Índice pronóstico de cronicidad en pacientes con migraña
DOI:
https://doi.org/10.22379/anc.2028Palabras clave:
Cefalea, Cefaleas primarias, Dolor crónico, Índice, Pronóstico, CausalidadResumen
Introducción: la migraña crónica es una cefalea primaria incapacitante, con gran impacto personal, social y económico. Su progresión desde la forma episódica depende de múltiples factores, cuya identificación permite anticipar el riesgo de cronicidad.
Materiales y métodos: se realizó un estudio observacional y analítico en pacientes atendidos en la consulta externa de cefalea del Hospital Clínico Quirúrgico “Hermanos Ameijeiras”, entre enero de 2017 y diciembre de 2022. Se analizaron variables clínicas y sociodemográficas, y se construyó un modelo predictivo validado mediante regresión logística y validación cruzada.
Resultados: el insomnio (P < 0,000), la ausencia de tratamiento preventivo (P < 0,000), el sobreconsumo de medicamentos (P < 0,000) y el grado de discapacidad (P < 0,000) se asociaron significativamente con la migraña crónica. El modelo alcanzó una exactitud del 91,2%, una sensibilidad del 97,3%, una especificidad del 66,7% y un área bajo la curva ROC (receiver operating characteristic) de 0,923. El índice derivado mostró una adecuada validación externa y permitió estratificar el riesgo en tres categorías: bajo (IP <5,284), intermedio (5,284 ≤ IP ≤ 8,216) y alto (IP >8,216).
Discusión: a diferencia de lo informado en otros estudios, factores como edad y sexo no influyeron significativamente en la evolución hacia la cronicidad. El insomnio y el sobreconsumo de fármacos emergieron como predictores clave, en concordancia con evidencia internacional, y la discapacidad también se confirmó como determinante clínico relevante.
Conclusiones: el índice pronóstico creado presenta un muy buen rendimiento y un adecuado poder discriminante, lo que constituye una herramienta útil para estratificar el riesgo de cronicidad en pacientes con migraña.
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