氣喘似乎會使慢性偏頭痛風險加倍


  【24drs.com】根據線上發表於11月19日頭痛(Headache)期刊的一篇研究,對於曾發生偏頭痛者而言,如果有氣喘病史,可以預測慢性偏頭痛。
  
  因為這兩種狀況都很常見—美國約有11.6%人口有偏頭痛、7.5%有氣喘—所以很可能會同時患有這兩個疾病,但是,目前並未確認兩者之間的風險關係。紐約布朗士阿爾伯特-愛因斯坦醫學院神經科名譽教授、蒙特菲爾頭痛中心主任Richard Lipton醫師表示,曾有氣喘和偏頭痛之關聯的報告,頭痛醫療實務方面也發現,許多偏頭痛患者同時也有氣喘。
  
  起初,本研究的資深作者Lipton醫師,以為他是看到患有這兩種疾病病患的偏差樣本,因為,是由一線照護醫師不確定是否可處方propranolol給氣喘患者預防偏頭痛時而轉介過來。但是,他後來發現其他線索,白三烯素抑制劑對於氣喘和偏頭痛有一些效果,而這兩種疾病都與發炎情況改變、某些平滑肌的變化有關。在氣喘方面,呼吸道平滑肌收縮和呼吸道內層發炎而引起支氣管收縮。至於在偏頭痛,是血管發炎、擴張與收縮。這些機械式關聯認為這兩個疾病之間可能有相關。
  
  Lipton醫師已經進行了「美國偏頭痛盛行率與預防(American Migraine Prevalence and Prevention[AMPP])」研究,所以他補充了氣喘問題;他表示,那麼,我們問氣喘可以預測一段時間後的偏頭痛惡化嗎?你瞧,它可以。
  
  這次的研究中,第一作者、俄亥俄州辛辛那提大學神經科學研究中心、頭痛與臉部疼痛計畫共同主持人Vincent T. Martin醫師等人假設,氣喘是從偶發偏頭痛變成慢性偏頭痛(每個月發作15次以上)的一個風險因素,很少有慢性偏頭痛是沒有先發生偶發性偏頭痛的。
  
  研究者使用來自2008和2009年的AMPP研究資料,納入來自「歐洲社區呼吸道健康研究(European Community Respiratory Health Survey)」這項調查的一份有6個項目的氣喘問卷,另外,為了探討氣喘情況比較嚴重時是否會增加演變成慢性偏頭痛的可能性,研究者發展出一份「呼吸道症狀嚴重度評分(Respiratory Symptom Severity Score)」量表,範圍從不嚴重(沒有陽性反應)到輕度嚴重(1-2個陽性反應)、中度嚴重(3-4個陽性反應)、高度嚴重(5-6個陽性反應);AMPP研究則是詢問有關頭痛時間與頻率。
  
  曾有偶發性偏頭痛的4,446人中,746人(16.8%)有氣喘、3,700人(83.2%)沒有。在2009年,這些人有2.9% (131/4446)新發生慢性偏頭痛,這也是研究的主要終點。
  
  這組包括了5.4% (40/746)的氣喘次組與2.5% (91/3700)的非氣喘次組。校正社會人口統計學因素(包括年齡、身體質量指數、性別、收入)、頭痛頻率、使用偏頭痛預防藥物之後,有氣喘的研究對象發生慢性偏頭痛的風險,是沒有氣喘者的2倍以上(校正風險比[aOR]為2.1;95%信賴區間[CI]為1.4 - 3.1)。
  
  此外,這個風險會隨著氣喘症狀的次數而增加,但是,與沒有氣喘者相比,只有氣喘嚴重程度高的人,發生慢性偏頭痛機會的增加情況才有達到統計上的顯著差異(aOR, 3.3;95% CI, 1.7 - 6.2)。
  
  Lipton醫師表示,如果嚴重氣喘症狀的發生頻率增加時,會增加發生慢性偏頭痛的風險,那麼,很有可能是呼吸道症狀扮演著致病作用。
  
  雖然我們發現有氣喘者約有2倍的風險,呼吸道症狀最嚴重者發生慢性偏頭痛的風險則是沒有氣喘者的3倍以上。他指出,這個明顯的劑量反應關係很像憂鬱症,整體而言,憂鬱使慢性偏頭痛風險增加約將近2倍,但是,憂鬱程度最嚴重者的風險則是3倍。
  
  其他共變項,包括藥物濫用、頭痛頻率與使用預防性藥物,都與新發生慢性偏頭痛無關。慢性偏頭痛的其他風險因素包括肥胖、異常疼痛、其他疼痛狀況、濫用barbiturates和narcotics等藥物。
  
  Lipton醫師表示,讓偶發偏頭痛的氣喘病患使用偏頭痛預防藥物的決定是複雜的,醫師應評估偏頭痛病程的整體風險因素資料,將這些納入治療決策考量,但是,我不認為有任何研究顯示,如果你發現偏頭痛病程風險高的患者時,使用偏頭痛預防性藥物可以預防病程進展。他也推測,如果發炎情形是關聯所在時,使用可以降低發炎的藥物治療氣喘時,對於偏頭痛病程可能會有保護效果。
  
  作者們指出,研究限制包括,未知的干擾因素、90%的研究對象是白人、問卷採自我報告、時間只有1年。
  
  資料來源:http://www.24drs.com/
  
  Native link:Asthma Appears to Double Chronic Migraine Risk

Asthma Appears to Double Chronic Migraine Risk

By Ricki Lewis, PhD
Medscape Medical News

A history of asthma may predict chronic migraine in individuals who have episodic migraine, according to a study published online November 19 in Headache.

