Premonitory symptoms in migraine
Premonitory symptoms in migraine
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偏头痛的先兆症状
作者：
N. Giffin;L. Ruggiero;R. Lipton;S. Silberstein;J. Tvedskov;J. Olesen;J. Altman;P. Goadsby;A. MacRae
背景：偏头痛通常在头痛之前、期间和之后伴有非头痛症状。发作前出现的先兆症状尚未得到严格研究。如果这些症状能准确地预测头痛，那么对于偏头痛的病理生理学和治疗就有相当大的意义。方法：在一项为期3个月的多中心研究中，使用电子日记记录偏头痛之前、期间和之后的非头痛症状。研究人员招募了一些受试者，他们认为三次发作中至少有两次没有出现头痛症状。症状由患者发起并通过每天随机时间的提示条目记录在日记中。不能回顾性地更改分录。记录的数据包括在偏头痛的所有三个阶段中出现的非头痛症状，从先兆症状预测发作，一般健康状况以及为预防头痛所采取的行动。结果：共纳入120例患者，其中97例提供可用资料。患者从72%有先兆症状的日记中正确预测偏头痛。在偏头痛的所有三个阶段中，一系列认知和身体症状的发生率相似。最常见的先兆症状是感到疲倦和疲倦（72%的发作具有警告特征），难以集中注意力（51%）和颈部僵硬（50%）。在前兆阶段功能较差的受试者最有可能正确预测头痛。结论：使用电子日记系统，作者表明报告先兆症状的偏头痛患者可以准确预测头痛的全面发作。
Background: Migraine is frequently associated with nonheadache symptoms before, during, and after the headache. Premonitory symptoms occurring before the attack have not been rigorously studied. Should these symptoms accurately predict headache, there are considerable implications for the pathophysiology and management of migraine. Methods: Electronic diaries were used in a 3-month multicenter study to record nonheadache symptoms before, during, and after migraine. The authors recruited subjects who reported nonheadache symptoms in at least two of three attacks that they believed predicted headache. Symptoms were entered in the diaries by patient initiation and through prompted entries at random times daily. Entries could not be altered retrospectively. Data recorded included nonheadache symptoms occurring during all three phases of the migraine, prediction of the attack from premonitory symptoms, general state of health, and action taken to prevent the headache. Results: One hundred twenty patients were recruited: 97 provided usable data. Patients correctly predicted migraine headaches from 72% of diary entries with premonitory symptoms. A range of cognitive and physical symptoms was reported at a similar rate through all three phases of the migraine. The most common premonitory symptoms were feeling tired and weary (72% of attacks with warning features), having difficulty concentrating (51%), and a stiff neck (50%). Subjects who functioned poorly in the premonitory phase were the most likely to correctly predict headache. Conclusions: Using an electronic diary system, the authors show that migraineurs who report premonitory symptoms can accurately predict the full-blown headache.