㈼-1-5

㈼−1- 5

片頭痛の誘発因子としてどんなものがあるか

1) Takeshima T, Ishizaki K, Fukuhara Y et al. Population-based door-to- 　 door survey of migraine in Japan : the Daisen study. Headache. 2004; 　 44:8-19
論文抄録	OBJECTIVES: To determine prevalence and characteristics of migraine in Japan , and to investigate use of medical care and whether food preference is associated with risk of migraine. METHODS: Structured questionnaires were given to all adult residents (N = 5758; 2681 men and 3077 women) in Daisen, a rural community in western Japan . Second questionnaires, specific to headache, were given to 1628 residents with headache. A telephone survey was also carried out. Statistical Packages for the Social Sciences analyzed the data. RESULTS: The 1-year prevalence of migraine was 2.3% (migraine with aura, 0.4% and without aura, 1.9%) in men and 9.1% (migraine with aura, 1.0% and migraine without aura, 8.1%) in women. Overall prevalence of migraine in Daisen was 6.0% (95% confidence interval [CI], 5.4% to 6.6%). Women observed a 5.9-fold higher risk of migraine than men (odds ratio, 5.9; 95% CI, 4.5 to 8.0; P <.0001, after age adjustment, by logistic analysis). Fatigue and loss of vigor were predominant premonitory symptoms of migraine. Fatigue, mental stress, and lack of sleep were the main headache triggers. Over a 3-month period, 20.3% of migraineurs experienced time or days off work due to headache. Only 7.3% of those with migraine with aura and 5.3% of those with migraine without aura had consulted a physician, and of those with migraine, 61.0% with aura and 71.8% without aura had never visited a medical doctor for their headache. Consumption of alcohol and cigarette smoking did not influence the risk for migraine or tension-type headache, after age and gender adjustment (logistic analysis). Migraineurs consume significantly more fatty/oily foods, coffee, and tea than nonheadache subjects of the same community. Migraineurs consume significantly fewer fish than nonheadache residents. CONCLUSIONS: Only a few Japanese migraineurs receive benefits of medical services and recent advances of headache medicine. Public education concerning headaches is one of the most urgent issues in Japan .
文献 PubMed−ID	PM:14979878
エビデンスレベル	III
文献タイトル (日本語)	日本における片頭痛の住民全戸調査：大山研究
目的	日本の片頭痛の有病率，臨床的特徴を明らかにし，片頭痛患者の医療サービスの利用状況を調査し，食事の嗜好が片頭痛のリスクになるか検討する．
研究デザイン	住民全戸調査：アンケート +電話調査
研究施設	鳥取大学医学部・脳神経内科
対象患者	大山町民の成人， 5758 名（男性 2681 名，女性 3077 名）
介入	アンケート調査
主要評価項目とそれに用いた統計学的手法	ogistic analysis
結果	年間，片頭痛有病率は男性 2.3 ％（ MA0.4 ％， MO1.9 ％），女性 9.1 ％（ MA1.0 ％， MO8.1 ％）全体の片頭痛粗有病率 6.0 ％（ 95 ％ CI: 5.4%- 6.6% ）過去 3 ヶ月の間に片頭痛患者の 20.3 ％は頭痛のために仕事が出来ない経験をしている． MA の 7.3 ％， MO の 5.3 ％のみが定期的に頭痛のために医師にかかっており， MA の 61 ％， MO の 72 ％は，頭痛のために医療機関を受診したことが一度もない．年齢と性を補正すると，飲酒量，喫煙は片頭痛，緊張型頭痛のリスクにはならなかった (logistic analysis). 片頭痛患者は脂肪の多い食事，コーヒー / 紅茶の摂取量が有意に多く，魚の摂取量が有意に少なかった．
作成者	竹島多賀夫

