O'Brien Hope L, Cohen Joshua M
Department of Pediatrics, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Neurology - Mount Sinai Roosevelt Hospital, New York, NY, USA.
Headache. 2015 Nov-Dec;55(10):1404-9. doi: 10.1111/head.12706. Epub 2015 Oct 31.
Migraine is a common condition that for many begins in childhood and may progress over the course of one's life. The transition from adolescence to adulthood is a critical time for those who suffer from migraine and can be marked by a variety of important considerations for the patient and practitioner. Medication choices may be a challenge during adolescent years as Food and Drug Administration (FDA) approved options are few and many more studies are needed to understand the benefits and risks of use of these agents in adolescents. However, as patients transition to adulthood, FDA approved options and the level of evidence improve significantly. Late adolescents may also struggle with a variety of psychiatric comorbidities that may simultaneously create challenges in determining treatment but also open opportunities to manage multiple comorbidities and address underlying depression, anxiety, and behavioral issues. For late adolescent girls, the beginning of sexual activity, onset of gynecologic conditions, or presence of irregular or painful menses may raise questions regarding the use of oral contraceptives (OCs). Given data on the risks of these medications in women with migraine, especially those with aura or those who smoke, important conversations between physicians and their migraine patients can help risk stratify and determine the risk/benefit profile for the potential use of these agents. Much more data are needed to fully understand the transition from adolescence to adulthood for those suffering with migraine and this article seeks to shed light on the limited understanding currently available in established literature.
偏头痛是一种常见病症，许多人从童年时期就开始发病，且可能会在一生的过程中发展变化。对于偏头痛患者而言，从青少年期到成年期的转变是一个关键阶段，对患者和医生来说都有诸多重要的考量因素。在青少年时期，药物选择可能是一项挑战，因为美国食品药品监督管理局（FDA）批准的药物选择较少，还需要开展更多研究来了解这些药物在青少年中的使用益处和风险。然而，随着患者步入成年期，FDA批准的药物选择以及证据水平都有显著改善。接近成年的青少年可能还会面临各种精神疾病合并症，这在确定治疗方案时可能会带来挑战，但同时也为管理多种合并症以及解决潜在的抑郁、焦虑和行为问题提供了机会。对于接近成年的少女来说，开始性活动、出现妇科疾病或月经不规律或疼痛，可能会引发关于口服避孕药（OCs）使用的问题。鉴于这些药物在偏头痛女性患者中存在风险的数据，尤其是有先兆偏头痛的患者或吸烟者，医生与其偏头痛患者之间进行重要的沟通有助于进行风险分层，并确定这些药物潜在使用的风险/获益情况。对于偏头痛患者从青少年期到成年期的转变，还需要更多数据来全面了解，本文旨在阐明现有文献中目前有限的认识。
