MacGregor E A
The City of London Migraine Clinic, United Kingdom.
Maturitas. 2009 May 20;63(1):51-5. doi: 10.1016/j.maturitas.2009.03.016. Epub 2009 Apr 16.
Four of every 10 women will experience migraine at some time in their lives, with peak prevalence in middle life. Evidence supports estrogen 'withdrawal' as one of the important triggers of menstrual attacks of migraine without aura. Improvement of migraine without aura postmenopause is generally attributed to the absence of variations in sex hormone levels. Maintaining a stable estrogen environment is best achieved using non-oral estrogen replacement. Unlike migraine without aura, migraine with aura is recognized as a marker for increased risk of ischemic stroke. Research suggests that aura may be more likely to affect women with underlying coagulation disorders. This could, at least in part, account for both increased risk of stroke and the dose related effect of estrogen replacement on the development of aura. Hence women with migraine with aura requiring estrogen replacement should be given the lowest effective dose necessary to control menopause symptoms, by a non-oral route.
每10名女性中就有4人在其一生中的某个时候会经历偏头痛，在中年时患病率达到峰值。有证据支持雌激素“撤退”是无先兆偏头痛月经发作的重要触发因素之一。绝经后无先兆偏头痛的改善通常归因于性激素水平无变化。使用非口服雌激素替代疗法可最好地维持稳定的雌激素环境。与无先兆偏头痛不同，有先兆偏头痛被认为是缺血性中风风险增加的一个标志。研究表明，先兆可能更易影响患有潜在凝血障碍的女性。这至少可以部分解释中风风险增加以及雌激素替代对先兆发生的剂量相关效应。因此，需要雌激素替代的有先兆偏头痛女性应通过非口服途径给予控制更年期症状所需的最低有效剂量。
