偏头痛与VTE高风险有关但与粥状动脉硬化无关

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项新研究结果显示，虽然偏头痛不会增加非偏头痛者粥状动脉硬化负担，但他们可能增加静脉栓塞（VTE）风险研究者、来自澳洲Innsbruck学通讯作者的StefanKiechl医师写道，过去的研究已经证实罹患偏头痛病患，特别是有兆的，其发生中风与其他心血管疾病风险较高，但是增

项新研究结果显示，虽然偏头痛不会增加非偏头痛者粥状动脉硬化负担，但他们可能增加静脉栓塞（VTE）风险
　　
　　研究者、来自澳洲Innsbruck学通讯作者的Stefan Kiechl医师写道，过去的研究已经证实罹患偏头痛病患，特别是有兆的，其发生中风与其他心血管疾病风险较高，但是增加风险的机转目前并不清楚。
　　
　　作者写道，项以群众主的Brueck研究，是第一项以高解析都卜勒超音波比较偏头痛与非偏头痛患者之间粥状动脉硬化负担的研究，且提供反驳偏头痛可能造成粥状动脉硬化的论点；偏头痛患者（倾向发生栓塞）发生静脉栓塞的高风险，值得在未来的研究中进一步确认与阐释。
　　
　　这项研究结果发表于9月16日的神经学期刊。
　　
　　【存在、严重度与恶化程度】
　　Bruneck研究是一项于Bruneck研究心血管与神经疾病，以群众为主的研究，Bruneck是义大利南提若尔阿尔卑斯山地区的一小村落，这些受试者在1990年间被收纳，且每5年后续追踪一次；在2005年的后续追踪中，574位年龄介于55至94岁的受试者接受神经学与实验室评估，包括标准化的头痛评估访谈，以及颈动脉与股动脉扫描，以评估是否有粥状动脉硬化的存在，以及其严重度与自从2000年以来的恶化程度。
　　
　　在574位受试者中，其中23位是男性（8.7%），88位是女性（28.5%），根据国际头痛异常诊断第二版（ICHD-2）标准来诊断，结果并未发现任何心血管危险因子与偏头痛有关。
　　
　　他们报告偏头痛患者与非偏头痛患者之间，颈动脉与股动脉粥状动脉硬化的盛行率、严重度与5年之间的恶化程度，并没有统计上显著差异，不论病患是否有前兆；他们表示，事实上，罹患偏头痛病患甚至有粥状动脉硬化程度较轻的趋势，且血管厚度也比较薄（P=0.029）。
　　
　　然而，以一个全新的发现来说，他们附带表示，偏头痛患者发生VTE风险显然较高。
　　
　　【偏头痛患者相较于非偏头痛患者发生静脉栓塞事件风险的比较】试验终点偏头痛患者 (%) 非偏头痛患者 (%) P 有一个或重复 VTE 事件（校正年龄与性别后） 18.9 7.6 .031
　　作者写道，外插这些研究数据至动脉栓塞仍需注意，即使越来越多的研究证据显示，罹患VTE病患发生心血管疾病（CVD）的风险较高。
　　
　　将偏头痛与VTE相连的潜在机转，可能是偏头痛患者遗传性凝血功能异常盛行率较高，例如第五因子Leiden突变，这已经被报导在他们与其他系列中是过度存在的，以及倾向造成VTE的生活型态，或是最吊诡的，他们推测偏头痛发作被证实会诱发血小板的过度活性，以及活化凝血机转，可能是透过血管内皮相关途径（内皮细胞活化），且诱发全身性压力反应。
　　
　　【确认过去的研究结果】
　　来自麻州波士顿布莱根妇女医院的Tobia Kurth医师，他领导许多证实有前兆偏头痛患者心血管疾病风险，特别是中风风险较高的关键研究，且被要求提供Bruneck研究目前发现的评论。
　　
　　Kurth医师向Medscape神经学与神经外科学表示，这确实是个很有趣的研究，且与过去许多研究文献结果在粥状动脉硬化上是一致的；Kurth医师表示，举例来说，一项来自女性缺血症候群评估（WISE）研究的结果显示，因为怀疑缺血而被转介到冠状动脉血管摄影的女性中，有偏头痛的女性，其冠状动脉疾病严重度比非偏头痛女性低（Ahmed B等人，Am J Med. 2003; 119: 670-675）。
　　
　　有关于静脉栓塞风险增加，他更加谨慎；有一些关于这项研究所发现证据的理论，但是我们必须更加谨慎，在根据这项研究结果做出更强烈的结论之前，我们必须将一些研究设计上的考量纳入等式。
　　
　　他附带表示，我认为，整体而言这是个非常有趣的故事，但是再次强调，将偏头痛患者归类为某些疾病的高风险群之前，仍然要非常谨慎，因为他们本身因为头痛所带来的负担已经很多。
　　
　　作者表示无相关需要公开事项。