2) Rasmussen BK. Migraine and tension-type headache in a general 　 population: precipitating factors, female hormones, sleep pattern and 　 relation to lifestyle. Pain. 1993 ;53:65-72.
論文抄録	In a cross-sectional epidemiological study of headache disorders information on precipitating factors, age at onset, influence of menstruation and pregnancy and use of oral contraceptives was collected. The presence of migraine and tension-type headache was ascertained by a clinical interview and examination using the operational diagnostic criteria of the International Headache Society. The prevalence of migraine and tension-type headache was also analysed in relation to variables of lifestyle: physical activity, smoking, consumption of coffee, alcohol intake and sleep pattern. In both migraine and tension-type headache, the most conspicuous precipitating factor was stress and mental tension. Other common precipitants were alcohol, weather changes and menstruation. Disappearance or substantial improvement of the headache during pregnancy was more frequent in migraineurs than in tension-type headache sufferers. The age at onset of both migraine and tension-type headache differs between men and women. Female hormones may be an important factor responsible for the sex difference of headache disorders. The level of physical activity showed no association with migraine, but a significantly higher prevalence of tension-type headache in men with exclusively sedentary activity emerged. Smoking, coffee and alcohol consumption showed no significant associations with the headache disorders. Sleep pattern was significantly associated with migraine and tension-type headache in both univariate and multivariate analyses. In conclusion, migraine and tension-type headache seem to be different with regard to a number of endogenous and exogenous factors.
文献 PubMed−ID	: 8316392
エビデンスレベル	㈽
文献タイトル (日本語)	一般人口における片頭痛と緊張型頭痛：誘発因子，女性ホルモン，睡眠パターン，ライフスタイルとの関係
目的	一般人口を対象として IHS診断基準をもとに診断した片頭痛と緊張型頭痛における誘発因子を検索した．
研究デザイン	無作為抽出した住民に招待状を送り，診察とインタビューを行なった．
研究施設	Department of Internal Medicine C, Glostrup Hospital , University of Copenhagen , Denmark .
研究期間	1989年１月〜７月
対象患者	コペンハーゲン西部に住む無作為に抽出した 975例，25-64歳，
介入	片頭痛を持つものは緊張型頭痛の有無に関わらず片頭痛群とした．誘発因子の検索は生涯有病率，ライフスタイルの影響は過去１年間の有病率を用いた．緊張型頭痛は過去１年間に１４日以上の頭痛があり，片頭痛のないものとした．
主要評価項目とそれに用いた統計学的手法	Chi-square test, logistic regression analysis
結果	975例中片頭痛の有病率は16％（生涯），10％（１年間）．過去１年間に14日以上緊張型頭痛の有病率は22%．
結論	片頭痛，緊張型頭痛とも最も顕著な誘発因子はストレスと精神的緊張であった．その他の一般的な誘発因子はアルコール，天候の変化，月経であった．妊娠中の頭痛の消失または改善は片頭痛患者においてより頻度が高かった．片頭痛，緊張型頭痛とも発症年齢は男女差がみられた．喫煙，コーヒー，アルコールの消費は頭痛の種類に関係せず．睡眠障害は片頭痛には関連がなく，緊張型頭痛に関連する可能性があった．
作成者	五十嵐久佳

