論文抄録

N/A

文献 PubMed−ID

PM:7969946

エビデンスレベル

N/A

文献タイトル (日本語)

片頭痛の共存症研究はなぜ必要か？

目的

N/A

研究デザイン

N/A

研究施設

Department of Neurology, Albert Einstein College of Medicine, Bronx , New York

研究期間

N/A

対象患者

N/A

介入

N/A

主要評価項目とそれに用いた
統計学的手法

N/A

結論

共存症と片頭痛の関係は，１）偶発的な共存，２）共存症が片頭痛をおこす，あるいは，片頭痛が共存症をおこす場合，３）共通のリスク要因により，片頭痛および共存症がおこる，４）ある遺伝的要因と環境的要因が，特定の脳の状態を惹起し，この状態が片頭痛と共存症をおこすなどが考えられる

コメント

片頭痛の共存症研究の必要性と研究の方向性に関する提言であり重要な記述である．

備考

Neurology44Sup7-S4.pdf

作成者

竹島多賀夫

論文抄録

This review addresses the methodologic issues relevant to the study of comorbidity and provides a broad overview of the medical and psychiatric conditions associated with migraine. Since the body of literature examining the comorbidity of migraine is enormous, the scope of this review will largely focus on community and case-control studies. Among the selected comorbid medical conditions, including disorders of the cardiovascular, respiratory, neurologic, gastrointestinal and immunologic systems, stroke, asthma, and allergies appear to be most strongly associated with migraine. Among the psychiatric illnesses, mood and anxiety disorders have been shown to be most strongly associated with migraine in the general population. Further research is indicated and necessary to elucidate the precise mechanism of migraine comorbidity

文献 PubMed−ID

PM:12858133

エビデンスレベル

IV

文献タイトル (日本語)

片頭痛の comorbidity（併存症）研究の必要性

目的

片頭痛と併存する医学的，精神科的状態に関する研究の方法論的問題をオーバービューする．

研究デザイン

報告文献のオーバービュー

研究施設

Mood and Anxiety Disorders Program of the Intramural Research Program at the National Institute of Mental Health, Maryland MD

対象患者

N/A

介入

片頭痛の同時罹患率を調べてた膨大な文献報告から，主として，共同体研究と，患者−対照研究に焦点をしぼって検討した．

主要評価項目とそれに用いた統計学的手法

オッズ比，有病率の検討．

結果

心血管系，呼吸器系，神経系、消化器系，及び免疫系を含む多数の医学的身体状況との併存研究の中で、脳血管障害，喘息およびアレルギーは、最も強く片頭痛と相関していると考えられた．

精神科的疾患の中では，気分障害と不安障害が，一般集団で最も強く片頭痛と相関した．

結論

片頭痛併存症の正確な機序を解明するために，更なる調査研究が必要．

コメント

文献のレビュー及び方法論を論じた文献．

作成者

竹島多賀夫

論文抄録

Recent studies reported an increased prevalence of patent foramen ovale (PFO) in patients with migraine with aura (MA +). To investigate the possible relationship between MA + and paradoxical embolism, we studied the prevalence of both conditions. Investigation of PFO was undertaken in 74 consecutive patients presenting with an acute stroke of undetermined origin. The patients were questioned about MA + or migraine without aura (MA -) according to the criteria of the International Headache Society. Follow-up was performed to investigate the evolution of MA + and MA - according to different treatments of stroke. PFO was found in 44 of 74 patients, 16 of whom had MA + (36%), compared to 4 (13%) MA + patients without PFO (p = 0.03). Of 25 patients in whom the PFO was considered to play a causal role in the stroke, 13 (52%) had MA +, whereas only 3 (16%) of 19 patients in whom PFO was considered unrelated had MA + (p = 0.014). Thirty-nine of the patients with MA + and MA - were studied over a mean follow-up of 13 months. Seven of 15 patients with MA + and PFO, treated either with surgical closure or anticoagulants, noticed complete disappearance of MA + attacks. The prevalence of MA + is high among stroke patients with PFO. In patients with a high presumption of paradoxical embolism, the proportion of MA + is increased, and this suggests a possible role of this association in the occurrence of the cerebrovascular event. Forty-seven percent of patients with PFO and MA + reported complete suppression of their aura attacks after surgical closure or anticoagulant treatment. This finding suggests that at least in some patients, MA + attacks may be due to paradoxical embolism. Comment: Reach for the stethoscope/echocardiogram! This paper emphasizes the importance of physicians adopting a holistic approach to patients with migraine, not forgetting to check for clinical signs of a septal defect and, if in doubt, to refer for cardiological review to exclude a surgically treatable source of paradoxical emboli. DSM

