Allais G, Benedetto C
Woman's Headache Center, Department of Gynecology and Obstetrics, University of Turin, Via Ventimiglia 3, I-10126 Turin, Italy.
Neurol Sci. 2004 Oct;25 Suppl 3:S229-31. doi: 10.1007/s10072-004-0292-6.
Migraine occurrence is strongly influenced by the hormonal fluctuations of the female reproductive cycle; at least 60% of women affected by migraine relate the periodicity of their attacks to the menstrual cycle. The so-called menstrual migraine, which occurs immediately before, during or at the end of the menstrual flow, has been a largely undefined condition, including some clinical subtypes which are not well defined. In the last edition of the International Classification of Headache Disorders (ICHD-II), menstrual migraine gained new attention in the Appendix, where three clinical patterns were pointed out: pure menstrual migraine without aura; menstrually related migraine without aura and non-menstrual migraine without aura. Menstrual migraine attacks show severe intensity, long duration (lasting even more than 72 h), marked unresponsiveness to pharmacological treatments, and present higher recurrence rate and work-related disability than non-menstrual attacks. The pharmacological treatment of menstrual migraine can require specific cyclic prophylactic approaches (non-steroidal anti-inflammatory drugs, coxibs, magnesium, long half-life triptans or oestrogen supplements in various formulations), but usually the low frequency of attacks suggests a first approach with specific symptomatic drugs. Preference should be given to triptans, due to their specificity in controlling migraine pain and its accompanying symptomatology; among them, in particular for sumatriptan, many specific studies proved a real effectiveness in the management of acute menstrual migraine attack.
偏头痛的发作受女性生殖周期激素波动的强烈影响；至少60%的偏头痛女性患者将其发作的周期性与月经周期联系起来。所谓的月经性偏头痛，发生在月经来潮前、期间或结束时，在很大程度上是一种未明确界定的病症，包括一些定义不明确的临床亚型。在最新版的《国际头痛疾病分类》（ICHD-II）中，月经性偏头痛在附录中受到了新的关注，其中指出了三种临床模式：无先兆的单纯月经性偏头痛；与月经相关的无先兆偏头痛和非月经性无先兆偏头痛。月经性偏头痛发作表现为强度严重、持续时间长（甚至超过72小时）、对药物治疗明显无反应，并且与非月经性发作相比，复发率更高，与工作相关的残疾率也更高。月经性偏头痛的药物治疗可能需要特定的周期性预防方法（非甾体抗炎药、环氧化酶-2抑制剂、镁、长半衰期曲坦类药物或各种制剂的雌激素补充剂），但通常发作频率较低，建议首先使用特定的对症药物。应优先选择曲坦类药物，因为它们在控制偏头痛疼痛及其伴随症状方面具有特异性；其中，特别是对于舒马曲坦，许多具体研究证明其在治疗急性月经性偏头痛发作方面具有实际疗效。
