Chronic versus episodic migraine: The 15-day threshold does not adequately reflect substantial differences in disability across the full spectrum of headache frequency
Chronic versus episodic migraine: The 15-day threshold does not adequately reflect substantial differences in disability across the full spectrum of headache frequency
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DOI：
10.1111/head.14154
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发表时间：
2021-06-03
期刊：
影响因子：
5
通讯作者：
Dodick, David W.
中科院分区：
文献类型：
--
作者：
Ishii, Ryotaro;Schwedt, Todd J.;Dodick, David W.
目的评估每月头痛天数的15天阈值是否充分反映了偏头痛全谱中残疾的实质性差异。每月头痛天数的频率定义了偏头痛亚型，对流行病学和临床研究以及获得护理具有重要意义。方法选取2016年2月至2020年3月参加美国偏头痛研究登记处（American Registry for migraine Research）的多中心纵向患者登记处的偏头痛患者（N = 836），根据每月头痛频率分为4组：1组（0-7头痛天/月，N = 286）， 2组（8-14头痛天/月，N = 180）， 3组（15-23头痛天/月，N = 153）， 4组（>= 24头痛天/月，N = 217）。比较残疾（MIDAS）、疼痛强度（NRS）、工作效率和活动障碍（WPAI）、疼痛干扰（promisi - pi）、患者健康问卷-4 （PHQ-4）和一般焦虑障碍-7 （GAD-7）评分。结果平均（标准差[SD]）年龄为46（13）岁，其中87.9%[735/836]为女性。各组患者比例分别为：组1（34.2%[286/836]）、组2（21.5%[180/836]）、组3（18.3%[153/836]）、组4（26.0%[217/836]）。在头痛频率较高的类别中，与残疾增加、生产时间损失和疼痛干扰有显著关系。2组和3组在大多数测量指标（NRS、所有WPAI评分、promisi - pi、GAD-7和PHQ-4）上没有显著差异，尽管MIDAS评分存在差异(中位数[四分位数间距（IQR）]；38[20-58]对55 [30-90]，p < 0.001)。病人在组1显著降低大富翁(中值(差),16 (7-30),p < 0.001), WPAI - %总活动障碍(意思是(SD):组1[30.9(26.8)]与组2 (39.2 (24.5),p = 0.017),与集团3 [45.9 (24.1),p < 0.001),与集团4 [55.3 (23.0),p < 0.001),和PROMIS-PI-T分数(组1[60.3(7.3)]与组2 (62.6 (6.4),p = 0.008),与集团3 [64.6 (5.6),p < 0.001),与集团4 [66.8 (5.9),p < 0.001])相比,所有其他组织。第4组患者的MIDAS（中位（IQR））显著高于对照组：组4[90(52 - 138)]与组1 (16 (7-30),p < 0.001),与组2 (38 (20-58),p < 0.001),与集团3 [55 (30 - 90),p < 0.001), WPAI - %的现象(集团4[50.4(24.4)]与第1组[28.8 (24.9),p < 0.001),与组2 (34.9 (22.3),p < 0.001),与集团3 (40.9 (22.3),p = 0.048), WPAI——%总生产能力下降(集团4[55.9(26.1)]与第1组[32.1 (37.6),p < 0.001),与组2 (38.3 (24.0),p < 0.001),与集团3 (44.6 (24.4),p = 0.019)),WPAI-%总活动障碍评分(4组[55.3(23.0)]比1组[30.9 (26.8),p < 0.001]， 2组[39.2 （24.5),p < 0.001]， 3组[45.9 (24.1),p = 0.025]）与其他各组比较。结论：我们的数据表明，使用15头痛日/月阈值来区分发作性和慢性偏头痛并不能反映疾病负担，也不能反映患者的治疗需求。这些结果对未来改进偏头痛的分类具有重要意义。
Objective To evaluate whether the 15-day threshold of headache days per month adequately reflects substantial differences in disability across the full spectrum of migraine.Background The monthly frequency of headache days defines migraine subtypes and has crucial implications for epidemiological and clinical research as well as access to care.Methods The patients with migraine (N = 836) who participated in the American Registry for Migraine Research, which is a multicenter, longitudinal patient registry, between February 2016 and March 2020, were divided into four groups based on monthly headache frequency: Group 1 (0-7 headache days/month, n = 286), Group 2 (8-14 headache days/month, n = 180), Group 3 (15-23 headache days/month, n = 153), Group 4 (>= 24 headache days/month, n = 217). Disability (MIDAS), Pain intensity (NRS), Work Productivity and Activity Impairment (WPAI), Pain Interference (PROMIS-PI), Patient Health Questionnaire-4 (PHQ-4), and General Anxiety Disorder-7 (GAD-7) scores were compared.Results Mean (standard deviation [SD]) age was 46 (13) years (87.9% [735/836] female). The proportion of patients in each group was as follows: Group 1 (34.2% [286/836]), Group 2 (21.5% [180/836]), Group 3 (18.3% [153/836]), and Group 4 (26.0% [217/836]). There were significant relationships with increasing disability, lost productive time, and pain interference in higher headache frequency categories. There were no significant differences between Group 2 and Group 3 for most measures (NRS, all WPAI scores, PROMIS-PI, GAD-7, and PHQ-4), although MIDAS scores differed (median [interquartile range (IQR)]; 38 [20-58] vs. 55 [30-90], p < 0.001). Patients in Group 1 had significantly lower MIDAS (median [IQR];16 [7-30], p < 0.001), WPAI-% total active impairment (mean (SD): Group 1 [30.9 (26.8)] vs. Group 2 [39.2 (24.5), p = 0.017], vs. Group 3 [45.9 (24.1), p < 0.001], vs. Group 4 [55.3 (23.0), p < 0.001], and PROMIS-PI-T score (Group 1 [60.3 (7.3)] vs. Group 2 [62.6 (6.4), p = 0.008], vs. Group 3 [64.6 (5.6), p < 0.001], vs. Group 4 [66.8 (5.9), p < 0.001]) compared to all other groups. Patients in Group 4 had significantly higher MIDAS (median (IQR): Group 4 [90 (52-138)] vs. Group 1 [16 (7-30), p < 0.001], vs. Group 2 [38 (20-58), p < 0.001], vs. Group 3 [55 (30-90), p < 0.001], WPAI-%Presenteeism (Group 4 [50.4 (24.4)] vs. Group 1 [28.8 (24.9), p < 0.001], vs. Group 2 [34.9 (22.3), p < 0.001], vs. Group 3 [40.9 (22.3), p = 0.048], WPAI-% total work productivity impairment (Group 4 [55.9 (26.1)] vs. Group 1 [32.1 (37.6), p < 0.001], vs. Group 2 [38.3 (24.0), p < 0.001], vs. Group 3 [44.6 (24.4), p = 0.019]), and WPAI-%Total activity impairment (Group 4 [55.3 (23.0)] vs. Group 1 [30.9 (26.8), p < 0.001], vs. Group 2 [39.2 (24.5), p < 0.001], vs. Group 3 [45.9 (24.1), p = 0.025]) scores compared with all other groups.Conclusion Our data suggest that the use of a 15 headache day/month threshold to distinguish episodic and chronic migraine does not capture the burden of illness nor reflect the treatment needs of patients.These results have important implications for future refinements in the classification of migraine.