Marcus D A, Scharff L, Turk D
Departments of Anesthesiology and Neurology, University of Pittsburgh (Penn) School of Medicine, USA.
Headache. 1999 Oct;39(9):625-32. doi: 10.1046/j.1526-4610.1999.3909625.x.
Chronic headache fluctuates in response to changes in hormonal levels. Headache generally improves with rising estrogen levels, and worsens with falling levels. Headache should, therefore, predictably improve with pregnancy and worsen postpartum. Several retrospective studies have confirmed this pattern. In this study, 49 pregnant women with chronic headache (18 with migraine, 16 with tension-type, and 15 with combined migraine and tension-type) were followed prospectively. Headache activity was recorded daily throughout pregnancy and for 3 months postpartum. Overall, there was a 30% improvement in headache between the second and third trimesters for the entire sample. This was not statistically significant. Headache improved significantly for 41% of the women, with a slightly greater tendency for headache to improve in women with migraine compared to those with tension-type or combined migraine and tension-type headaches. Headache activity was not influenced by history of menstrual migraine, history of headache change with prior pregnancies, parity, or breast-feeding. In general, women reporting headache at the end of their first trimester continued to report headache throughout pregnancy and postpartum.
慢性头痛会随着激素水平的变化而波动。头痛通常会随着雌激素水平的升高而改善，随着雌激素水平的下降而加重。因此，头痛在孕期应可预见地改善，而在产后恶化。多项回顾性研究证实了这种模式。在本研究中，对49名患有慢性头痛的孕妇（18名偏头痛患者、16名紧张型头痛患者以及15名偏头痛合并紧张型头痛患者）进行了前瞻性随访。在整个孕期及产后3个月每天记录头痛活动情况。总体而言，整个样本在孕中期和孕晚期之间头痛改善了30%。这在统计学上无显著意义。41%的女性头痛明显改善，与紧张型头痛或偏头痛合并紧张型头痛的女性相比，偏头痛女性的头痛改善趋势略大。头痛活动不受月经性偏头痛病史、既往妊娠时头痛变化史、产次或母乳喂养的影响。一般来说，在孕早期末报告有头痛的女性在整个孕期及产后仍会报告头痛。
