The City of London Migraine Clinic, London, UK.
Headache. 2010 Apr;50(4):528-38. doi: 10.1111/j.1526-4610.2010.01625.x. Epub 2010 Mar 2.
To compare, using a within-woman analysis, the severity, duration, and relapse of menstrual vs nonmenstrual episodes of migraine during treatment with usual migraine therapy.
Studies comparing the clinical characteristics of menstrual and nonmenstrual migraine attacks have yielded conflicting results, contributing to disagreement regarding whether menstrual migraine attacks are clinically more problematic than nonmenstrual migraine attacks.
Post hoc within-woman analysis of the usual-care phase (month 1) of a 2-month, multicenter, prospective, open-label study at 21 US medical practices (predominantly primary care). Participants were women > or =18 years of age with regular predictable menstrual cycles (28 +/- 4 days) who self-reported a > or =1-year history of migraine attacks occurring between days -2 and +3 (menses onset = day +1) and > or =8 such attacks within the previous 12 cycles. Migraine treatment episodes were categorized as menstrual (occurring on days -2 to +3 of menses) or nonmenstrual (occurring on days +4 to -3 of menses). Pain severity, functional impairment, duration, relapse in 24 hours, and use of rescue medication were compared. Sources of variability (within- or between-patient) were determined using mathematical modeling. The http://www.clinicaltrial.gov code for trial is NCT00904098.
Women (n = 153; intent to treat) reported 212 menstrual (59.2%) and 146 nonmenstrual (40.8%) migraine treatment episodes. Compared with nonmenstrual treatment episodes, menstrual episodes were more likely to cause impairment (unadjusted odds ratio, 1.65, 95% CI, 1.05-2.60; P = .03), were longer (unadjusted hazard ratio 1.68; 95% CI, 1.31-2.16; P < .001), and were more likely to relapse within 24 hours (unadjusted odds ratio, 2.66; 95% CI, 1.25-5.68; P = .01). Within-patient effects accounted for only 18-33% of the total variance in these outcomes.
Post hoc, within-woman analysis of migraine treatment episodes categorized based on International Headache Society criteria showed that menstrual treatment episodes were more impairing, longer lasting, and more likely to relapse than nonmenstrual treatment episodes in this selected population of women with frequent menstrual migraine. The current analysis indicates that most of the variability in these outcomes is due to differences between headache types and not within-patient differences for a given type of headache, suggesting that menstrual episodes are potentially treatable. These findings underscore the differences between menstrual and nonmenstrual episodes of migraine and the need to offer effective migraine treatment to women.
通过对接受常规偏头痛治疗的女性患者进行个体内分析，比较月经性偏头痛与非月经性偏头痛发作的严重程度、持续时间和复发情况。
比较月经性偏头痛发作与非月经性偏头痛发作临床特征的研究结果存在差异，这导致人们对于月经性偏头痛发作是否比非月经性偏头痛发作更具临床问题存在分歧。
在 21 家美国医疗机构（主要为初级保健机构）开展的为期 2 个月、多中心、前瞻性、开放标签研究的常规治疗期（第 1 个月）进行个体内事后分析。参与者为年龄 > 或 =18 岁、月经周期规律（28 +/- 4 天）的女性，自述 > 或 =1 年偏头痛发作史，发作发生于月经周期的第 -2 天至第 +3 天（月经开始 = 第 +1 天），并且在过去 12 个周期中发作 > 或 =8 次。偏头痛治疗发作分为月经性（发生于月经周期的第 -2 天至第 +3 天）或非月经性（发生于月经周期的第 +4 天至第 -3 天）。比较疼痛严重程度、功能障碍、持续时间、24 小时内复发情况和使用解救药物情况。采用数学模型确定变异源（个体内或个体间）。试验的 http://www.clinicaltrial.gov 注册号为 NCT00904098。
153 名女性（意向治疗）报告了 212 次月经性（59.2%）和 146 次非月经性（40.8%）偏头痛治疗发作。与非月经性治疗发作相比，月经性治疗发作更有可能导致功能障碍（未经调整的优势比，1.65，95%可信区间，1.05-2.60；P =.03），持续时间更长（未经调整的危险比，1.68；95%可信区间，1.31-2.16；P <.001），并且在 24 小时内更有可能复发（未经调整的优势比，2.66；95%可信区间，1.25-5.68；P =.01）。这些结局的总变异中只有 18%-33%是个体内效应引起的。
根据国际头痛协会标准对偏头痛治疗发作进行个体内事后分析显示，在选择的具有频繁月经性偏头痛的女性人群中，月经性治疗发作比非月经性治疗发作更具致残性、持续时间更长、并且更有可能在 24 小时内复发。目前的分析表明，这些结局的大多数变异性是由于头痛类型的差异引起的，而不是同一类型头痛的个体内差异，提示月经性偏头痛发作可能是可以治疗的。这些发现强调了月经性偏头痛与非月经性偏头痛发作之间的差异，以及为女性提供有效偏头痛治疗的必要性。
