美国约翰霍普金斯大学医学院研究人员发现，肥胖个体发作性 偏头痛 （ EM ）发生风险较高。论文 2013 年 9 月 11 日在线发表于《神经病学》（ Neurology ）。 研究人员以 3862 名黑人和白人成年受试者为研究对象，调查 EM 与肥胖的关系，以及年龄、种族和性别的影响。研究结果表明，与正常体重个体相比，肥胖个体发生 EM 的风险增加 81% ；随着肥胖的加重，发生 EM 的几率有显著增加趋势；此外，与正常体重受试者相比，年龄小于 50 岁、白人和女性肥胖受试者 EM 的发生风险增加。该结果表明，肥胖个体 EM 发生风险增加，并在年龄小于 50 岁、白种人和女性中有最强的关系。 （来源： Neurology ， http:// www.ncbi.nlm.nih.gov/pubmed/24027060 ） Neurology. 2013 Sep 11. Episodic migraine and obesity and the influence of age, race, and sex. Peterlin BL , Rosso AL , Williams MA , Rosenberg JR , Haythornthwaite JA , Merikangas KR , Gottesman RF , Bond DS , He JP , Zonderman AB . Source From the Departments of Neurology (B.L.P., J.R.R., R.F.G.) and Psychiatry Behavioral Sciences (J.A.H.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology (A.L.R.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (M.A.W.), Harvard School of Public Health, Boston, MA; Genetic Epidemiology Research Branch (K.R.M., J.-P.H.), Intramural Research Program, National Institute of Mental Health, NIH, Department of Health and Human Services, Bethesda, MD; Brown Alpert Medical School (D.S.B.), Department of Psychiatry and Human Behavior/The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI; and Intramural Research Program (A.B.Z.), National Institute on Aging, Biomedical Research Center, NIH, Baltimore, MD. Abstract OBJECTIVE: To evaluate the episodic migraine (EM)-obesity association and the influence of age, race, and sex on this relationship. METHODS: We examined the EM-obesity association and the influence of age, race, and sex in 3,862 adult participants of both black and white race interviewed in the National Comorbidity Survey Replication. EM diagnostic criteria were based on the International Classification of Headache Disorders. Body mass index was classified as underweight (18.5 kg/m 2 ), normal (18.5-24.9 kg/m 2 ), overweight (25-29.9 kg/m 2 ), or obese (≥30 kg/m 2 ). Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for EM were estimated using logistic regression. Models were stratified by age (50/≥50 years), race (white/black), and sex (male/female). RESULTS: A total of 188 participants fulfilled criteria for EM. In all participants, the adjusted odds of EM were 81% greater in individuals who were obese compared with those of normal weight (OR 1.81; 95% CI: 1.27-2.57; p = 0.001), with a significant trend of increasing odds of EM with increasing obesity status from normal weight to overweight to obese (p = 0.001). In addition, stratified analyses demonstrated that the odds of EM were greater in obese as compared with normal-weight individuals who were 1) younger than 50 years of age (OR 1.86; 95% CI: 1.20-2.89; p for trend = 0.008), 2) white (OR 2.06; 95% CI: 1.41-3.01; p for trend ≤0.001), or 3) female (OR 1.95; 95% CI: 1.38-2.76; p for trend ≤0.001). CONCLUSION: The odds of EM are increased in those with obesity, with the strongest relationships among those younger than 50 years, white individuals, and women. PMID:24027060 LinkOut - more resources Full Text Sources HighWire 01. headache disorders 31 篇 96.875% 02. migraine