Tietjen Gretchen E, Conway Anita, Utley Christine, Gunning William T, Herial Nabeel A
Department of Neurology, Medical College of Ohio, Toledo 43614, USA.
Headache. 2006 Mar;46(3):422-8. doi: 10.1111/j.1526-4610.2006.00290.x.
To evaluate the frequency of menorrhagia and endometriosis in female migraineurs compared to age-matched women without headache.
Migraine predominantly affects women of childbearing age and is often associated with the menstrual period, yet there is a paucity of data regarding the relationship of migraine and menstrual disorders.
Women diagnosed with migraine, using International Headache Society criteria and an age- and sex-matched control group, were administered a semistructured questionnaire regarding migraine and migraine-related disability, menstrual history, other bleeding history, vascular event history, and vascular risk factors.
Fifty female migraineurs between the ages of 22 and 50 years and 52 age-matched women (mean age 37 years) were enrolled in the study. Similar proportions of women in each group reported using hormone contraceptives (30% vs. 33%, P = .77) and hormone replacement therapy (12% vs. 8%, P = .69). The proportions presently menstruating (64 % vs. 80%, P = .20) and status after hysterectomy were similar (24% vs. 14%, P = .84). Menorrhagia (defined as at least three consecutive heavy periods), both current and prior, was more commonly reported in migraineurs (63% vs. 37%, P = .009), with higher likelihood of staining clothes by menses (35% vs. 8%, P = .003), and significant impact of menses on activities of daily living (on a 10-point Likert scale) with work/school participation (P = .02), family activities (P < .0001), sleep (P = .003), life enjoyment (P = .001), mood (P = .02), and overall quality of life (P = .003). Endometriosis, which may be associated with menorrhagia, was also more commonly diagnosed in the migraineurs (30% vs. 4%, P = .001). The migraineurs more frequently described bruising (40% vs. 10%, P < .001) and rectal bleeding (18% vs. 2%, P = .017) but not more serious bleeding problems. Nonsteroidal anti-inflammatory drug (NSAID) use was more frequent in the migraine group (28% vs. 12%, P = .036), and significance for increased menorrhagia, endometriosis, menstrual interference, and bruising was maintained, even when controlling for the use of NSAIDs. With logistic regression, menorrhagia was significantly associated with migraine, adjusted odds ratio (OR) = 2.8 (95% CI 1.2 to 6.5), and with endometriosis, adjusted OR = 10.5 (95% CI 2.2 to 51.4). There were no differences in vascular events and risk factors, except for trends of increased hypertension (25% vs. 10%, P = .05), transient ischemic attack/stroke (10% vs. 2%, P = .08), and Raynaud's disease (10% vs. 2%, P = .08) in the migraineurs.
Women with migraine have a higher frequency of menorrhagia, endometriosis, and associated psychosocial consequences. These findings suggest that there should be further study of factors influencing endometriosis and menstrual blood flow, such as eicosanoids and platelet function, in migraineurs.
评估女性偏头痛患者与年龄匹配的无头痛女性相比，月经过多和子宫内膜异位症的发生率。
偏头痛主要影响育龄女性，且常与月经期相关，但关于偏头痛与月经紊乱之间关系的数据较少。
采用国际头痛协会标准诊断为偏头痛的女性以及年龄和性别匹配的对照组女性，接受了一份关于偏头痛及偏头痛相关残疾、月经史、其他出血史、血管事件史和血管危险因素的半结构化问卷。
50名年龄在22至50岁之间的女性偏头痛患者和52名年龄匹配的女性（平均年龄37岁）纳入研究。每组中使用激素避孕药的女性比例相似（30%对33%，P = 0.77），使用激素替代疗法的比例也相似（12%对8%，P = 0.69）。目前正在月经的比例（64%对80%，P = 0.20）以及子宫切除术后的状况相似（24%对14%，P = 0.84）。偏头痛患者中，当前和既往月经过多（定义为至少连续三个月经量多的时期）的报告更为常见（63%对37%，P = 0.009），月经弄脏衣服的可能性更高（35%对8%，P = 0.003），月经对日常生活活动有显著影响（采用10分制李克特量表），包括工作/学习参与（P = 0.02）、家庭活动（P < 0.0001）、睡眠（P = 0.003）、生活乐趣（P = 0.001）、情绪（P = 0.02）和总体生活质量（P = 0.003）。可能与月经过多相关的子宫内膜异位症在偏头痛患者中也更常被诊断出（30%对4%，P = 0.001）。偏头痛患者更频繁地描述有瘀伤（40%对10%，P < 0.001）和直肠出血（18%对2%，P = 0.017），但没有更严重的出血问题。偏头痛组使用非甾体抗炎药（NSAID）的频率更高（28%对12%，P = 0.036），即使在控制NSAID使用后，月经过多、子宫内膜异位症、月经干扰和瘀伤增加的显著性仍然存在。通过逻辑回归分析，月经过多与偏头痛显著相关，调整后的优势比（OR） = 2.8（95%可信区间1.2至6.5），与子宫内膜异位症相关，调整后的OR = 10.5（95%可信区间2.2至51.4）。除偏头痛患者中高血压（25%对10%，P = 0.05）、短暂性脑缺血发作/中风（10%对2%，P = 0.08）和雷诺病（10%对2%，P = 0.08）有增加趋势外，血管事件和危险因素没有差异。
偏头痛女性月经过多、子宫内膜异位症及相关心理社会后果的发生率更高。这些发现表明，应进一步研究影响偏头痛患者子宫内膜异位症和月经血流量的因素，如类花生酸和血小板功能。
