偏头痛与紧张型头痛前驱症状比较及预测能力

Comparison and predictive ability of premonitory symptoms between migraine and tension-type headache

目的探讨偏头痛和紧张型头痛患者前驱症状出现率差异及其预测头痛发作能力。方法纳入2020-07—2021-07于武汉大学人民医院头痛门诊就诊的偏头痛患者和紧张型头痛患者,对2组间头痛特征、前驱症状及其预测效能进行比较。结果偏头痛和紧张型头痛中前驱症状发生率分别为87.5%和75.0%,2组间差异无统计学意义(P=0.124)。偏头痛与紧张型头痛平均前驱症状数量(7.0 vs 4.3,P=0.004)、预测头痛能力(42.2%vs 15.9%,P=0.006)差异有统计学意义。偏头痛前驱期疲乏(54.7%)、颈强直(45.3%)、头晕(45.3%)、激惹(43.8%)、焦虑(42.2%)、恶心(40.6%)发生率较高,紧张型头痛中焦虑(47.7%)和疲乏(43.2%)发生率较高。2组发生率差异有统计学意义的前驱症状分别为畏光(P=0.004)、畏声(P=0.004)、颈强直(P=0.043)、恶心(P=0.010)、头晕(P=0.043)、激惹(P=0.040)。具有预测性的偏头痛前驱症状异质性较强,其中预测率较高的症状为打呵欠(22.2%)、疲乏(22.2%)、焦虑(25.9%)、头晕(22.2%)、视力模糊(22.2%)。在偏头痛和紧张型头痛中,前驱症状数量均与偏头痛失能程度评估问卷分值、头痛影响测试问卷分值、医院焦虑抑郁量表分值相关。结论偏头痛与紧张型头痛前驱症状发生率均较高,但其症状学表型存在差异,且偏头痛患者通过前驱症状预测头痛发作能力显著强于紧张型头痛。

Objective graine and tension-type headache patients and their ability to predict headache attacks.MethodsMigraine patients and tension-type headache patients in the headache clinic of Renmin Hospital of Wuhan University from July 2020 to July 2021 were enrolled for analysis,and the headache characteristics,premonitory symptoms and prediction efficiency between the two groups were compared.ResultsThe incidences of premonitory symptoms in migraine and tension-type headache were 87.5%and 75.0%,with no significant difference(P=0.124).There were significant differences between migraine and tension-type headache in the average number of premonitory symptoms(7.0 vs 4.3,P=0.004)and the ability to predict headache attacks(42.2%vs 15.9%,P=0.006).Fatigue(54.7%),neck stiffness(45.3%),dizziness(45.3%),irritability(43.8%),anxiety(42.2%)and nausea(40.6%)are common premonitory symptoms in migraine,while anxiety(47.7%)and fatigue(43.2%)are in high prevalence in premonitory tension-type headache.Photophobia(P=0.004),phonophobia(P=0.004),neck stiffness(P=0.043),nausea(P=0.010),dizziness(P=0.043),irritability(P=0.040)are premonitory symptoms with significant differences between the two groups.Predictive premonitory symptoms in migraine are yawning(22.2%),fatigue(22.2%),anxiety(25.9%),dizziness(22.2%)and blurred vision(22.2%),although there is strong heterogeneity between different patients.In both two groups,the number of premonitory symptoms is related to migraine disability assessment score,hospital anxiety and depression scale score and hospital anxiety and depression scale score.Conclusion symptomatic phenotypes are in variance.Migraine patients have a significantly stronger ability to predict headache attacks through premonitory symptoms than tension-type headache patients.