aDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland bCarolina Headache Institute, University of North Carolina, Chapel Hill, North Carolina, USA.
Curr Opin Neurol. 2014 Jun;27(3):315-24. doi: 10.1097/WCO.0000000000000091.
The aim is to systematically and critically review the relationship between migraine and estrogen, the predominant female sex hormone, with a focus on studies published in the last 18 months.
Recent functional MRI (fMRI) studies of the brain support the existence of anatomical and functional differences between men and women, as well as between participants with migraine and healthy controls. In addition to the naturally occurring changes in endogenous sex hormones over the lifespan (e.g. puberty and menopause), exogenous sex hormones (e.g. hormonal contraception or hormone therapy) also may modulate migraine. Recent data support the historical view of an elevated risk of migraine with significant drops in estrogen levels. In addition, several lines of research support that reducing the magnitude of decline in estrogen concentrations prevents menstrually related migraine (MRM) and migraine aura frequency.
Current literature has consistently demonstrated that headache, in particular migraine, is more prevalent in women as compared with men, specifically during reproductive years. Recent studies have found differences in headache characteristics, central nervous system anatomy, as well as functional activation by fMRI between the sexes in migraine patients. Although the cause underlying these differences is likely multifactorial, considerable evidence supports an important role for sex hormones. Recent studies continue to support that MRM is precipitated by drops in estrogen concentrations, and minimizing this decline may prevent these headaches. Limited data also suggest that specific regimens of combined hormone contraceptive use in MRM and migraine with aura may decrease both headache frequency and aura.
目的在于系统地、批判性地综述偏头痛与雌激素（主要的女性性激素）之间的关系，重点关注过去 18 个月内发表的研究。
最近对大脑的功能性磁共振成像（fMRI）研究支持了男性和女性之间以及偏头痛患者和健康对照者之间存在解剖和功能差异。除了内源性性激素在整个生命周期中（如青春期和更年期）的自然变化外，外源性性激素（如激素避孕或激素治疗）也可能调节偏头痛。最近的数据支持了雌激素水平显著下降会增加偏头痛风险的历史观点。此外，有几条研究线支持降低雌激素浓度下降幅度可以预防与月经相关的偏头痛（MRM）和偏头痛先兆的频率。
目前的文献一致表明，与男性相比，偏头痛尤其是头痛在女性中更为常见，尤其是在生育期。最近的研究发现，偏头痛患者的头痛特征、中枢神经系统解剖结构以及 fMRI 功能性激活方面存在性别差异。尽管这些差异的根本原因可能是多因素的，但有大量证据表明性激素起着重要作用。最近的研究继续支持雌激素浓度下降会引发 MRM，并且尽量减少这种下降可能会预防这些头痛。有限的数据还表明，MRM 和有先兆偏头痛中联合激素避孕的特定方案可能会降低头痛发作的频率和先兆。