disorders 29 篇 90.625% 03. body weight 16 篇 50.000% 04. chronic disease 15 篇 46.875% 05. obesity 15 篇 46.875% 06. risk factors 13 篇 40.625% 07. comorbidity 10 篇 31.250% 08. disease progression 9 篇 28.125% 09. analgesics 7 篇 21.875% 10. cardiovascular diseases 6 篇 18.750% 11. prevalence 5 篇 15.625% 12. questionnaires 5 篇 15.625% 13. mental disorders 5 篇 15.625% 14. health surveys 5 篇 15.625% 15. quality of life 4 篇 12.500% 16. adipokines 4 篇 12.500% 17. adipose tissue 4 篇 12.500% 18. body mass index 3 篇 9.375% 19. life style 3 篇 9.375% 20. treatment outcome 3 篇 9.375% 01. migraine 32 篇 100.000% 02. obesity 30 篇 93.750% 03. depression 11 篇 34.375% 04. chronic daily headache 9 篇 28.125% 05. obese 7 篇 21.875% 06. tension type headache 5 篇 15.625% 07. diabetes 4 篇 12.500% 08. hypertension 4 篇 12.500% 09. asthma 3 篇 9.375% 10. bronchitis 2 篇 6.250% 数据分析来源 http://www.pubmedplus.cn/
头痛（图1），这是一个有难度的话题，博大精深；也是一个让人头痛的症状，看似简单，背后的机制却十分复杂。没办法，因为它太常见了，几乎每天在急诊都会遇到。不了解的情况下，有时本来没什么事的头痛，患者和家属却十分紧张，十万火急的打120送到急诊，担惊受怕；或有时本来是有生命威胁的疾病，患者和家属却认为这是常见症状，没什么大不了，错过了最佳的就诊时机，造成不可挽回的后果。因此，在这里介绍下头痛，至少让大家了解哪些需要紧急处理，立即送到医院，哪些可以从容些，并且了解一点预防与治疗的知识，更好的选择治疗和预防方案，也就达到目的了。 先明确下定义，这里的头痛指的是头颅上半部（眉弓、耳廓上部和枕外隆突连线以上）的头痛。头痛的机制是头部的痛觉敏感结构受到刺激引起的。有趣的是，绝大部分脑组织本身并无痛觉感受器。引起头痛的结构非常多，颅外有皮肤、皮下组织、头皮下的肌肉、颅外的动脉、颅内的骨膜；眼、耳、鼻、鼻窦等结构。颅内有静脉窦及附近其大分支，脑底部的硬脑膜、大动脉，脑膜中动脉、颞浅动脉、三叉神经等脑神经等。 头痛是超级常见的症状，一年中，约90%的人会出现至少1次头痛症状。3%的急诊患者主诉症状为头痛。 从病因的角度分类，可分为原发性头痛和继发性头痛，前者是指不伴其他疾病的头痛，后者常有明确的病因导致头痛如蛛网膜下腔出血、脑膜炎、颞动脉炎等。 总体上讲，头痛分为两种，安全的头痛和危险的头痛。当然，前者是主要的，90%以上都是相对安全的头痛，至少不会造成生命危险，顶多就是带来暂时的不适，影响工作与生活。后者虽然少见，但脑子里应该有这样的警惕，有的时候，错过一天，会错过力挽狂澜的宝贵机会，造成患者永久的严重功能障碍甚至死亡。 最常见的原发性头痛为偏头痛和紧张性头痛，这两种都为反复发作，但仅仅造成暂时性不适，一般不会有什么严重后果。什么样的头痛会有严重后果呢？往往为继发性头痛中的一些类型：主要为蛛网膜下腔出血，急性脑膜炎、急性脑炎、其他的颅内出血如脑出血、硬膜下血肿，硬膜外血肿，脑静脉窦血栓形成，脑动脉夹层，颞动脉炎等，这些是需要迅速行包括头CT等影像学检查在内的一系列评估，确定头痛原因，选择合适的治疗的。如何及时识别这些有潜在风险的头痛患者呢？表1有助鉴别，出现下列征象应及时到医院就诊，完善相关检查。我曾经遇到一名患者，以发热伴严重头痛为主要症状，自以为感冒，口服抗生素3天后症状有所减轻，以为没事了，停服抗生素，没想到发热和头痛症状明显加重，来急诊一做腰穿，典型的细菌性脑膜炎，幸亏及时给予针对性的抗生素，很快的治愈。细菌性脑膜炎，如果不及时处理的话，有可能遗留肢体瘫痪、智力减低、癫痫、脑积水等后遗症，甚至有死亡风险。还是很可怕的。可见，有些头痛大意不得。 由于紧张性头痛和偏头痛为最常见的两大类原发性头痛，下面对这两种疾病做一简单介绍。 紧张性头痛为患病率最高的头痛，全球患病率为38%，占头痛患者的70-80%。发病机制目前尚不清楚。疼痛部位通常为双侧性，枕项部、颞部或额部多见，也常为整个头部。多为轻至中度头痛，多不影响日常活动。疼痛感觉多为压迫感、紧束感、胀痛、钝痛，也可以为酸痛，甚至可表现为要爆炸的感觉。【无持续性搏动感，一般不伴恶心、呕吐，不会同时伴畏光和畏声，日常体力活动不导致疼痛加重，应激和精神紧张常加重病情。】（中括号内的部分强调的是与偏头痛不同的地方）有的患者描述似乎有带子紧紧勒在头上（图2），还有的患者会有带紧箍咒的感觉。治疗方法主要为非药物治疗、急性发作时的药物治疗和预防性用药。非药物治疗包括松弛训练、认知行为治疗、针灸等。急性发作常用一些非处方的止痛药物如芬必得、散利痛、阿司匹林、泰诺林等。预防治疗最常用的药物为阿米替林 ，如果服阿米替林有明显副作用的话可以服用米氮平或文拉法辛 。 偏头痛患病率仅次于紧张性头痛，但常为中至重度头痛，较紧张性头痛程度重，所以为门诊、急诊最常遇到的头痛。常反复发作，多为搏动性，与脉搏搏动频率一致，常单侧分布，多伴恶心、呕吐，畏光和畏声，体力活动加重头痛。少数患者头痛发作前有视觉、感觉和运动等先兆，以视觉先兆最为常见，可为暗点、闪光和黑矇（图3）。症状多持续4-72小时，女性可与月经周期有关。85%的患者诉及诱因，常见的诱因包括：天气变化、压力、抑郁、焦虑、睡眠障碍、过劳、光刺激、噪音、饮酒、巧克力奶酪、咖啡、茶等。因此，注意回避诱因可减少头痛发作。治疗分为发作期的治疗和预防性用药两个方面，发作期可应用一些止痛药物如泰诺林、散利痛、芬必得等，严重头痛可使用曲普坦类药物。如果患者头痛频繁发作，症状较重，严重干扰工作、生活，可予以预防用药，减少发作频率和减轻发作时的症状。常用预防用药为β受体阻滞剂（如美托洛尔、普奈洛尔），钙通道拮抗剂（氟桂利嗪）、抗癫痫药（丙戊酸钠和托吡酯）和抗抑郁药（阿米替林和文拉法辛）。 主要参考文献： 1.http://en.wikipedia.org/wiki/Headache 2.吴江.神经病学. 第2版. 北京: 人民卫生出版社. 2010 3.William Young MD , Stephen Silberstein MD, Stephanie Nahas MD, Michael Marmura MD. Jefferson Headache Manual.Demos Medical Publishing.2010 4.ICSI Health care guideline: diagnosis and treatment of Headache. http://www.icsi.org/headache/headache__diagnosis_and_treatment_of_2609.html 5. Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, Sándor PS; European Federation of Neurological Societies.EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force.Eur J Neurol. 2009 Sep;16(9):968-81. 图1 表1 图2 紧张性头痛 图3 视觉先兆