文献PubMed−ID

PM:12603672

エビデンスレベル

㈽

文献タイトル(日本語)

潜在的卵円孔開存は症候性片頭痛の原因となるか；
急性期脳梗塞74症例での検討

目的

卵円孔開存と前兆のある片頭痛との関連性の有無を検討する．

研究デザイン

後方的症例研究及び一部症例の追跡調査

研究施設

スイス神経超音波施設神経内科入院患者

研究期間

1998年3月〜2000年1月（平均13ヶ月）

対象患者

明らかな原因危険因子を有さない急性期脳梗塞患者74症例

介入

外科的卵円孔閉塞術あるいは抗凝固療法

主要評価項目とそれに用いた統計学的手法

潜在性卵円孔開損と片頭痛の各頻度と関連性を求める．

χ2試験，Fisher直接法，Mantel-Haenszel法

結果

潜在的卵円孔開損を有する患者で前兆のある片頭痛が有意に高頻度であった．

潜在的卵円孔開存を治療介入した前兆のある片頭痛患者15名中7名で頭痛が完全に消失した．

結論

一部の症例で前兆のある片頭痛発作は奇異性塞栓に起因しているかもしれない．

コメント

今後，前向きで無作為化症例対照比較試験による検証が必要である．

作成者

古和久典

論文抄録

OBJECTIVE: To evaluate, in a prospective design, whether migraine is an independent risk factor for subsequent stroke. DESIGN: Evaluated as part of the Physicians' Health Study, a randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in the primary prevention of cardiovascular disease and cancer begun in 1982. The aspirin component of the study was terminated in 1988, with average follow-up of 60.2 months.

SETTING: Conducted by mail among male physicians throughout the United States.

PARTICIPANTS: A total of 22,071 US male physicians aged 40 to 84 years in 1982 with no prior history of cancer or cardiovascular diseases who were enrolled in the Physicians' Health Study. INTERVENTIONS: Participants were randomized to receive 325 mg of aspirin or aspirin placebo every other day and to receive 50 mg of beta-carotene or placebo on alternate days.

MAIN OUTCOME MEASURES: The primary outcomes of the Physicians' Health Study were cardiovascular disease and cancer. Because stroke was a main outcome, this provided the opportunity to evaluate the association between migraine headaches and stroke.

RESULTS: Physicians reporting migraine (n = 1479) had significantly increased risks of subsequent total stroke and ischemic stroke compared with those not reporting migraine. After adjustment for age, aspirin and beta-carotene treatment assignment, and a number of cardiovascular risk factors, the relative risks were 1.84 (95% confidence interval, 1.06 to 3.20) for total stroke and 2.00 (95% confidence interval, 1.10 to 3.64) for ischemic stroke. There were too few hemorrhagic strokes in the study to evaluate this end point. No associations were seen between ordinary nonmigraine headache and subsequent stroke or between migraine and subsequent myocardial infarction or cardiovascular death.

CONCLUSION: These data raise the possibility that vascular events associated with migraine may also have causative importance in stroke but require confirmation in other studies specifically designed to evaluate this question.

文献PubMed−ID

7848119

エビデンスレベル

㈼a

文献タイトル(日本語)

医師健康研究における片頭痛とそれに続く脳卒中

目的

片頭痛は脳卒中の独立した危険因子となるか否かを明らかにする．

研究デザイン

症例対照前向き臨床研究

研究施設

米国the Physicians' Health Study

研究期間

1982年より追跡平均60カ月

対象患者

米国the Physicians' Health Studyに登録した男性医師22071名

片頭痛あり 1479例，片頭痛なし 20481例

介入

アスピリン325mg，或いはβカロテン50mg，或いはプラセボの隔日内服

主要評価項目とそれに用いた統計学的手法

心血管疾患（脳卒中を含む）と癌の発症率

研究開始後に頭痛に関して調査，評価

オッズ比

結果

片頭痛患者では，非片頭痛患者に比して有意に脳卒中および脳梗塞の発症率が高かった．年齢，介入薬剤の有無，心血管疾患の既存の危険因子を補正しても結果は変わらなかった．片頭痛以外の頭痛は脳卒中と関連性がなかった．

結論

片頭痛に関連した血管障害は脳卒中の原因となるかもしれないので，更なる検討が必要である．

コメント

片頭痛の診断は医師の自己申告に基づいており，IHSの診断基準に従っておらず，また，前兆の有り無しについても不明である．脳梗塞の発症機序や臨床病型についても確認されていない．

作成者

古和久典

論文抄録

OBJECTIVE: To examine the association between stroke and migraine in an epidemiological study.