3) Zivadinov R, Willheim K, Sepic-Grahovac D, Jurjevic A, Bucuk M, 　 Brnabic-Razmilic O, Relja G, Zorzon M. Migraine and tension-type 　 headache in Croatia : a population-based survey of precipitating factors. 　 Cephalalgia. 2003;23:336-43.
論文抄録	The careful monitoring of the trigger factors of headache could be an important step in treatment, because their avoidance may lessen the frequency and severity of attacks. Furthermore, they may provide a clue to the aetiology of headache. The aim of the present study was to estimate the prevalence of tension-type headache (TTH) and to establish the frequency of precipitating factors in subjects with migraine and TTH in the adult population of Bakar, County of the Coast and Gorski Kotar , Croatia . Another important purpose of the study was to examine the relationship of the precipitating factors with migraine and TTH, and with migraine subtypes: migraine with aura (MA) and migraine without aura (MO). We performed a population-based survey using a 'face-to-face door-to-door' interview method. The surveyed population consisted of 5173 residents aged between 15 and 65 years. The 3794 participants (73.3%) were screened for headache history according to the International Headache Society (IHS) criteria. Headache screen-positive responders, 2475 (65.2%), were interviewed by trained medical students with a structured detailed interview focused on the precipitating factors. The following precipitating factors in lifetime migraineurs and tension-type headachers have been assessed: stress, sleep disturbances, eating habits, menstrual cycle, oral contraceptives, food items, afferent stimulation, changes in weather conditions and temperature, frequent travelling and physical activity. A total of 720 lifetime migraineurs and 1319 tension-type headachers have been identified. The most common precipitants for both migraine and TTH were stress and frequent travelling. Stress (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.17, 1.69) was associated with migraine, whereas physical activity (OR 0.72, 95% CI 0.59, 0.87) was related to TTH. Considering MA and MO, frequent travelling (OR 2.2, 95% CI 1.59, 2.99), food items (OR 2.2, 95% CI 1.35, 3.51) and changes in weather conditions and temperature (OR 1.75, 95% CI 1.27, 2.41) exhibited a significant positive association with MA. The present study demonstrated that precipitant-dependent attacks are frequent among both migraineurs and tension-type headachers. Lifetime migraineurs experienced headache attacks preceded by triggering factors more frequently than tension-type headachers. MA was more frequently associated with precipitating factors than MO. We suggest that some triggering factors may contribute to the higher occurrence of precipitant-dependent headache attacks in susceptible individuals. PMID: [PubMed - indexed for MEDLINE]
文献 PubMed−ID	12780762
エビデンスレベル	㈽
文献タイトル (日本語)	クロアチアにおける片頭痛と緊張型頭痛：誘発因子の一般人口調査
目的	緊張型頭痛の有病率，片頭痛と緊張型頭痛の誘発因子の頻度を調査．片頭痛と緊張型頭痛，前兆のない片頭痛と前兆のある片頭痛の誘発因子の関連性を調査．
研究デザイン	一般住民に対するインタビュー調査
研究施設	Department of Clinical Medicine and Neurology, University of Trieste , Trieste , Italy .
研究期間	1999年
対象患者	クロアチア Bakarの15〜65歳の一般住民5173中，頭痛のある住民2475例．
介入	トレーニングを受けた医学生が対面式インタビューを行った．
主要評価項目とそれに用いた統計学的手法	OR, 95%CI
結果	片頭痛と緊張型頭痛の両群において最も一般的な誘発因子はストレスと頻回の旅行であった．特にストレスは片頭痛，肉体活動は緊張型頭痛に関連が深かった．前兆のある片頭痛と前兆のない片頭痛では，頻回の旅行，食品，天候や温度の変化は前兆のある片頭痛により関連が深かった．
結論	片頭痛持ちの人は緊張型頭痛に比し，誘発因子によって起こる頭痛をより経験している．いくつかの誘発因子は頭痛発作の発現を高める．
作成者	五十嵐久佳

4) Turner LC, Molgaard CA , Gardner CH, Rothrock JF, Stang PE . 　 Migraine trigger factors in non-clinical Mexican-American population in 　 San Diego county: implications for etiology. Cephalalgia. 1995 　 Dec;15(6):523-30.
論文抄録	We conducted an investigation of migraine headache in a general population of Mexican-Americans living in San Diego county. Specific headache triggers were reported and analyzed, the most frequently reported for females with migraine being missing meals (58.9%), weather changes (54.4%), menstruation (53.6%), post-crisis letdown (52.7%), and fatigue (51.8%). The most frequently reported trigger factors for migraines reported by males were fatigue (58.8%), sleep (as a precipitating factor) (56.3%), post-crisis letdown (41.2%), and weather changes (37.5%). Trigger factors were further evaluated using stratification by presence or absence of Raynaud's phenomenon (RP), menstrual migraine, family history of migraine, and by migraine type. Odds ratios and 95% confidence intervals were calculated. These results suggest that subjects with migraine and RP (perhaps indicative of a systematic vascular tone disorder) and those with menstrual migraine (indicative of sensitivity to hormonal changes) may overall be more sensitive to certain environmental stimuli, particularly those involving change in the internal environment.
文献 PubMed−ID	10357602
エビデンスレベル	㈽
文献タイトル (日本語)	サンディエゴのメキシコ系アメリカ人住民における片頭痛誘発因子：
目的	一般住民における片頭痛誘発因子の頻度
研究デザイン	電話インタビュー調査
研究施設	Graduate School of Public Health , San Diego State University , CA , USA .
研究期間	1992年12月〜1993年3月
対象患者	サンディエゴに住む 15〜45歳のラテンアメリカ系住民
介入	層別解析は女性のみで行った．
主要評価項目とそれに用いた統計学的手法	片頭痛誘発因子の頻度 Odds ratios and 95% confidence intervals
結果	片頭痛の女性 115例と男性17例で誘発因子がみられた．女性では食事抜き（58.9%），天候の変化（54.4%），月経（53.6%），危機後のゆるみ（52.7%），疲れ（51.8%），男性では疲れ（58.8%），睡眠（56.3%），危機後のゆるみ（41.2%），天候の変化（37.5%）などが多かった．各誘発因子をレイノー現象，月経片頭痛，片頭痛の家族歴の有無，片頭痛の型による層別で評価した．これらの結果は片頭痛とレイノー現象を持つ人，月経片頭痛のある人はある環境刺激に対する感受性がよりあるようである．
結論	レイノー現象のある片頭痛，月経片頭痛，前兆のある片頭痛の患者はある環境刺激に対する感受性が強いようである．
作成者	五十嵐久佳