http://www.gopubmed.org/web/gopubmed/2?WEB0iyduvle1bej0I2cI1I00f01000j10040001rl child AND migraine AND Abuse 43 documents semantically analyzed top author statistics 1 2 Top Years Publications 2004 5 2007 4 1995 4 2009 3 1987 3 2003 2 1999 2 1996 2 1981 2 1979 2 2008 1 2005 1 2002 1 2001 1 1998 1 1997 1 1994 1 1993 1 1991 1 1985 1 1 2 Top Countries Publications USA 6 United Kingdom 3 France 2 Canada 2 Spain 2 Netherlands 2 Italy 2 Israel 2 Turkey 1 Norway 1 New Zealand 1 Oman 1 Belgium 1 Saudi Arabia 1 Germany 1 1 2 Top Cities Publications Indianapolis 2 Lille 2 London 2 Camden 1 Columbus 1 Saskatoon 1 Toledo 1 Montreal 1 Oslo 1 Alicante 1 Utrecht 1 Milan 1 New York 1 Dunedin 1 Muscat 1 Tienen 1 Hartlepool 1 Jeddah 1 Leiden 1 Pavia 1 1 2 1 2 Top Journals Publications Headache 7 Cephalalgia 4 J Child Neurol 3 Pediatr Neurol 2 Pediatr Emerg Care 1 Agri 1 Can J Neurol Sci 1 Neurology 1 Int J Clin Pract 1 Med Hypotheses 1 Rev Neurologia 1 J Affect Disorders 1 Am J Public Health 1 Psychother Psychosom 1 Acta Clin Belg 1 Arch Dis Child 1 Emerg Med Clin N Am 1 Curr Opin Neurol 1 Med Clin-barcelona 1 Postgrad Med J 1 1 2 1 2 3 ... 21 Top Terms Publications Migraine Disorders 43 Humans 43 Child 38 Adolescent 29 Adult 27 Headache 26 Patients 24 Middle Aged 17 Pharmaceutical Preparations 15 Diagnosis 13 Substance-Related Disorders 13 Headache Disorders 12 Analgesics 12 Aged 12 Syndrome 10 Child, Preschool 9 Evaluation Studies as Topic 9 Physics 8 Depression 8 Retrospective Studies 7 1 2 3 ... 21 1 2 3 ... 7 Top Authors Publications Cuvellier J 2 Bussone G 2 Gadoth N 2 Hering-Hanit R 2 Markey C 1 Marmorstein N 1 Iacono W 1 Valle L 1 Couttenier F 1 Joriot-Chekaf S 1 Fong J 1 Pakalnis A 1 Butz C 1 Splaingard D 1 Kring D 1 Lowry N 1 Fitzpatrick W 1 Valle L 1 Fily A 1 Joriot S 1 1 2 3 ... 7 http://news.sciencenet.cn//htmlnews/2010/1/227012.shtm 儿时受过虐待的偏头痛患者易发生其他疼痛 美国头痛学会日前公布的一项最新研究成果显示，童年遭受过身体或精神虐待的偏头痛患者发生其他疼痛共病的风险要明显高于一般患者。此前已有研究表明，在偏头痛患者中，儿童时期受过虐待，尤其是精神虐待或者其家长疏于照顾的现象比较普遍。 这项新的研究由美国托莱多大学医学中心完成。该中心研究人员以来自11家医院头疼门诊的确诊偏头痛患者为调查对象，通过儿童期创伤问卷判断他们是否曾遭受过虐待，包括身体虐待、性虐待、精神虐待以及家长疏于照顾等。调查内容还包括调查对象是否确诊出现过肠易激综合征、周期性疲劳综合征、纤维肌痛、间质性膀胱炎及关节炎等疼痛共病。 共有1348名偏头痛患者完成了整个调查，其中61%的受访患者至少有一种疼痛共病，这些人中，又有58%的受访患者表示在儿童时期曾遭受过虐待。调查发现，儿童时期遭受过精神或身体虐待的偏头痛患者发生其他疼痛共病的风险要明显高于那些儿时没有受过虐待的患者。 具体来说，儿童时期遭受过身体虐待的偏头痛患者长大后出现关节炎的风险升高；遭受过精神虐待的患者长大后出现肠易激综合征、周期性疲劳综合征、纤维肌痛和关节炎的风险都明显升高。 这一研究成果发表在最新一期的美国《头痛》（ Headache ）杂志上。研究人员表示，为防止儿时受过虐待的偏头痛患者出现其他的疼痛共病，可以对他们实施认知行为疗法。 更多阅读 EurekAlert!