Maasumi Kasra, Tepper Stewart J, Kriegler Jennifer S
Department of Neurology Headache Center, University of California at San Francisco, San Francisco, CA, USA.
Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Headache. 2017 Feb;57(2):194-208. doi: 10.1111/head.12978. Epub 2016 Dec 2.
A review of treatment options for menstrual migraine.
Migraine affects ∼30 million people in the US. A subset of female migraineurs have migraines that are mainly associated with menstruation. Menstrual migraine (MM) is divided into pure MM and menstrually related migraine. Pure MM attacks occur only with menstruation and have a prevalence of 1%. Menstrually related migraine has a prevalence of 6-7%, and occurs both during menstruation as well as during the rest of the cycle. MM is usually without aura and is more severe, longer lasting, and more resistant to treatment due to the effects of ovarian hormones, specifically estrogen. MM treatment is divided into acute, short-term prophylaxis, and daily prevention. The best-studied acute treatments are triptans. For short-term prophylaxis, triptans, non-triptans, or combinations are used. Some preventive medications may be used daily to prevent MM. Many anti-epileptic medications used in migraine prevention can affect the efficacy of oral contraceptives and hormonal treatments, so caution is indicated when these are used.
PubMed, Scopus, Cochrane, and Embase were searched for MM and treatments.
Many randomized, placebo-controlled, prospective studies have evaluated the efficacy of sumatriptan, rizatriptan, naratriptan, zolmitriptan, and almotriptan in MM. Reviewing numerous studies with statistically significant results, rizatriptan has the best overall evidence for acute treatment of MM, ranging from pain-free responses of 33-73% at 2 hours. Sumatriptan and rizatriptan have shown similar efficacies of 61-63% in terms of 2 hour pain freedom. Rizatriptan showed sustained pain relief between 2 and 24 hours with an efficacy of 63% and sustained pain freedom for MM between 2 and 24 hours with an efficacy of 32%. For short-term prevention of MM, there were four randomized controlled trials for frovatriptan taken twice daily, one trial for zolmitriptan taken three times daily, and two studies for naratriptan taken twice daily, all of which showed statistically significant results. Among studies on non-triptans for short-term prevention of MM, magnesium, estrogen, naproxen sodium, and dihydroergotamine all had statistically significant results. Many antiepileptic medications taken for prevention of MM can cause enzyme induction affecting oral contraceptives (OCs) and hormonal treatments to different degrees. Topiramate has the least effect on OCs at doses below 200 mg/day. Lamotrigine noticeably decreases oral contraceptive levels; however, the evidence for it as a preventive medication is not strong.
MM can be very difficult to treat. For acute treatments, rizatriptan has the best overall evidence. For short-term prevention, frovatriptan, zolmitriptan, or naratriptan, as well as magnesium, estrogen, naproxen sodium, or dihydroergotamine may be useful.
综述月经性偏头痛的治疗选择。
偏头痛在美国影响约3000万人。一部分女性偏头痛患者的偏头痛主要与月经有关。月经性偏头痛（MM）分为纯月经性偏头痛和月经相关性偏头痛。纯月经性偏头痛仅在月经期间发作，患病率为1%。月经相关性偏头痛患病率为6 - 7%，在月经期间以及月经周期的其余时间均可发作。MM通常无先兆，由于卵巢激素尤其是雌激素的影响，症状更严重、持续时间更长且更难治疗。MM治疗分为急性治疗、短期预防和每日预防。研究最多的急性治疗药物是曲坦类药物。短期预防可使用曲坦类药物、非曲坦类药物或联合用药。一些预防性药物可每日使用以预防MM。许多用于预防偏头痛的抗癫痫药物会影响口服避孕药和激素治疗的疗效，因此使用时需谨慎。
检索PubMed、Scopus、Cochrane和Embase数据库中关于MM及其治疗的文献。
许多随机、安慰剂对照的前瞻性研究评估了舒马曲坦、利扎曲坦、那拉曲坦、佐米曲坦和阿莫曲坦在MM中的疗效。回顾众多具有统计学显著结果的研究，利扎曲坦在MM急性治疗方面总体证据最佳，2小时无痛反应率为33% - 73%。舒马曲坦和利扎曲坦在2小时无痛方面显示出相似的疗效，为61% - 63%。利扎曲坦在2至24小时显示持续疼痛缓解，疗效为63%，在2至24小时MM持续无痛疗效为32%。对于MM的短期预防，有四项关于每日服用两次夫罗曲坦的随机对照试验，一项关于每日服用三次佐米曲坦的试验，以及两项关于每日服用两次那拉曲坦的研究，所有这些研究均显示出统计学显著结果。在关于非曲坦类药物用于MM短期预防的研究中，镁、雌激素、萘普生钠和双氢麦角胺均有统计学显著结果。许多用于预防MM的抗癫痫药物可导致酶诱导，不同程度地影响口服避孕药（OCs）和激素治疗。托吡酯在每日剂量低于200毫克时对OCs影响最小。拉莫三嗪显著降低口服避孕药水平；然而，其作为预防性药物的证据并不充分。
MM可能非常难以治疗。急性治疗方面，利扎曲坦总体证据最佳。短期预防方面，夫罗曲坦、佐米曲坦或那拉曲坦，以及镁、雌激素、萘普生钠或双氢麦角胺可能有效。