Because both conditions are prevalent — about 11.6% of the US population has migraine and 7.5% has asthma — comorbidity is likely, but a risk relationship has not been established. "Links between asthma and migraine had been reported, and people who practice headache medicine have noticed that a lot of patients with migraine also have asthma," Richard Lipton, MD, director of the Montefiore Headache Center and the Edwin S. Lowe Chair in Neurology, Albert Einstein College of Medicine, Bronx, New York, told Medscape Medical News.

At first, Dr Lipton, who is senior author on the paper, thought he was seeing a skewed sample of patients with both disorders who had been referred by primary care physicians uncertain of whether to prescribe propranolol to prevent migraine to patients with asthma. But then he noted other clues: "Leukotriene inhibitors have some effect in asthma and migraine, and both disorders involve inflammatory changes and changes in smooth muscle. In asthma, bronchoconstriction is caused by contractility of smooth muscle in the airways and inflammation of the airway linings. And in migraine there's inflammation, and dilation and constriction of blood vessels. These mechanistic links suggested that the two conditions might be associated."

Dr Lipton was already conducting the American Migraine Prevalence and Prevention (AMPP) study, so he added asthma questions. "Then we asked, 'Does asthma predict worsening of migraine over time?' Lo and behold, it did," he said.

Link Apparent in Large Study

For the current study, lead author Vincent T. Martin, MD, codirector of the Headache and Facial Pain Program at the University of Cincinnati Neuroscience Institute in Ohio, and colleagues hypothesized that asthma is a risk factor for the transition from episodic to chronic migraine (15 or more headaches a month). Chronic migraine rarely occurs without episodic migraine first.

The researchers used data from the AMPP for 2008 and 2009. The instrument included a six-item asthma questionnaire from the European Community Respiratory Health Survey. Also, to investigate whether more severe asthma increased the likelihood of progressing to chronic migraine, the researchers developed a Respiratory Symptom Severity Score, ranging from no severity (zero positive responses), to low severity (one to two positive responses), moderate severity (three to four positive responses), and high severity (five to six positive responses). The AMPP asked about headache duration and frequency.

Of 4446 participants who had episodic migraine, 746 (16.8%) had asthma and 3700 (83.2%) did not. In 2009, new-onset chronic migraine developed in 2.9% (131/4446) of the cohort, which was the primary endpoint.

This group included 5.4% (40/746) of the asthma subgroup and 2.5% (91/3700) of the nonasthma subgroup. Participants with asthma had a greater than twofold risk for progression to chronic migraine compared with those without asthma, after adjusting for sociodemographic factors (including age, body mass index, sex, and income), headache frequency, and migraine preventive medication use (adjusted odds ratio [aOR], 2.1; 95% confidence interval [CI], 1.4 - 3.1).

Moreover, the risk appeared to increase as the number of asthma symptoms increased, but only those in the high asthma severity group exhibited a statistically significant increase in the odds of chronic migraine onset compared with those without asthma (aOR, 3.3; 95% CI, 1.7 - 6.2).

"If increasingly severe asthma symptoms increase the risk of progression to chronic migraine, then it is more likely that respiratory symptoms play a causal role," Dr Lipton said. "While we found that overall presence of asthma about doubles the risk, the group with the most severe respiratory symptoms was more than three times as likely to develop chronic migraine as people free of asthma." The apparent dose-response is similar to that for depression, he added. "Overall, depression a little less than doubles the risk of chronic migraine, but the highest depression triples risk."

The other covariates, including medication overuse, headache frequency, and preventative medication use, were not associated with new-onset chronic migraine. Other risk factors for chronic migraine are obesity, allodynia, other pain disorders, and overuse of barbiturates and narcotics.

The decision to use migraine preventive medication in patients with asthma with episodic migraine is complex, Dr Lipton said. "Physicians should assess the overall profiles of risk factors for migraine progression and take them into account in treatment decisions. But I don't think any studies have shown that if you identify people at high risk for migraine progression that treatment with migraine preventive medication prevents progression." He also speculates that treating asthma with drugs that reduce inflammation may have a protective effect against migraine progression, if inflammation is the link.

The authors note several study limitations including unknown confounders, the fact that 90% of the participants were Caucasian, self-reporting on questionnaires, and the 1-year duration.

McNeil-Janssen Scientific Affairs LLC funded The AMPP study and donated the resulting database to the National Headache Foundation. The authors have disclosed no relevant financial relationships.

Headache. Published online November 19, 2015.

    
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