MacGregor E Anne
Continuum (Minneap Minn). 2015 Aug;21(4 Headache):990-1003. doi: 10.1212/CON.0000000000000196.
Migraine is most prevalent in women during their reproductive years. An understanding of the effects of menstruation and menopause on migraine can enable neurologists to provide targeted and appropriate medical and hormonal strategies, enabling their patients to achieve better control of migraine and reduced disability. This article reviews the effects of hormonal events on migraine and summarizes the evidence-based options available for management.
Estrogen "withdrawal" during the late luteal phase of the natural menstrual cycle and the hormone-free interval of combined hormonal contraceptives has long been implicated in the pathophysiology of menstrual migraine. However, more recent research suggests that other independent mechanisms may be relevant. Prostaglandin inhibitors used for management of dysmenorrhea are effective for associated menstrual migraine, suggesting a common pathophysiology. The interplay between serotonin and estrogen also deserves further research.
Menstrual and perimenopausal migraine can be managed effectively using a variety of strategies, the choice of which depends on the efficacy of acute treatment, predictability and regularity of menstruation, use of contraception, and presence of menstrual disorders or perimenopausal vasomotor symptoms.
偏头痛在育龄女性中最为常见。了解月经和绝经对偏头痛的影响，可使神经科医生能够提供有针对性且合适的药物和激素治疗方案，帮助患者更好地控制偏头痛并减少功能障碍。本文回顾了激素变化对偏头痛的影响，并总结了基于证据的可供选择的治疗方法。
自然月经周期黄体晚期的雌激素“撤退”以及复方激素避孕药的无激素间期，长期以来一直被认为与月经性偏头痛的病理生理学有关。然而，最近的研究表明其他独立机制可能也起作用。用于治疗痛经的前列腺素抑制剂对相关的月经性偏头痛有效，提示存在共同的病理生理学机制。5-羟色胺与雌激素之间的相互作用也值得进一步研究。
月经性和围绝经期偏头痛可通过多种策略有效治疗，具体选择取决于急性治疗的疗效、月经的可预测性和规律性、避孕措施的使用以及是否存在月经紊乱或围绝经期血管舒缩症状。
