Headache, depression and anxiety: associations in the Eurolight project.
Headache, depression and anxiety: associations in the Eurolight project.
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DOI：
10.1186/s10194-016-0649-2
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Steiner TJ
中科院分区：
文献类型：
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作者：
Lampl C;Thomas H;Tassorelli C;Katsarava Z;Laínez JM;Lantéri-Minet M;Rastenyte D;Ruiz de la Torre E;Stovner LJ;Andrée C;Steiner TJ
头痛障碍和精神障碍都是常见的，而大多数与偏头痛有关的证据表明，它们的共病率比偶然预期的要高。有很好的理由来确定它们是否是：共病的症状可能是协同的;共病阻碍了管理，对结果产生负面影响;高水平的共病表明，当一种疾病发生时，应该寻找另一种疾病。Eurolight项目从6624名参与者中收集了有关这些疾病的基于人群的数据。Eurolight是一项从10个欧盟国家的成年人口（18-65岁）中抽样的横断面调查。我们使用了6个数据。问卷包括基于ICHD-II的头痛诊断问题、头痛归因损失时间（HALT）问卷以及抑郁和焦虑的HADS。我们估计了优势比（OR），以显示偏头痛、紧张型头痛（TTH）或可能的药物过度使用头痛（pMOH）与抑郁或焦虑之间的相关性。pMOH与这两种精神疾病的相关性最强：对于抑郁症，（与无头痛相比）为5.5 [2.2-13.5]男性为5.5 [2.9-10.5]（p <0.0001），女性为5.5 [2.9-10.5]（p < 0.0001）;对于焦虑，OR分别为10.4 [4.9-21.8]（p < 0.0001）和7.1 [4.5-11.2]（p < 0.0001）。偏头痛也与两者相关：抑郁症的OR值分别为2.1 [1.3-3.4]（p = 0.002）和1.8 [1.1-3.1]（p = 0.030）;焦虑症的OR值分别为4.2 [2.8-6.3]（p < 0.0001）和2.4 [1.7-3.4]（p < 0.0001）。TTH仅与焦虑相关：男性OR为2.5 [1.7-3.7]（p < 0.0001），女性为1.5 [1.1-2.1]（p = 0.021）。偏头痛患者共患焦虑的概率为19.1%，抑郁的概率为6.9%，两者均为5.1%，高于代表性的一般人群样本（14.3%，5.6%和3.8%）。MOH组的概率分别为38.8%、16.9%和14.4%，TTH组的概率均未超过整个样本的概率。共病的精神障碍并没有增加头痛归因的生产时间损失，但弱协会存在（R2 = 0.020-0.082）之间的生产时间损失和抑郁症的概率，焦虑的所有头痛类型。在这项大型研究中，我们证实了抑郁症，尤其是焦虑症与偏头痛的共病率高于偶然性，并表明MOH也是如此，但更强烈。可以说，偏头痛患者，更肯定的是，MOH患者应该用HADS进行筛查，以追求最佳结果。
Headache disorders and psychiatric disorders are both common, while evidence, mostly pertaining to migraine, suggests they are comorbid more often than might be expected by chance. There are good reasons for establishing whether they are: symptoms of comorbid illnesses may summate synergistically; comorbidities hinder management, negatively influencing outcomes; high-level comorbidity indicates that, where one disease occurs, the other should be looked for. The Eurolight project gathered population-based data on these disorders from 6624 participants. Eurolight was a cross-sectional survey sampling from the adult populations (18–65 years) of 10 EU countries. We used data from six. The questionnaire included headache-diagnostic questions based on ICHD-II, the Headache-Attributed Lost Time (HALT) questionnaire, and HADS for depression and anxiety. We estimated odds ratios (ORs) to show associations between migraine, tension-type headache (TTH) or probable medication-overuse headache (pMOH) and depression or anxiety. pMOH was most strongly associated with both psychiatric disorders: for depression, ORs (vs no headache) were 5.5 [2.2–13.5] (p < 0.0001) in males, 5.5 [2.9–10.5] (p < 0.0001) in females; for anxiety, ORs were 10.4 [4.9–21.8] (p < 0.0001) and 7.1 [4.5–11.2] (p < 0.0001). Migraine was also associated with both: for depression, ORs were 2.1 [1.3–3.4] (p = 0.002) and 1.8 [1.1–3.1] (p = 0.030); for anxiety 4.2 [2.8–6.3] (p < 0.0001) and 2.4 [1.7–3.4] (p < 0.0001). TTH showed associations only with anxiety: ORs 2.5 [1.7–3.7] (p < 0.0001) for males, 1.5 [1.1–2.1] (p = 0.021) for females. Participants with migraine carried 19.1 % probability of comorbid anxiety, 6.9 % of depression and 5.1 % of both, higher than the representative general-population sample (14.3, 5.6 and 3.8 %). Probabilities in those with MOH were 38.8, 16.9 and 14.4 %; in TTH, they did not exceed those of the whole sample. Comorbid psychiatric disorder did not add to headache-attributed productive time losses, but weak associations existed (R2 = 0.020–0.082) for all headache types between lost productive time and probabilities of depression and, less so, anxiety. In this large study we confirmed that depression and especially anxiety are comorbid more than by chance with migraine, and showed the same is true, but more strongly, with MOH. Arguably, migraine patients and, more certainly, MOH patients should be screened with HADS in pursuit of best outcomes.