Zurich Cohort Study of Young Adults

在NIMH，我们继续与Jules Angst教授和Wulf Rossler教授合作，分析这项独特的纵向前瞻性研究，该研究对一群从18岁起被跟踪了25年的年轻人进行了研究。在过去的一年中，我们重点评估了头痛亚型定义的有效性，它们的纵向稳定性以及与精神障碍共现的模式。结果证实了先前的研究，即偏头痛和其他头痛亚型在一般人群中的高患病率和影响。头痛亚型之间的大量纵向重叠表明，偏头痛可能不是一个同质的实体，并且病因学研究，特别是基于回顾性分类的有先兆和无先兆的偏头痛终身诊断之间的区别的治疗和遗传学研究可能无法捕获一般人群中头痛的真实性质。最后，治疗、药物使用、损伤、严重程度和慢性程度的头痛亚型之间的严重程度梯度表明，不同的头痛亚型可能更好地表征在一个谱上，而不是作为不同的临床实体。我们对偏头痛与心境障碍和焦虑障碍共病的纵向模式的分析表明，偏头痛与社交恐惧症、惊恐障碍和双相情感障碍特别相关。这些具体的调查结果证实了美国全国科摩罗重复调查（NCS-R）的横截面样本的结果。 这些发现对偏头痛和其他头痛的卫生政策、分类和病因学研究具有重要意义。首先，我们的研究结果证实了先前对基于人群的样本进行的横断面、回顾性和短期前瞻性研究的大量证据，这些研究涉及偏头痛的高患病率和对主观痛苦和工作障碍的巨大影响，以及与医疗保健系统的高频率接触。其次，头痛亚型之间的大量纵向重叠也表明，偏头痛可能不是一个同质的实体，并且病因学研究，特别是基于回顾性分类的有先兆和无先兆偏头痛的终身诊断之间的区别的治疗和遗传研究可能无法捕获一般人群中头痛的真实性质。随着时间的推移，头痛亚型的表达会发生剧烈波动，需要终身诊断的研究可能会更好地通过对患者进行跨时间的分类，而不是通过可能在整个生命周期中发生变化的急性发作来进行。最后，关于合并症模式的研究结果对未来研究这些疾病的生物学途径具有重要意义。

At the NIMH, we have continued to collaborate with Professors Jules Angst and Wulf Rossler to analyze this unique longitudinal prospective study of a cohort of young adults who have been followed for 25 years since the age of 18. During the past year we focused on assessing the validity of the definitions of headache subtypes, their longitudinal stability, and patterns of co-occurrence with mental disorders. The results confirm those of prior studies that document the high prevalence and impact of migraine and other headache subtypes in the general population. The substantial longitudinal overlap across headache subtypes suggests that migraine may not be a homogenous entity and that etiologic studies, particularly treatment and genetic studies that are based on the distinction between life time diagnoses of migraine with and without aura based on retrospective classification may not capture the true nature of headache in the general population. Finally, the gradient of severity across headache subtypes for treatment, medication use, impairment, severity and chronicity suggest that the various headache subtypes may be better characterized on a spectrum rather than as distinct clinical entities. Our analyses of the longitudinal patterns of co-occurrence of migraine with mood and anxiety disorders reveals that migraine is specifically associated with social phobia, panic disorder and bipolar disorder. These specific findings confirm the results in a cross-sectional sample of the U.S. National Comorbidity Survey-Replication(NCS-R). These findings have important implications for the health policy, classification and etiologic studies of migraine and other headaches. First, our findings confirm the abundant evidence from prior cross sectional and retrospective and short-term prospective studies of population-based samples regarding the high prevalence rates and dramatic impact of migraine on subjective distress and work impairment, as well as the high frequency of contact with the health care system. Second, the substantial longitudinal overlap across headache subtypes also suggests that migraine may not be a homogenous entity and that etiologic studies, particularly treatment and genetic studies that are based on the distinction between life time diagnoses migraine with and without aura based on retrospective classification may not capture the true nature of headache in the general population. With the dramatic fluctuations in expression across headache subtypes over time, research requiring a lifetime diagnosis might be better served by classification of the person across time rather than by acute episodes that may change across the life span. Finally, the findings regarding patterns of comorbidity have important implications for future studies of the biologic pathways underlying these conditions.