子宫内膜异位症与偏头痛之间的关系:观察性研究的系统回顾和荟萃分析。

IF 7.3 1区 医学 Q1 CLINICAL NEUROLOGY
Giorgia Elisabeth Colombo, Sofia Makieva, Edgardo Somigliana, Georgios Schoretsanitis, Brigitte Leeners, Christian Polli, Noemi Salmeri, Dimitrios Rafail Kalaitzopoulos, Paola Vigano'
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引用次数: 0

摘要

背景:子宫内膜异位症影响育龄妇女。越来越多的关注正在给予表征合并症的子宫内膜异位症,以加强临床表型。在这些合并症中,据报道,偏头痛在子宫内膜异位症患者中比一般人群更常见。然而,真正的流行病学负担仍然不确定,并且没有确凿的证据将子宫内膜异位症的特定亚型与偏头痛联系起来。正文:对7个电子数据库进行检索,检索时间为成立至2024年7月22日,检索方式为相关关键词组合。普洛斯彼罗注册CRD42023449492。两名独立审稿人根据纳入/排除标准筛选记录并提取数据。使用ROBINS-E工具进行偏倚风险评估。采用随机效应模型计算子宫内膜异位症与偏头痛之间的比值比(ORs)和95%置信区间(CIs)。定性综合纳入14项研究,荟萃分析纳入13项研究,共纳入331,655人(32,489例子宫内膜异位症,对照组299,166例)。大多数纳入的研究存在严重的偏倚风险,其中50%的研究存在非常高的偏倚风险。子宫内膜异位症患者患偏头痛的风险高于无子宫内膜异位症患者(OR 2.25, 95%CI = 1.85-2.72;N = 13项研究;i2 = 81%)。这种关联在敏感性分析中仍然显著:(i)当排除非常高或高偏倚风险的研究时(or 2.64;95%ci = 1.62-4.31;N = 4项研究;I2 = 77%), (ii)当仅包括经临床相关混杂因素调整的风险估计时(OR 2.35;95%ci = 1.77-3.13;N = 6项研究;I2 = 88%)和(iii)仅包括经激素治疗调整的风险估计值时(OR 1.95;95%ci = 1.42-2.66;n = 3;i2 = 92%)。子宫内膜异位症与无先兆偏头痛显著相关(OR 2.64, 95%CI 1.89-3.69;N = 3项研究;I2 = 0%),但没有先兆偏头痛(OR 3.47, 95%CI = 0.53-22.89;n = 3, I2 = 73%)。结论:这项荟萃分析强调了子宫内膜异位症患者偏头痛的高患病率。然而,由于观察到的高异质性和偏倚风险,建议在临床实践中解释和应用这些发现时谨慎。未来的研究应该通过限制诊断标准的变化、对研究人群进行分层、考虑关键混杂因素、调查潜在的潜在病理生理机制来解决这些问题,以增强对子宫内膜异位症-偏头痛关系的理解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The association between endometriosis and migraine: a systematic review and meta-analysis of observational studies.

Background: Endometriosis affects women of reproductive age. Increasing attention is being given to the characterization of comorbidities in endometriosis to enhance clinical phenotyping. Among these comorbidities, migraine has been reported to be significantly more common in individuals with endometriosis compared to the general population. However, the true epidemiological burden remains uncertain, and no conclusive evidence links specific subtypes of endometriosis to migraine.

Main body: Seven electronic databases were searched from inception until July 22nd, 2024, using combinations of relevant keywords. PROSPERO Registration CRD42023449492. Two independent reviewers screened the records according to inclusion/exclusion criteria and abstracted data. The risk of bias assessment was undertaken using the ROBINS-E tool. Random effects models were implemented to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between endometriosis and migraine. Fourteen studies were included in the qualitative synthesis, and 13 in the meta-analysis, accounting for a total of 331,655 individuals (32,489 with endometriosis vs. 299,166 controls). There was a serious risk of bias in the majority of the included studies, with 50% being at very high risk of bias. The risk of migraine was higher in individuals with endometriosis compared to those without (OR 2.25, 95%CI = 1.85-2.72; n = 13 studies; I2 = 81%). This association remained significant in the sensitivity analyses: (i) when excluding studies at very high or high risk of bias (OR 2.64; 95%CI = 1.62-4.31; n = 4 studies; I2 = 77%), (ii) when including only risk estimates adjusted for clinically relevant confounders (OR 2.35; 95%CI = 1.77-3.13; n = 6 studies; I2 = 88%), and (iii) when including only risk estimates adjusted for hormonal therapy (OR 1.95; 95%CI = 1.42-2.66; n = 3; I2 = 92%). Endometriosis was significantly associated with migraine without aura (OR 2.64, 95%CI 1.89-3.69; n = 3 studies; I2 = 0%), but not migraine with aura (OR 3.47, 95%CI = 0.53-22.89; n = 3, I2 = 73%).

Conclusion: This meta-analysis highlights the high prevalence of migraine in patients with endometriosis. However, due to observed high heterogeneity and risk of bias, caution is advised when interpreting and applying these findings in clinical practice. Future research should address these issues by limiting variations in diagnostic criteria, stratifying study populations, accounting for key confounders, and investigating potential underlying pathophysiological mechanisms to enhance understanding of the endometriosis-migraine relationship.

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来源期刊
Journal of Headache and Pain
Journal of Headache and Pain 医学-临床神经学
CiteScore
11.80
自引率
13.50%
发文量
143
审稿时长
6-12 weeks
期刊介绍: The Journal of Headache and Pain, a peer-reviewed open-access journal published under the BMC brand, a part of Springer Nature, is dedicated to researchers engaged in all facets of headache and related pain syndromes. It encompasses epidemiology, public health, basic science, translational medicine, clinical trials, and real-world data. With a multidisciplinary approach, The Journal of Headache and Pain addresses headache medicine and related pain syndromes across all medical disciplines. It particularly encourages submissions in clinical, translational, and basic science fields, focusing on pain management, genetics, neurology, and internal medicine. The journal publishes research articles, reviews, letters to the Editor, as well as consensus articles and guidelines, aimed at promoting best practices in managing patients with headaches and related pain.
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