| Part ?:Predictors of Episodic Migraine Transformed to Chronic Migraine,a Systematic Review and Meta-analysis of Observational Cohort StudiesObjective:There are approximately 2.5%of episodic migraine(EM)progress to chronic migraine(CM)each year.Several risk factors were reported to increase the risk of CM from observational studies,but lack of consensus and concerns in clinic.We systematically reviewed the published observational cohort studies to provide quantitative and qualitive data on predictors of EM transformed to CM.Methods:An electronic search was conducted for prospective cohort studies which report the risk factors or predictors of CM.Risk bias of including studies was assessed by Newcastle-Ottawa Quality Assessment Scale(NOS).Evidence quality was determined according to the Grading of Recommendations Assessment,Development and Evaluation(GRADE)guidelines.Effect estimates were summarized using risk ratio(RR)with 95%confidence interval(CI).Results:Of the initial 5695 searched studies,ten studies were eligible for inclusion with NOS range from 6 to 9 stars.In the pooled analysis,there is "high" evidence on monthly headache day frequency?10 days(RR,5.95;95%CI,4.75-7.46),"moderate"evidence on depression(RR,1.58;95%CI,1.35-1.85),monthly headache day frequency?5 days(RR,3.18;95%CI,2.65-3.82),annual household income?$50,000(RR,0.65;95%CI,0.54-0.79),and "very low" evidence on allodynia(RR,1.40;95%CI,1.23-1.59),medication overuse(RR,8.82;95%CI,2.88-27)in predicting CM progression.Conclusions:Strong evidence supports monthly headache day frequency of 10 or more as a predictor of CM progression.Moderate evidence indicates depression and monthly headache day frequency?5 days increase the risk of new onset of CM,while an annual household income ?$50,000 decrease the risk.A "very low" evidence for allodynia and medication overuse on predicting CM progressionPart ?:Chronification Risk Factors and Cerebral Blood Flow Changes of Status Migrainosus,A Clinical StudyObjective:Status migrainosus(SM)tends to progress to chronic migraine(CM),but report in literature is scarce.We aimed to investigate the clinical characteristics and risk factors of SM progress to chronic CM.Methods:We consecutively registered CM and SM patients and compared the clinical presentation between two groups.Cerebral blood flow(CBF)of SM at migraine attack was measured by transcranial Doppler ultrasonography(TCD).A receiver operating characteristic curve was plotted to assess the diagnostic value of TCD in confirming SM.A logistic regression model was employed to determine the risk factors of SM progress to CM.Results:SM patients suffered lesser bilateral pain(OR=0.22;95%CI,0.05-0.98)but endured severe pain(8.4±1.17 vs.6.8± 1.22,P=0.02)compared to CM patients.Although sleep disorder(OR=0.36;95%CI,0.14-0.93),mental stress(OR=0.07;95%CI,0.01-0.54),and nausea and/or vomiting(OR=0.30;95%CI,0.11-0.84)were less aggravated in such patients,migraine aura(62.5%vs.44.32%,P=0.04)and medication overuse(62.5%vs.51.70,P=0.01)are were more commonly seen.CBF remains unchanged between pain side and non-pain side during migraine attack of SM,while the CBFV of non-pain side vertebral artery(VA)was decreased for CM.When headache attack,the CBFV of anterior circulation of SM patients was decrased compared with CM patients.Diastolic velocity(Vd),Mean velocity(Vm)of bilateral anterior cerebral artery(ACA)and Vd of pain side middle cerebral artery(MCA)are helpful in diagnosing SM.Medication overuse(OR=4.19;95%CI,2.25-7.81,P=0.03),mental stress(OR=14.23;95%CI,1.79-112.62,P=0.012),and nausea and/or vomiting(OR=4.47;95%CI,1.42-13.98,P=0.01)are potential risk factors of SM progress to CM.Conclusions:SM appears to have slight differences in clinical manifestations from CM while CBF remains stable during migraine attack.Medication overuse,migraine attack aggravated by mental stress,and headache-associated nausea and/or vomiting are potential risk factors of SM progress to CM. |
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