DATA SOURCES AND DESIGN: The National Health and Nutrition Examination Survey baseline and first follow-up data were used to investigate cross-sectional and longitudinal associations between headache/migraine and stroke.

SETTING: Study participants from a national probability sample of the civilian noninstitutionalized population of the United States.

MAIN OUTCOME MEASURE: Self-reported physician diagnosis of stroke.

RESULTS: After controlling for established risk factors for stroke (hypertension, diabetes, heart disease, and gender), both migraine and severe nonspecific headache were associated with a significantly increased risk for stroke reported at follow-up. The risk for stroke associated with migraine decreased as the age at stroke increased.

CONCLUSIONS: Our results strengthen previous evidence regarding a nonrandom association of both headache and migraine with stroke, particularly among young women. To our knowledge, this is the first systematic examination in a large-scale prospective epidemiological study of men and women with sufficient statistical power to test the association between migraine and stroke in women. Severe headache and migraine should be considered as risk factors for the development of stroke, particularly in the absence of other well-established stroke risk factors. Further investigation is required to identify the putative mechanisms underlying comorbidity of migraine and stroke.

文献PubMed−ID

9109736

エビデンスレベル

㈼a

文献タイトル(日本語)

合衆国大規模疫学研究による片頭痛と脳卒中の関連性

目的

疫学研究において脳卒中と片頭痛の関連性を明らかにする

研究デザイン

症例対照前向き臨床研究

研究施設

The National Health and Nutrition Examination Survey (NHANES)

研究期間

1971年より追跡平均10年

主要評価項目とそれに用いた統計学的手法

脳卒中発症

オッズ比，有病率

結果

片頭痛と脳卒中の有意な関連性を認めた．特に若年女性でその傾向が強かった．

結論

とりわけ既存の脳卒中危険因子を有しない症例で，片頭痛や強い頭痛は，脳卒中発症の危険因子と考えられた．

コメント

片頭痛の診断はIHSの診断基準以前のために従っておらず，また，前兆の有り無しについても不明である．脳梗塞の発症機序や臨床病型についても確認されていない．

作成者

古和久典

論文抄録

BACKGROUND: A history of migraine has been proposed as a risk factor for cerebral ischaemia in women under 45. METHODS: To investigate the association between history of migraine and cerebral ischaemia, we performed a case-control study of 308 patients aged 15-44, with either transient ischaemic attack (TIA) or stroke, and of 591 age- and sex- matched controls prospectively recruited in seven university hospitals. Crude and adjusted odds ratios were calculated using logistic regression analysis. FINDINGS: A history of migraine was more frequent in patients than in controls (14.9% vs 9.1%; adjusted odds ratio 1.9, 95% confidence interval 1.1-3.1). In the prospectively designed subgroup analyses, a history of migraine reached the highest odds ratio (3.7, 95% CI 1.5-9) and was the only significant risk factor in women below age 35 (p=0.003); atherogenic risk factors were more relevant in men and in patients older than 35; previous migraine attacks with aura were more frequent in stroke patients (odds ratio 8.6, 95% CI 1-75). INTERPRETATION: Our findings indicated that the rare association between migraine and cerebral ischaemia is limited to women below age 35, and suggest a need for careful clinical evaluation of comorbidity in the presence of migraine with aura

文献 PubMed−ID

PM:8684100

エビデンスレベル

III

文献タイトル (日本語)

若年成人における片頭痛の病歴と脳虚血のリスク

目的

片頭痛の既往歴と脳虚血の相関を調査する

研究デザイン

case-control study

研究施設

7つの大学病院

対象患者

一過性脳虚血発作（ TIA）または脳卒中を有する15〜44才の患者308例と，591例の性/年齢をマッチさせた患者対照を前向きに実施

介入

case-control study

主要評価項目とそれに用いた統計学的手法

ロジスティック回帰分析を使用して，オッズ比および補正オッズ比を算出　

結果

片頭痛の既往歴は、患者で対照より頻度が高かった

（ 14.9%対9.1%;補正オッズ比1.9（95%信頼区間1.1-3.1））

サブグループ分析では， 35歳以下の女性では，片頭痛の既往が最高のオッズ比を示し（3.7，95%CI 1.5-9）で，片頭痛の既往が唯一の有意な危険因子であった．