5) Spierings EL, Ranke AH, Honkoop PC. Precipitating and aggravating 　 factors of migraine versus tension-type headache. Headache. 　 2001;41:554-8
論文抄録	OBJECTIVE: We conducted the present study to determine whether there are headache precipitating and aggravating factors that differentiate migraine from tension-type headache and headache precipitating and aggravating factors that differentiate tension-type headache from migraine. METHODS: We interviewed 38 patients with migraine and 17 patients with tension-type headache (diagnosed using International Headache Society criteria) by telephone, using a questionnaire. The questionnaire inquired about the following precipitating and aggravating headache factors: (1) physical activity, (2) straining, (3) bending over, (4) stress/tension, (5) coughing/sneezing, (6) fatigue, (7) reading, (8) driving, (9) lack of sleep, (10) specific foods/drinks, (11) alcohol, (12) not eating on time, (13) smoke, (14) smell, (15) light, (16) noise, (17) menstruation, and (18) weather. RESULTS: The most common precipitating factors acknowledged by both groups of patients were stress/tension, not eating on time, fatigue, and lack of sleep. Weather, smell, smoke, and light were the precipitating factors that differentiated migraine from tension-type headache. Excluding those factors that are part of the International Headache Society migraine diagnosis, the aggravating factors were straining, bending over, and smell. We found no precipitating or aggravating factors differentiating tension-type headache from migraine. CONCLUSION: Apparently there are precipitating and aggravating factors differentiating migraine from tension-type headache but not vice versa. It is interesting that three of the migraine-specific precipitating factors (ie, weather, smell, and smoke) involve the nose/sinus system, suggesting a greater significance of this system in headache than is generally considered.
文献 PubMed−ID	11437890
エビデンスレベル	㈿
文献タイトル (日本語)	片頭痛と緊張型頭痛の誘発・増悪因子
目的	片頭痛と緊張型頭痛で誘発・増悪因子に違いがあるか否かを検討した．
研究デザイン	質問票を用いた電話インタビュー
研究施設	Department of Neurology, Brigham & Women's Hospital and Harvard Medical School , Boston , Mass, USA .
対象患者	38例の片頭痛患者と17例の緊張型頭痛患者
結果	両群に共通の最も一般的な誘発因子はストレス／緊張，不規則な食事，疲れ，睡眠不足であった．天候，匂い，喫煙，光は片頭痛に特徴的な誘発因子であった． IHS診断基準に含まれた因子以外の片頭痛の増悪因子は力み，屈む，匂いであった．緊張型頭痛に特徴的な誘発・増悪因子はなかった．
結論	片頭痛を緊張型頭痛と鑑別する誘発・増悪因子はあったが，その逆はなかった．片頭痛に特徴的な３つの誘発因子（天候，匂い，喫煙）は鼻・副鼻腔系に関連しており，頭痛における鼻・副鼻腔系の重要性が示唆される．
作成者	五十嵐久佳

