Sex Differences in the Prevalence, Symptoms, and Associated Features of Migraine, Probable Migraine and Other Severe Headache: Results of the American Migraine Prevalence and Prevention (AMPP) Study
Sex Differences in the Prevalence, Symptoms, and Associated Features of Migraine, Probable Migraine and Other Severe Headache: Results of the American Migraine Prevalence and Prevention (AMPP) Study
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DOI：
10.1111/head.12150
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发表时间：
2013-09-01
期刊：
影响因子：
5
通讯作者：
Lipton, Richard B.
中科院分区：
文献类型：
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作者：
Buse, Dawn C.;Loder, Elizabeth W.;Lipton, Richard B.
背景。-女性偏头痛的发病率明显高于男性，这是偏头痛的标志之一。全球有大量证据表明偏头痛患病率存在性别差异，女性与男性的比例为2：1至3：1，并在中年达到峰值。一些数据可用于相关症状，头痛相关的残疾和损害，偏头痛的医疗资源利用的性别差异。关于可能的偏头痛（PM）和其他严重头痛（即，非偏头痛谱严重头痛）的相应性别差异的数据很少。清楚地了解一系列严重头痛疾病的性别差异可能有助于区分头痛类型。在这里，我们比较了性别的患病率和偏头痛，PM和其他严重头痛的一系列临床变量在美国人口的大样本。这项研究分析了2004年美国偏头痛患病率和预防研究的数据。报告了头痛亚型（偏头痛、PM和其他严重头痛）的总体和人口统计学分层的性别特异性患病率估计值。使用对数二项模型计算各人口统计学分层的性别特异性调整后的患病率和95%置信区间。偏头痛和PM的平滑性别患病率比率（女性对男性）图。2004年美国偏头痛患病率和预防研究调查（64.9%的应答率）中，16万2700五十六例年龄在12岁及以上的患者做出了应答。二万八千二百六十一（17.4%）在前一年报告严重头痛（23.5%的女性和10.6%的男性），11.8%符合头痛疾病国际分类-偏头痛的2项标准（17.3%的女性和5.7%的男性），4.6%符合PM标准（5.3%的女性和3.9%的男性），1.0%被归类为其他严重头痛（0.9%的女性和1.0%的男性）。偏头痛和PM的患病率存在性别差异，但其他严重头痛的患病率没有性别差异。偏头痛的女性与男性患病率调整后的终生患病率为1.48至3.25，PM为1.22至1.53。在相关的神经病学、先兆、头痛相关残疾、医疗资源利用以及偏头痛和PM的诊断方面也观察到性别差异。尽管偏头痛的诊断率较高的医疗保健专业人员，女性偏头痛患者不太可能比男性使用预防性药物治疗头痛。在这个大的美国人口样本中，偏头痛和PM在女性中更常见，但在其他严重头痛的患病率中没有观察到性别差异。偏头痛和PM的性别差异在不同年龄和大多数其他社会人口学变量中均成立，但PM的种族除外。女性偏头痛和PM有较高的比例，大多数偏头痛症状，先兆，更大的相关损害，和更高的医疗资源利用比男性。在大多数这些比较中，在患有其他严重头痛的个体中没有观察到相应的性别差异。结果表明，PM是偏头痛谱的一部分，而其他严重的头痛类型不是。结果还证实了有关原发性头痛性别差异的现有文献，并将结果扩展到其他头痛类型和相关因素。
Background.-The strikingly higher prevalence of migraine in females compared with males is one of the hallmarks of migraine. A large global body of evidence exists on the sex differences in the prevalence of migraine with female to male ratios ranging from 2:1 to 3:1 and peaking in midlife. Some data are available on sex differences in associated symptoms, headache-related disability and impairment, and healthcare resource utilization in migraine. Few data are available on corresponding sex differences in probable migraine (PM) and other severe headache (ie, nonmigraine-spectrum severe headache). Gaining a clear understanding of sex differences in a range of severe headache disorders may help differentiate the range of headache types. Herein, we compare sexes on prevalence and a range of clinical variables for migraine, PM, and other severe headache in a large sample from the US population.Methods.-This study analyzed data from the 2004 American Migraine Prevalence and Prevention Study. Total and demographic-stratified sex-specific, prevalence estimates of headache subtypes (migraine, PM, and other severe headache) are reported. Log-binomial models are used to calculate sex-specific adjusted prevalence ratios and 95% confidence intervals for each across demographic strata. A smoothed sex prevalence ratio (female to male) figure is presented for migraine and PM.Results.-One hundred sixty-two thousand seven hundred fifty-six individuals aged 12 and older responded to the 2004 American Migraine Prevalence and Prevention Study survey (64.9% response rate). Twenty-eight thousand two hundred sixty-one (17.4%) reported severe headache in the preceding year (23.5% of females and 10.6% of males), 11.8% met International Classification of Headache Disorders-2 criteria for migraine (17.3% of females and 5.7% of males), 4.6% met criteria for PM (5.3% of females and 3.9% of males), and 1.0% were categorized with other severe headache (0.9% of females and 1.0% of males). Sex differences were observed in the prevalence of migraine and PM, but not for other severe headache. Adjusted female to male prevalence ratios ranged from 1.48 to 3.25 across the lifetime for migraine and from 1.22 to 1.53 for PM. Sex differences were also observed in associated symptomology, aura, headache-related disability, healthcare resource utilization, and diagnosis for migraine and PM. Despite higher rates of migraine diagnosis by a healthcare professional, females with migraine were less likely than males to be using preventive pharmacologic treatment for headache.Conclusions.-In this large, US population sample, both migraine and PM were more common among females, but a sex difference was not observed in the prevalence of other severe headache. The sex difference in migraine and PM held true across age and for most other sociodemographic variables with the exception of race for PM. Females with migraine and PM had higher rates of most migraine symptoms, aura, greater associated impairment, and higher healthcare resource utilization than males. Corresponding sex differences were not observed among individuals with other severe headache on the majority of these comparisons. Results suggest that PM is part of the migraine spectrum whereas other severe headache types are not. Results also substantiate existing literature on sex differences in primary headaches and extend results to additional headache types and related factors.