アテローム硬化性の危険因子は男性，及び 35才以上の患者でより強い関連を示した．

前兆のある片頭痛の既往は脳卒中患者で高頻度であった（オッズ比 8.6（95%CI 1-75））．

結論

片頭痛と脳虚血の相関は 35才以下の女性に限られている．

前兆のある片頭痛患者では，脳虚血の合併の臨床評価を注意深く行う必要がある．

コメント

中規模のケースコントロール研究．

作成者

竹島多賀夫

論文抄録

OBJECTIVE: To explore the association between migraine and risk of ischaemic stroke. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Observational studies published between 1966 and June 2004 (identified through Medline and Embase) that examined the association between migraine and risk of ischaemic stroke. RESULTS: 14 studies (11 case-control studies and 3 cohort studies) were identified. These studies suggest that the risk of stroke is increased in people with migraine (relative risk 2.16, 95% confidence interval 1.89 to 2.48). This increase in risk was consistent in people who had migraine with aura (relative risk 2.27, 1.61 to 3.19) and migraine without aura (relative risk 1.83, 1.06 to 3.15), as well as in those taking oral contraceptives (relative risk 8.72, 5.05 to 15.05). CONCLUSIONS: Data from observational studies suggest that migraine may be a risk factor in developing stroke. More studies are needed to explore the mechanism of this potential association. In addition, the risk of migraine among users of oral contraceptives must be further investigated

文献PubMed−ID

PM:15596418

エビデンスレベル

㈽

文献タイトル(日本語)

片頭痛患者における脳梗塞の危険性：観察研究のメタアナリシス

目的

片頭痛が脳梗塞危険因子となるかどうかを明らかにする．

研究デザイン

報告文献のオーバービューとメタアナリシス

対象患者

N/A

介入

1966年より2004年までの報告から抽出した15文献

ただし，横断的研究の1報告は片頭痛の診断と脳梗塞発症との関連を結論付けることが困難と判断し除外した．

主要評価項目とそれに用いた統計学的手法

オッズ比

結果

片頭痛を有する群では，片頭痛を有さない群と比較して2.16倍脳梗塞になりやすかった．内訳では，前兆のある片頭痛では2.27倍，前兆のない片頭痛では1.83倍であった．経口避妊薬を内服中の群では，8.72倍であった．

結論

片頭痛は脳梗塞発症に関与する危険因子のひとつと考えられる．今後その機序を明らかにしていくことが必要である．

コメント-1

recall biasや他の脳梗塞危険因子を調整した検討が必要であり，解釈には注意や配慮を要する．

コメント-2

IHS(1989)やCVD㈽(1990)の各診断基準が発表される以前の研究も含まれており，まとめて論じることに注意が必要であると思われる．

作成者

古和久典

論文抄録

BACKGROUND: An association between migraine and major depression has been observed in clinical and community samples. The factors that contribute to this association and their implications remain unclear. OBJECTIVE: To determine the factors contributing to the association of migraine and major depression. METHODS: A cohort study of persons aged 25 to 55 years with migraine (n = 496) or with other headaches of comparable severity (n = 151) and control subjects with no history of severe headaches (n = 539) randomly selected from the general community were interviewed first in 1997 and then reinterviewed in 1999. RESULTS: Major depression at baseline predicted the first-onset migraine during the 2-year follow-up period (odds ratio [OR] = 3.4; 95% CI = 1.4, 8.7) but not other severe headaches (OR = 0.6; 95% CI = 0.1, 4.6). Migraine at baseline predicted the first-onset major depression during follow-up (OR = 5.8; 95% CI = 2.7, 12.3); the prospective association from severe headaches to major depression was not significant (OR = 2.7; 95% CI = 0.9, 8.1). Comorbid major depression did not influence the frequency of migraine attacks, their persistence, or the progression of migraine-related disability over time. CONCLUSIONS: Major depression increased the risk for migraine, and migraine increased the risk for major depression. This bidirectional association, with each disorder increasing the risk for first onset of the other, was not observed in relation to other severe headaches. With respect to other severe headaches, there was no increased risk associated with pre-existing major depression, although the possibility of an influence in the reverse direction (i.e., from severe headaches to depression) cannot be securely ruled out

文献 PubMed−ID

PM:12707434

エビデンスレベル

IIｂ

文献タイトル (日本語)

片頭痛と抑うつの同時罹患率：潜在的病因と予後調査

目的

片頭痛と大うつ病の合併に関与する因子を特定すること

研究デザイン

前向きコホート研究

研究施設

Departments of Psychiatry and Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit .

Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor; Department of Psychiatry, Case Western Reserve University, Cleveland, OH;

Innovative Medical Research and Departments of Neurology and Epidemiology and

Social Medicine, Albert Einstein College of Medicine, New York , NY ,

Department of Epidemiology, Johns Hopkins University , Baltimore , MD ; and University of Kansas Medical Center , Kansas City.

研究期間

1997年〜2003年（観察期間　1997〜1999年）

対象患者

介入

2年間のコホート調査

主要評価項目とそれに用いた統計学的手法

片頭痛，他の重度頭痛と大うつ病の既往と 2年間の新規の発症．

オッズ比（ OR）を用いて解析

性別と大うつ病以外の共存精神障害によって補正した ORは、多変量ロジスティック回帰によって推定．  

結果

大うつ病があると 2年以内の片頭発症は OR = 3.4（95%CI； 1.4-8.7，他の重度頭痛発症はOR = 0.6　（95%CI； 0.1　-　4.6）であった．

Migraine at baseline predicted the first-onset major depression during follow-up (OR = 5.8; 95% CI = 2.7, 12.3);

片頭痛があると 2年以内に大うつ病を発症するリスクはOR = 5.8　（95%のCI 2.7-2.3）で有意に高かった．重度の非片頭痛性頭痛からの大うつ病の合併は有意でなかった(OR = 2.7; 95% CI = 0.9- 8.1).

大うつ病の共存は、片頭痛発作の頻度，持続時間，他の片頭痛関連障害への進展に有意な影響は示さなかった．

結論

•  大うつ病は片頭痛の発症リスクを増加させ，片頭痛は大うつ病の発症リスクを増加させた．

•  この双方向性の有意な合併の相関は　片頭痛以外の重度の頭痛では観察されない．

•  片頭痛以外の重度の頭痛に関しては，大うつ病の存在が片頭痛以外の頭痛の重度の頭痛を発症するリスクを増加させないが，逆方向，すなわち重度頭痛から大うつ病への可能性は完全には否定できなかった．  

コメント

中規模の良質な前向きコホート研究．観察期間が 2年間とやや短い．

備考

Neurology601308.pdf

作成者

竹島多賀夫

論文抄録

We investigated comorbidity of migraine and epilepsy by using information from structured telephone interviews with 1,948 adult probands with epilepsy and 1,411 of their parents and siblings. Epilepsy was defined as a lifetime history of two or more unprovoked seizures, and migraine as severe headaches with two or more of the following symptoms: unilateral pain, throbbing pain, visual aura, or nausea. Cumulative incidence of migraine to age 40 was 24% in probands with epilepsy, 23% in relatives with epilepsy, and 12% in relatives without epilepsy. Using Cox proportional hazards analysis to control for years at risk and gender, the rate ratio for migraine was 2.4 (95% CI, 2.02 to 2.89) among probands and 2.4 (1.58 to 3.79) among relatives with epilepsy in comparison with relatives without epilepsy. Migraine risk was highest in probands with epilepsy due to head trauma, but it was significantly higher in every subgroup of probands than in unaffected relatives when probands were stratified by seizure type, age at onset, etiology of epilepsy, and history of epilepsy in first-degree relatives. Age-specific incidence of migraine among probands was increased to a greater extent after onset of epilepsy than before, but it was also significantly increased more than 5 years before onset and 1 to 5 years before onset. These results indicate that migraine and epilepsy are strongly associated, independent of seizure type, etiology, age at onset, or family history of epilepsy

文献 PubMed−ID

PM:7969967

エビデンスレベル

III

文献タイトル (日本語)

片頭痛とてんかんの同時罹患率

目的

片頭痛とてんかんの同時罹患率を調査する．

研究デザイン

構造化した質問の電話インタビュー

研究施設

G.H. Sergievsky Center , School of Public Health , Columbia University , New York , Department of Neurology, Albert Einstein College of Medicine, Bronx , NY

