偏头痛伴发震颤患者的临床特征

Clinical characteristics of patients with migraine accompanied by tremor

目的:偏头痛与震颤有部分基因突变位点相同,临床研究也证实二者具有关联性。本研究探讨偏头痛伴发震颤患者的临床及电生理特征,并分析震颤发生的相关影响因素。方法:回顾性分析2022年6月至2023年10月就诊于齐齐哈尔医学院附属第三医院的217例偏头痛患者的临床资料。采用临床震颤评定量表(Clinical Rating Scale for Tremor,CRST)、数字分级评分法(Numerical Rating Scale,NRS)、广泛性焦虑量表-7(Generalized Anxiety Disorder-7,GAD-7)和患者健康问卷-9(Patient Health Questionnaire-9,PHQ-9)分别对患者的震颤症状、头痛程度、焦虑和抑郁状况进行评估。患者均接受常规头颅MR扫描和肌电图检查。根据肌电图结果将患者分为伴有震颤的偏头痛组和无震颤的偏头痛组。结果:伴有震颤的偏头痛组、无震颤的偏头痛组分别纳入52例(23.96%)、165例(76.04%)患者。与无震颤的偏头痛组相比,伴有震颤的偏头痛组有更长的病程和头痛持续时间,更高的头痛发作频率、NRS评分、GAD-7评分和PHQ-9评分,更少的每周体育锻炼次数,差异均有统计学意义(均P<0.05)。2组患者在是否有先兆头痛和是否伴有脑白质高信号(white matter hyperintensities,WMHs)方面的差异均无统计学意义(均P>0.05)。CRST评估结果显示:在217例偏头痛患者中,有39例(17.97%)伴有震颤。肌电图结果显示:52例伴有震颤的偏头痛患者均存在上肢震颤,其中姿势性震颤的偏头痛患者28例、静止性震颤的偏头痛患者24例。与静止性震颤的偏头痛患者相比,姿势性震颤的偏头痛患者的平均频率、峰值频率和头痛发作频率均较低(均P<0.05)。多元线性回归分析显示,体育锻炼频次、病程、头痛持续时间、头痛发作频率、NRS评分、GAD-7评分和PHQ-9评分是偏头痛患者伴发震颤的危险因素(均P<0.05)。结论:偏头痛患者出现的震颤以上肢姿势性震颤为主。体育锻炼次数少、病程长、头痛持续时间长、头痛发作频繁、头痛严重、焦虑和抑郁是偏头痛患者伴发震颤的危险因素。

Objective:Migraine and tremor share some genetic mutation sites,and clinical studies have also confirmed their correlation.This study aims to explore the clinical and electrophysiological characteristics of migraine patients with concomitant tremor,and to analyze the relevant influential factors of tremor occurrence.Methods:We retrospectively analyzed the clinical data of 217 migraine patients who visited the Third Affiliated Hospital of Qiqihar Medical University from June 2022 to October 2023.The Clinical Rating Scale for Tremor(CRST),Numerical Rating Scale(NRS),Generalized Anxiety Disorder-7(GAD-7),and Patient Health Questionnaire-9(PHQ-9)were respectively used to assess the tremor symptoms,degree of headache,anxiety,and depression of patients.All patients underwent routine head MR scanning and electromyography examination,and were divided into a migraine with tremor group and a migraine without tremor group based on the electromyogram examination.Results:The migraine with tremor group and the migraine without tremor group were included 52 patients(23.96%)and 165 patients(76.04%),respectively.Compared with the migraine without tremor group,the migraine with tremor group had a longer course and duration of headache,higher frequency of headache attacks,higher NRS score,GAD-7 score,and PHQ-9 score,and fewer weekly physical exercises.The differences were statistically significant(all P<0.05).There were no statistically significant differences in the presence or absence of prodromal headache and white matter hyperintensities(WMHs)between the 2 groups(both P>0.05).The evaluation results of the CRST showed that out of 217 migraine patients,39 patients(17.97%)were accompanied by tremors.The electromyographic results showed that all 52 migraine patients with tremors had upper limb tremors,including 28 migraine patients with postural tremors and 24 migraine patients with static tremors.Compared with the migraine patients with static tremors,the migraine patients with postural tremors had lower average frequency,peak frequency,and headache onset frequency(all P<0.05).Multiple linear regression analysis showed that frequency of physical exercise,duration of illness,frequency of headache attacks,NRS score,GAD-7 score,and PHQ-9 score were risk factors for migraine patients with concomitant tremors(all P<0.05).Conclusion:Patients with migraine mainly experience upper limb postural tremors.Reduced physical exercise,long course of disease,long duration of headache,frequent headache attacks,severe headache,anxiety,and depression are risk factors for migraine patients with concomitant tremors.