Calhoun Anne H
Carolina Headache Institute, Durham, NC, USA.
Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA.
Headache. 2017 Feb;57(2):184-193. doi: 10.1111/head.12960. Epub 2016 Oct 24.
Unnecessary confusion still surrounds the use of combined hormonal contraceptives (CHCs) in the setting of migraine with aura (MwA). Clearing this confusion is a key issue for headache specialists, since most women with migraine have menstrual-related migraine (MRM), and some CHCs can prevent this particularly severe migraine. Their use, however, is still restricted by current guidelines due to concerns of increased stroke risk - concerns that originated over half a century ago in the era of high dose contraceptives. Yet studies consistently show that stroke risk is not increased with today's very low dose CHCs containing 20-25 µg ethinyl estradiol (EE), and continuous ultra low-dose formulations (10-15 µg EE) may even reduce aura frequency, thereby potentially decreasing stroke risk. This article clarifies the stroke risk of CHCs and examines their impact on migraine. It also examines how stroke risk is altered by the estrogen content of the CHC, by contributing factors such as smoking, age and hypertension, and by aura frequency. And finally, it puts these risks into a meaningful context with a risk/benefit assessment.
在伴先兆偏头痛（MwA）的情况下使用复方激素避孕药（CHC）仍存在不必要的困惑。消除这种困惑是头痛专家面临的关键问题，因为大多数偏头痛女性患有与月经相关的偏头痛（MRM），一些CHC可以预防这种特别严重的偏头痛。然而，由于担心中风风险增加，其使用仍受到现行指南的限制——这种担忧源于半个多世纪前高剂量避孕药的时代。然而，研究一致表明，当今含有20 - 25微克炔雌醇（EE）的极低剂量CHC不会增加中风风险，连续超低剂量制剂（10 - 15微克EE）甚至可能降低先兆频率，从而潜在地降低中风风险。本文阐明了CHC的中风风险，并研究了它们对偏头痛的影响。它还研究了CHC的雌激素含量、吸烟、年龄和高血压等促成因素以及先兆频率如何改变中风风险。最后，通过风险/效益评估将这些风险置于有意义的背景中。
