青少年和年輕成人之重度憂鬱症共病偏頭痛與雙相性疾患的風險：全國性追蹤性研究

Migraine Comorbidity and Subsequent Diagnostic Conversion to Bipolar Disorder among Adolescents and Young Adults with Major Depression: A Nationwide Longitudinal Study

背景：偏頭痛常和重度憂鬱症或雙相性疾患共病。偏頭痛病人有較高的雙相性疾患的 風險，但其在重度憂鬱症轉換為雙相性疾患的風險和角色仍未明。方法：利用台灣健保資 料庫，在 2002 年至 2008 年間，2120 位重度憂鬱症合併偏頭痛的青少年和年輕成人與 10,600 位年紀性別配合但僅有重度憂鬱症的個案納入本研究，且追蹤至 2011 年底。分析其診斷是 否從重度憂鬱症轉換為雙相性疾患。結果：合併偏頭痛的重度憂鬱症病人相較於僅有重度憂 鬱症的病人，有顯著的較高的風險在追蹤期間其診斷轉換為雙相性疾患 (hazard ratio = 1.31, 95% confidence interval = 1.16 - 1.48 p < 0.001)。這些雙相性疾患較轉換的病人有顯著的有合 併焦慮症 (HR = 1.68, 95% CI = 1.49 - 1.88, p < 0.001)、物質使用疾患 (HR = 2.34, 95% CI = 1.98 - 2.76, p < 0.001)、酒精使用疾患 (HR = 1.70, 95% CI = 1.37 - 2.10, p < 0.001)、行為疾患 (HR = 1.50, 95% CI = 1.01 - 2.11, p < 0.05)、和注意力不足過動症 (HR = 1.91, 95% CI = 1.41 - 2.59, p < 0.001) 的風險。結論：重度憂鬱症病人帶有偏頭痛共病，也許可以作為雙相性疾患體質的臨 床標記。

Background: Migraine is commonly comorbid with major depression and bipolar disorder. Previous studies suggested that patients with migraine have a higher prevalence of bipolar disorder, but the possible role of migraine comorbidity in the diagnostic conversion to bipolar disorder among patients with major depression is still unknown. Methods: With the Taiwan National Health Insurance Research Database, we enrolled 12,720 adolescents and young adults with major depression between 2002 and 2008 in this study. Totally, 2,120 patients had migraine comorbidity and 10,600 (1: 5) age- and sex-matched patients did not. We followed up the study subjects to the end of 2011, and identified those who developed bipolar disorder during the follow-up. Results: Cox regression analysis with adjustment of demographic data and psychiatric comorbidities showed that patients with major depression and migraine had significantly more diagnostic conversion to bipolar disorder (hazard ratio = 1.31, 95% confidence interval = 1.16 - 1.48, p = 0.001) than those without migraine. Furthermore, those MDD patients with conversion to bipolar disorder were found to be significantly more comobid with anxiety disorder (HR = 1.68, 95% CI = 1.49 - 1.88, p < 0.001), to be significantly more comorbid with substance use disorder (HR = 2.34, 95% CI = 1.98 - 2.76, p < 0.001), to be significantly more comorbid with alcohol use disorder (HR = 1.70, 95% CI = 1.37 - 2.10, p < 0.001), to be significantly more disrupted behavior disorder (HR = 1.50, 95% CI = 1.01 - 2.11, p < 0.05), and to be more comorbid with attention deficit/hyperactivity disorder (HR = 1.91, 95% CI = 1.41 - 2.59, p, p < 0.001). Discussion: The comorbidity of migraine among adolescents and young adult patients with major depression increased the risk of developing subsequent bipolar disorder, compared to those without migraine. Migraine comorbidity may be a clinical marker to indicate the bipolar trait among major depression patients.