相关报道（英文） http://www.eurekalert.org/pub_releases/2010-01/w-aic010410.php Public release date: 6-Jan-2010 ', ' ')" onmouseout="addthis_close()" onclick="return addthis_sendto()" href="http://www.addthis.com/bookmark.php?v=20"> Share ] Contact: Dawn Peters medicalnews@wiley.com 781-388-8408 Wiley-Blackwell Abuse in childhood linked to migraine and other pain disorders Findings suggest abuse is a risk factor for chronic headache Researchers from the American Headache Society's Women's Issues Section Research Consortium found that incidence of childhood maltreatment, especially emotional abuse and neglect, are prevalent in migraine patients. The study also found that migraineurs reporting childhood emotional or physical abuse and/or neglect had a significantly higher number of comorbid pain conditions compared with those without a history of maltreatment. Full findings of the study appear in the January issue of Headache: The Journal of Head and Face Pain, published on behalf of the American Headache Society by Wiley-Blackwell. According to a report by the U.S. Department of Health and Human Services, state and local child protective services (CPS) investigated 3.2 million reports of child abuse or neglect in 2007. CPS classified 794,000 of these children as victims with 59% classified as child neglect; 4% were emotional abuse; 8% as sexual abuse; and 11% were physical abuse cases. Both population- and clinic-based studies, including the current study, have demonstrated an association between childhood maltreatment and an increased risk of migraine chronification years later. To conduct this study, Gretchen E. Tietjen, M.D, from the University of Toledo Medical Center, and colleagues, recruited a cross-sectional survey of headache clinic patients with physician-diagnosed migraine at 11 outpatient headache centers. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ), a 28-item self-reported quantitative measure of childhood abuse (physical, sexual, and emotional) and neglect (physical and emotional). Self-reported physician-diagnosed history of comorbid pain conditions such as irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS), fibromyalgia (FM), interstitial cystitis (IC), and arthritis was recorded on the survey. A total of 1348 patients diagnosed with migraine completed the surveys. Researchers found migraineurs who reported childhood emotional abuse or physical neglect had a significantly higher incidence of comorbid pain conditions compared with those without a history of maltreatment. In the study population, 61% had at least 1 comorbid pain condition and 58% reported experiencing childhood trauma either by abuse or neglect. The number of different maltreatment types suffered in childhood correlated with the number of comorbid pain in adulthood. Specifically, physical abuse was associated with a higher incidence of arthritis; emotional abuse was linked to a greater occurrence of IBS, CFS, FM, and arthritis; and physical neglect connected with more reports of IBS, CFS, IC, and arthritis. In women, physical abuse and physical neglect was associated with endometriosis (EM) and uterine fibroids, emotional abuse with EM, and emotional neglect with uterine fibroids. Our study found that while childhood maltreatment is associated with