Zurich Cohort Study of Young Adults

在NIMH，我们继续与Jules Anst教授和Wulf Rossler教授合作，分析这项独特的纵向前瞻性研究，研究对象是一群年轻人，他们从18岁开始接受了25年的跟踪调查。在过去的一年里，我们专注于评估头痛亚型定义的有效性、其纵向稳定性以及与精神障碍共存的模式。这些结果证实了先前的研究，即偏头痛和其他头痛亚型在普通人群中的高患病率和高影响。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实体，病因学研究，特别是基于回顾分类基础上区分有先兆和无先兆的偏头痛终生诊断的治疗和遗传学研究，可能无法捕捉到普通人群中头痛的真实本质。最后，不同治疗、用药、损伤、严重程度和慢性化的头痛亚型的严重程度的梯度表明，不同的头痛亚型可能在谱系上更好地表征，而不是作为不同的临床实体。我们对偏头痛与情绪和焦虑障碍并存的纵向模式的分析表明，偏头痛与社交恐惧症、恐慌症和双相情感障碍特别相关。这些具体的发现证实了美国国家共病调查-复制(NCS-R)的横断面样本的结果。 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，我们的发现证实了先前对人群样本进行的横断面、回顾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损害的巨大影响，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，病因学研究，特别是基于回顾分类基础上区分有先兆和无先兆的终生诊断偏头痛的治疗和遗传学研究，可能无法捕捉到普通人群中头痛的真实本质。随着时间的推移，头痛亚型的表现会有戏剧性的波动，需要终生诊断的研究可能更好地支持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内发生变化的急性发作。最后，关于共病模式的发现对这些疾病背后的生物途径的未来研究具有重要意义。

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.