Carolina Headache Institute, 103 Market Street, Chapel Hill, NC, 27516, USA,
Curr Treat Options Neurol. 2012 Feb;14(1):1-14. doi: 10.1007/s11940-011-0153-6.
Menstrual migraine (MM) is often reported to be more severe and more resistant to treatment than other migraines. Nevertheless, initial treatment should be the same as for any migraine. When results of acute therapy are incomplete or unsatisfactory, preventive strategies are warranted, including both pharmacologic preventives and careful adherence to lifestyle modifications. Where MM differs from other attacks is in its predictable timing and discrete precipitants. These differences allow for unique preventive strategies that target either the timing of the attacks or their hormonal precipitants. Nonspecific MM strategies-those that do not address the hormonal mechanism-include scheduled dosing of nonsteroidal anti-inflammatory drugs (NSAIDs) or triptans throughout the menstrual window. NSAIDs are a good choice when there is comorbid dysmenorrhea and allow for treatment of breakthrough headaches with triptans. Both strategies require that the timing of MM is highly predictable. Specific strategies for MM are those that reduce or eliminate the premenstrual decline in estradiol that predictably precipitates attacks. These include continuous or extended-cycle dosing of combined hormonal contraceptives (CHCs). A number of common gynecologic comorbidities argue for early adoption of these treatments, as CHCs effectively treat dysmenorrhea, menorrhagia, ovarian cysts, endometriosis, and irregular cycles. In the author's experience, hormonal preventives are the best approach for most women whose menstrual attacks are resistant to acute therapy. They afford the greatest therapeutic benefit in prevention while treating common comorbidities and allowing for acute treatment with triptans when needed.
经期偏头痛（MM）通常比其他偏头痛更严重且更难治疗。然而，初始治疗应与任何偏头痛相同。在急性治疗效果不完全或不理想时，应采用预防策略，包括药物预防和仔细遵循生活方式改变。MM 与其他发作的区别在于其可预测的时间和离散的诱因。这些差异允许针对发作时间或其激素诱因的独特预防策略。非特异性 MM 策略（即不针对激素机制的策略）包括在整个月经期间定期使用非甾体抗炎药（NSAIDs）或曲坦类药物。当存在合并痛经时，NSAIDs 是一个不错的选择，并且允许使用曲坦类药物治疗突破性头痛。这两种策略都需要 MM 的时间高度可预测。针对 MM 的具体策略是那些减少或消除预测性发作的雌二醇经前期下降的策略。这些策略包括联合激素避孕药（CHC）的连续或延长周期给药。许多常见的妇科合并症都主张早期采用这些治疗方法，因为 CHC 可有效治疗痛经、月经过多、卵巢囊肿、子宫内膜异位症和不规律周期。根据作者的经验，对于大多数对急性治疗有抵抗的月经发作的女性，激素预防是最佳方法。它们在预防方面提供最大的治疗益处，同时治疗常见的合并症，并在需要时使用曲坦类药物进行急性治疗。