depression, the child abuse-adult pain relationship is not fully mediated by depression, explained Dr. Tietjen. Results from this study, as well as three recent population-based studies, indicate that associations of maltreatment and pain were independent of depression and anxiety, both of which are highly prevalent in this population. Researchers suggest that for persons presenting for migraine treatment, childhood maltreatment may be an important risk factor for development of comorbid pain disorders. Since migraine onset preceded onset of the comorbid pain conditions in our population, treatment strategies such as cognitive behavioral therapy may be particularly well suited in these cases, concluded Dr. Tietjen. ### This study is published in Headache: The Journal of Head and Face Pain . Media wishing to receive a PDF of this article may contact medicalnews@wiley.com Article: Childhood Maltreatment and Migraine (Part III). Association With Comorbid Pain Conditions. Gretchen E. Tietjen, Jan L. Brandes, B. Lee Peterlin, Arnolda Eloff, Rima M. Dafer, Michael R. Stein, Ellen Drexler, Vincent T. Martin, Susan Hutchinson, Sheena K. Aurora, Ana Recober, Nabeel A. Herial, Christine Utley, Leah White, Sadik A. Khuder. Headache; Published Online: January 6, 2009 (DOI: 10.1111/j.1526-4610.2009.01558.x); Print Issue Date: January 2010. Article: Childhood Maltreatment and Migraine (Part I). Prevalence and Adult Revictimization: A Multicenter Headache Clinic Survey. Gretchen E. Tietjen, Jan L. Brandes, B. Lee Peterlin, Arnolda Eloff, Rima M. Dafer, Michael R. Stein, Ellen Drexler, Vincent T. Martin, Susan Hutchinson, Sheena K. Aurora, Ana Recober, Nabeel A. Herial, Christine Utley, Leah White, Sadik A. Khuder. Headache; Published Online: January 6, 2009 (DOI: 10.1111/j.1526-4610.2009.01556.x); Print Issue Date: January 2010. Article: Childhood Maltreatment and Migraine (Part II). Emotional Abuse as a Risk Factor for Headache Chronification. Gretchen E. Tietjen, Jan L. Brandes, B. Lee Peterlin, Arnolda Eloff, Rima M. Dafer, Michael R. Stein, Ellen Drexler, Vincent T. Martin, Susan Hutchinson, Sheena K. Aurora, Ana Recober, Nabeel A. Herial, Christine Utley, Leah White, Sadik A. Khuder. Headache; Published Online: January 6, 2009 (DOI: 10.1111/j.1526-4610.2009.01557.x); Print Issue Date: January 2010. The American Headache Society, founded in 1959, is the nation's professional organization for those interested in the study and management of headache and face pain. The Society's objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders. Educating physicians, health professionals and the public and encouraging scientific research are the primary functions of the Society. AHS activities include an annual scientific meeting, two comprehensive headache symposia, publication of the journal Headache and sponsorship of the American Council for Headache Education (ACHE). For more information, please visit www.AmericanHeadacheSociety.org . Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit www.wileyblackwell.com or www.interscience.wiley.com .
标签: 偏头痛