6) Chabriat H, Danchot J, Michel P, Joire JE, Henry P. Precipitating factors 　 of headache. A prospective study in a national control-matched survey 　 in migraineurs and nonmigraineurs. Headache. 1999 May;39(5):335-8.
論文抄録	Prospective studies of precipitating factors in migraine are rare. Mig Access is a national control-matched survey conducted to evaluate the access of migraineurs to health care in France . This study allowed us to screen prospectively some precipitating factors of headache in migraineurs and in nonmigraineurs. Three hundred eighty-five migraineurs (group 1) and 313 nonmigraineurs (group 2) kept a diary for a 3-month period (a total of 35,805 day in group 1 and 29,109 days in group 2). Precipitating factors were reported for each headache period. Headache intensity was self-assessed during each headache period using a visual analog scale of 0 to 100. Headache was reported on 4274 days (12%) in group 1 and on 602 days (2%) in group 2. Headache intensity was greater in group 1 (39 +/- 20 versus 32 +/- 19, P < .05). The most frequent precipitating factors (reported at least once by more than 10% of subjects [range 18% to 80%] in both groups) were fatigue and/or sleep, stress, food and/or drinks, menstruation, heat/cold/weather, and infections in both groups. All these factors except infections were reported to cause headache more frequently in migraineurs than in nonmigraineurs. Mean intensity of headache related to fatigue and/or sleep, stress, food and/or drinks, hot/cold weather, and menstruation varied from 37 to 43 in migraineurs and from 29 to 35 in nonmigraineurs. Headache with the highest mean intensity was due to infections in the two groups (47 +/- 20 in group 1, 45 +/- 23 in group 2). Our results support that endogenous factors are the most frequent triggers of headache in migraineurs. The most frequent precipitating factors of headache appear identical in migraineurs and in nonmigraineurs. Our results suggest that similar triggers could precipitate headache of different type in these two populations.
文献 PubMed−ID	11279913
エビデンスレベル	㈼ b
文献タイトル (日本語)	頭痛誘発因子．｣片頭痛持ちと非片頭痛持ちの前向き対照試験
目的	片頭痛持ちと非片頭痛持ちにおける頭痛誘発因子を前向きに調査する．
研究デザイン	無作為に選んだ 6000例の住民に過去３ヶ月間の頭痛の有無を質問した後，HIS診断基準に基づいたアンケート用紙を郵送し，650例の片頭痛例と650例の非片頭痛例を選んだ．
研究施設	Services de Neurologie, Hopital Lariboisiere, Paris, France.
研究期間	1994 年
対象患者	一般住民から無作為に選んだ 385例の片頭痛持ち（グループ１）と313例の非片頭痛持ち（グループ２）
介入	３ヶ月間日記をつけ，誘発因子を検索
主要評価項目とそれに用いた統計学的手法	頭痛の強さは VAS（０〜100）を使用 Student t test, global chi-square
結果	最も頻度の高い誘発因子（ 10%以上の対象者が１回以上報告）は両群とも，疲労，睡眠，ストレス，食物，飲酒，月経，暑さ，寒さ，天候，感染症であった．これらのうち感染症以外のすべての因子は非片頭痛持ちに比し，片頭痛持ちのほうがより頻回に頭痛を起こした．頭痛の程度は両群とも感染症によって起こった場合に最も強かった．
結論	片頭痛持ちでは内因性の因子が最も頭痛を起こしやすい．頭痛の最も頻度の高い誘発因子は片頭痛持ちと非片頭痛持ちで同じようである．
コメント	一般住民を対象として３ヶ月間日記をつけることにより，誘発因子を検索したユニークな論文
備考	Publication Types: Clinical Trial
作成者	五十嵐久佳

7) Robbins L. Precipitating factors in migraine: a retrospective review of 　 494 patients. Headache. 1994;34:214-6.
論文抄録	The predominance of certain triggers for migraine was assessed in 494 migraine patients. Stress (62%) was the most frequently cited precipitant. Weather changes (43%), missing a meal (40%), and bright sunlight (38%) were also prominent factors. Sexual activity (5%) was the precipitant cited by the least number of patients. Significant differences were found between men and women in their responses to weather changes, perfumes, cigarette smoke, missing a meal, and sexual activity. Spring was cited by 14% of patients as a time for increased migraine attacks, followed by fall (13%), summer (11%), and winter (7%).
文献 PubMed−ID	8014037
エビデンスレベル	㈽
文献タイトル (日本語)	片頭痛の誘発因子： 494例の患者の後ろ向き調査
目的	494例の片頭痛患者において，誘発因子を後ろ向きに検討した．
研究デザイン	患者へのインタビュー調査
研究施設	Rush Medical College , Northbrook , IL .
対象患者	494例の片頭痛患者
介入	片頭痛のみを持つ患者で，緊張型頭痛や連日性頭痛を併せ持つものは除外した
結果	ストレス（ 62%）が最も頻度が高い片頭痛誘発因子であった．天候の変化（43%），食事抜き（40%），明るい太陽の光（38%）もまた重要な誘発因子であった．性活動は．天候の変化，香水，巻タバコ，食事抜き，性活動などに対する反応は男性と女性との有意な差がみられた．片頭痛発作が増加するのは春（14%），秋（13%），夏（11%），冬（7%）の順であった．
作成者	五十嵐久佳