Migraine Linked to Higher Risk for VTE, but Not for AtherosclerosisBy Susan Jeffrey
Medscape Medical NewsA new study suggests that although migraineurs appear to have no increase in atherosclerotic burden over nonmigraineurs, they may have an increased risk for venous thromboembolic (VTE) events.Previous studies have shown that patients with migraine, particularly migraine with aura, have an increased risk for stroke and other cardiovascular diseases, but the mechanism underlying this increased risk has not been clear, the researchers, with corresponding author Stefan Kiechl, MD, from Innsbruck Medical University, in Austria, write."The population-based Bruneck Study is the first to compare the burden of atherosclerosis as quantified by high-resolution duplex ultrasound between migraineurs and nonmigraineurs and provides solid evidence to refute the standpoint that migraine predisposes to atherosclerosis," the authors write. "The higher risk for venous thromboembolism among migraineurs (prothrombotic state) awaits confirmation and elaboration in future research."Their findings are published in the September 16 issue of Neurology.Presence, Severity, and Progression The Bruneck Study is a population-based study of the epidemiology of cardiovascular and neurologic diseases in Bruneck, a small village in the alpine region of Italy, South Tyrol. Subjects were enrolled in 1990 and followed up every 5 years. During the 2005 evaluation, 574 participants aged 55 to 94 years underwent neurologic and laboratory assessments, including a standardized headache interview and scanning of the carotid and femoral arteries to evaluate the presence, severity, and progression since the 2000 examination of atherosclerosis.Of the 574 subjects, 23 men (8.7%) and 88 women (28.5%) had a diagnosis of migraine according to [page]International Classification of Headache Disorders, 2nd ed (ICHD-2) criteria.No cardiovascular risk factors were found to be statistically significantly associated with migraine.They report that the prevalence, severity, and 5-year progression of carotid and femoral atherosclerosis did not differ between migraineurs, either with or without aura, and nonmigraineurs. "In fact, there was even a tendency for atherosclerosis to be less pronounced among patients with migraine and for the intima-media thickness to be lower (P = 0.029)," they note.However, "as a novel finding," they add, migraineurs appeared to have a significantly increased risk for VTE events.

Venous Thromboembolism in Migraineurs vs Nonmigraineurs End Point Migraineurs (%) Nonmigraineurs (%) P History of 1 or repeated VTE events (age and sex adjusted) 18.9 7.6 .031

"Extrapolation of these data to arterial thrombosis requires caution, even though evidence is growing that patients with VTE are at an increased risk for [cardiovascular disease] CVD," the authors write.Potential mechanisms linking migraine and VTE might include a higher prevalence of inherited coagulation abnormalities in migraineurs, such as factor V Leiden mutation, which has already been reported as overrepresented in their and others' series, lifestyle behaviors predisposing to VTE, or, "most intriguing," they speculate, that "migraine attacks have been shown to trigger platelet hyperreagibility and activate the coagulation cascade putatively through endothelium-dependent pathways (endothelial activation) and induction of a systemic stress reaction."Confirms Previous FindingsTobias Kurth, MD, from the Brigham and Women's Hospital, in Boston, Massachusetts, has led some of the pivotal research that has shown an increase in cardiovascular risk and in particular stroke in patients with migraine with aura and was asked for comment on the current findings from the Bruneck Study."It is certainly interesting work and agrees with many previous papers" on the finding on atherosclerosis, Dr. Kurth told Medscape Neurology & Neurosurgery. For example, a report from the Women's Ischemia Syndrome Evaluation (WISE) study showed that among women referred for coronary angiography for suspected ischemia, women with migraine had less severe coronary artery disease than those without migraine (Ahmed B et al. Am J Med 2003;119:670-675.), Dr. Kurth noted.About the increased risk for venous thromboembolism, he was more cautious. "There is some theory about this and evidence here, but we have to be careful as there are some methodological considerations that have to be taken into the equation before making strong conclusions from this," he said."I think it's a very interesting story overall, but again I'm still very careful of throwing at migraineurs anything that they may have an increased risk of — because their burden is too much by headache itself already," he added.The authors report no disclosures. Neurology. 2008;71:937-943. Abstract

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