対象患者

てんかんに罹患している 1,948人の成人患者とその両親，同胞1,411人

介入

電話調査

主要評価項目とそれに用いた統計学的手法

てんかん患者（の定義）： 2回以上の明確なてんかん発作があった者

片頭痛の定義：重度の頭痛発作で，以下４つうちの 2項目以上：片側性頭痛，拍動痛，視覚性前兆，悪心．

Cox proportional hazards analysis

結果

40才までの片頭痛の蓄積の出現率は，てんかんをもつ発端者で24％，てんかんのある近親者で23%，てんかんのない近親者では12%であった．

てんかんのない近親者を対照としたコックス・ハザード分析では，片頭痛の罹患リスク比はてんかんの発端者が 2.4（95%CI：2.02〜2.89），てんかんのある近親者でも2.4（1.58〜3.79）と有意に増加していた．

片頭痛の罹患リスクは頭部外傷によるてんかんの発端者で最も増加していた．

片頭痛の年齢別出現率は，てんかんの発症の後に増加した．

また、てんかん発症後の 5年間は発症前の1〜5年と比較して有意な増加であった．

結論

片頭痛とてんかんは強く関連している．この相関は，てんかんの発作型，病因，発病年齢，家族歴とは独立している

作成者

竹島多賀夫

論文抄録

BACKGROUND: Earlier studies have suggested a link between asthma and severe headache, and also between migraine and wheezing illness. Recent analysis have also shown an increase of asthma among cases with a prior history of migraine but without a history of hay fever, allergic rhinitis or eczema. AIM: To examine whether there is an association between migraine and asthma in the United Kingdom . DESIGN OF STUDY: Matched case-control study using the General Practice Research Database (GPRD). SETTING: Practices in the United Kingdom providing data on 5,110,619 patients to the GPRD. METHOD: The subjects were the patients with one or more diagnoses of migraine plus treatment for migraine. Each case was matched by general practice, sex, and age, with one control who had never been given a diagnosis of migraine. Case and control groups were compared for prevalence of asthma, chronic obstructive pulmonary disease, respiratory symptoms treated with inhalers or hay fever. Investigations were carried out to determine whether the association between migraine and asthma was stronger among patients with hayfever or those without hayfever, and whether patients with migraine had an increased prescription of other (non-migraine and non-asthma) medications. RESULTS: Among 64 678 case-control pairs, the relative risk of asthma in patients with migraine was 1.59 (95% CI = 1.54 to 1.65) among definite cases, and 0.75 (95% CI = 0.67 to 0.83) among those whose selection as case included beta-blocker prophylaxis. Among definite migraine cases, relative risks of chronic obstructive pulmonary disease, respiratory symptoms, eczema, and hay fever (pollinosis), were all raised (at 1.22, 1.85, 1.55, and 1.67, respectively). The association between migraine and asthma was stronger in patients without a diagnosis of hay fever, than in those with hayfever (relative risk = 1.32 and 1.19, respectively). The relative risk of prescription for a range of non-migraine, non-asthma medications was raised, the exception being anti-diabetic medication. CONCLUSION: This large case-control study provides evidence for an association between migraine and asthma. Frequent attendance at a general practice surgery may confound this association. However, if the association is real, its elucidation may help the understanding of disease mechanisms shared by migraine and asthma

文献 PubMed−ID

PM:12236275

エビデンスレベル

III

文献タイトル (日本語)

片頭痛と喘息の相関：症例 -対照研究

目的

英国において，片頭痛と喘息の罹患に相関があるかどうかを検証する

研究デザイン

General Practice Research Database (GPRD)を用いた症例-対照研究．

研究施設

Department of Public Health Sciences, St George's Hospital Medical School , London

対象患者

General Practice Research Database (GPRD)に登録されている5,110,619人の英国の患者．

介入

被検症例は，片頭痛のための治療を受けており，片頭痛以外に一つ以上の診断名がある患者とした．

対照は，同じ診療所で医療をうけた患者で，過去に片頭痛の診断を受けておらず、性と年齢が一致するものをマッチさせた．

主要評価項目とそれに用いた統計学的手法

症例群と対照群について，喘息，慢性閉塞性肺疾患，吸入器による治療を受ける呼吸器症状，花粉症の有病率を比較した．

オッズ比を使用

結果

64,678組の症例-対照組で，片頭痛患者における喘息合併の相対危険度は1.59（95%CI = 1.54-1.65）と有意に増加していた．

診断が確実な片頭痛症例の中では慢性閉塞性肺疾患、呼吸器症状，湿疹，花粉症（枯草熱）の相対危険度が増加していた（各々， 1.22，1.85，1.55，1.67）．

結論

大規模な症例 -対照研究により片頭痛と喘息の相関が示唆された

コメント

大規模な検討である．本研究結果の信頼性は登録された診断の精度により影響をうける可能性がある．

作成者

竹島多賀夫