釋偏頭痛對於認知沒有影響。
  
  他們寫道,過去的研究探討對於記憶和一般認知能力的影響,但是未包括速度或執行功能的測量,因為我們的結果來自一個大型縱向族群研究,聚焦在廣泛的認知面向,這些結果顯示偏頭痛對於認知的影響不存在,或者這些效果是被一個或更多個其他因素影響。
  
  Baars醫師指出,在我們的研究中,並未發現偏頭痛會影響認知表現或改變表現,不過,後續研究應探討偏頭痛患者的白質病灶,因為這些可能與偏頭痛及認知功能有關聯。
  
  【並未篩檢先兆型問題】
  賓州費城Thomas Jefferson 大學Jefferson頭痛中心神經科教授、美國頭痛協會前任理事長Stephen Silberstein醫師向Medscape Neurology表示,偏頭痛的治療不足、診斷偏低、此領域的資金也不足。
  
  他提出對於這個特別研究的兩個問題:偏頭痛是採用自我報告,也未區別有先兆和無先兆型的偏頭痛,與該試驗無關的Silberstein醫師表示,Baltimore研究顯示,先兆型偏頭痛病患保有認知功能,不過,這些研究者並未做出相關的任何聲明,因為他們並未面談或調查確定病患是否有無先兆。
  
  他指出,雖然只有大約20%至25%的病患有先兆,其關聯對於改善認知功能是重要的,但是本研究未進行篩檢或探討,我認為,他們並未如同其他研究般認真地仔細研究資料。
  
  Silberstein醫師結論表示,世界衛生組織表示,偏頭痛是已知對於人類最容易造成失能的疾病,整體而言,我認為整個偏頭痛領域需要更多資金與更多研究。
  
  研究作者們與Silberstein醫師皆宣告沒有相關財務關係,Silberstein醫師是Medscape Neurology編輯委員的無給職委員。

Migraine Headaches May Not Affect Cognitive Decline

By Deborah Brauser
Medscape Medical News

February 5, 2010 — Neither migraine headaches nor migraine-related medications affect cognitive performance, new results from the Maastrict Aging Study suggest.

In addition, "no evidence was found that [they] are risk or protective factors for cognitive dysfunction or cognitive deterioration over time," Maria A. E. Baars, MD, from the School for Mental Health and Neuroscience at Maastricht University in the Netherlands, and colleagues conclude.

"Migraine is a prevalent condition and [its] consequences for daily life functioning can be vast," Dr. Baars told Medscape Neurology. "Research into the topic of migraines and cognitive functioning has yielded such contradicting results that we thought it important to investigate the topic in our large-scale, longitudinal, epidemiological data set."

The results are published in the February issue of Headache.

Mixed Results From Past Studies

The study authors report that although past study results have been contradictory, magnetic resonance imaging studies have suggested a relationship between migraine and cognitive dysfunction due to the presence of more white matter lesions in those with migraines vs those without.

However, results from the Baltimore Epidemiologic Catchment Area Study suggested that patients with migraines, especially those who experienced aura, showed less cognitive decline over time than the patients without migraines (Kalaydjian A, et al. Neurology. 2007;68:1417-1424).

For this study, the investigators sought to investigate the longitudinal effects of migraines on a range of cognitive domains.

"We were hoping to shed light on the connection between migraine and cognitive performance and to help answer the question, 'Do these patients show different cognitive performance patterns over time compared to nonmigraineurs?'" said Dr. Baars.

They also wanted to assess the effects of medications, both those specifically for migraines and nonspecific headache medications, on cognitive abilities.

Dr. Baars and her team evaluated 1823 patients from the Maastricht Aging Study who were cognitively tested at baseline, including 99 patients who had migraines (migraineurs; 64% female; mean age, 47.1 years) and 1724 who did not (healthy controls; 49.1% female; mean age, 51.8 years). A total of 1376 patients were tested again after 6 years, including 71% of the migraineurs.

The investigators compared scores between the 2 groups using the Mini-Mental State Examination, immediate and delayed recall tests, and simple and complex speed tests.

No Cognitive Differences Found

Results showed no significant differences between the groups for any of the cognitive measures. In addition, "medication use, both specific and nonspecific, did not alter the relation between migraines and cognitive function," write the study authors.

They add that although this study focused on the effects of current migraine on cognitive decline over time, post hoc analyses also showed no difference in decline pattern between the patients with a history of migraines compared with the healthy controls.

The most straightforward explanation ... is that migraine headaches simply do not have a substantial ... effect on cognitive performance.

"The most straightforward explanation for the results of this study is that migraine headaches simply do not have a substantial negative or positive effect on cognitive performance or change therein," write the study authors.

That only half of the migraineurs reported using migraine medication could be an indication that migraine severity was relatively low in this group, they speculate. In addition, because long-term use of psychotropic drugs was an exclusion criterion, "this may have caused migraineurs using these types of medication for their migraines to be excluded from the study."

They also did not have information on patient aura, the study authors note. "So the lack of effect of migraines on cognition could be explained by this difference."

"Past studies investigated effects on memory and general cognitive abilities but did not include measures for speed or executive functioning," they write. "Considering that [our] findings came from a large, longitudinal population study focusing on a wide range of cognitive domains, these results are an indication that effects of migraine on cognition do not exist or that these effects are mediated by one or more of the factors described."

"In our study, migraine was not found to influence cognitive performance or change in performance" added Dr. Baars. However, "white matter lesions should be investigated further in migraineurs, since these may connect migraines to cognitive functioning."

Not Screening for Aura Problematic

"Migraines are undertreated, underdiagnosed, and the field is underfunded," Stephen Silberstein, MD, professor of neurology at the Jefferson Headache Center at Thomas Jefferson University in Philadelphia, Pennsylvania, and past president of the American Headache Society, told Medscape Neurology.

He cautioned that he had 2 problems with this particular study: that migraine was self-reported and that no distinction was made between migraines with and without aura. "The Baltimore study showed that patients with migraine and aura have preserved cognitive functions. However, these investigators couldn't make any statements about that because they weren't able to interview or survey to decide whether or not patients did or did not have aura," said Dr. Silberstein, who was not associated with this trial.

"Although aura only occurs in about 20% to 25% of patients, its association with improved cognitive function is important," he added. "But this study didn't screen for or look at that at all. I just think they didn't dissect the data as carefully as the other study."

"The World Health Organization has said that migraines are the most disabling attacks known to mankind," concluded Dr. Silberstein. "Overall, I'd say that the entire field of migraine needs more funding and more studies."

The study authors and Dr. Silberstein have reported no relevant financial relationships. Dr. Silberstein is a member of the Medscape Neurology editorial advisory board without reimbursement.

Headache. 2010;50:176-184.

    
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