Merki-Feld Gabriele S, Epple Gina, Caveng Nina, Imthurn Bruno, Seifert Burkhardt, Sandor Peter, Gantenbein Andreas R
Department of Reproductive Endocrinology, University Hospital Zürich, Frauenklinikstrasse 10, CH - 8091, Zürich, Switzerland.
Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zürich, Zürich, Switzerland.
J Headache Pain. 2017 Aug 25;18(1):91. doi: 10.1186/s10194-017-0801-7.
Menstrually related migraine (MRM) in the hormone-free interval (HFI) of combined hormonal contraceptives (CHC) are according to the ICHD definition also estrogen withdrawal migraines (EWH). MRMs are less responsive to acute medication. Therefore short-term prevention, initiated 1-2 days before onset of the anticipated bleeding and continued for 6 days, is recommended. Such a long prophylactic triptan use might increase the risk for medication overuse headache in women suffering in addition from non-menstrual migraines. In CHC users onset of hormone decline is predictable. It is however unknown, whether the EWHs are rather associated with onset of hormone withdrawal or onset of bleeding. Improved understanding of this relation might contribute to better define and shorten the time interval for prevention.
For this observational diary-based pilot study we collected data from daily conducted headache diaries of CHC users with MRM in at least two of three cycles, visiting our clinic from 2009 to 2015. We analyzed frequency of migraines for each hormone free day, onset of migraine, onset of bleeding and the relation of migraine to onset of bleeding in the 7-day period following estrogen withdrawal. We identified in addition the onset of migraine attacks lasting more than 1 day (episodes).
Forty patient charts met the inclusion criteria, what allowed us to analyze 103 cycles. The mean number of migraine days in the HFI was 2.2 ± 1.6. Migraine started typically on days 1-5 and bleeding on days 3-5. In relation to first day of bleeding, migraines started on days -1 to 4. Almost half of the migraine attacks lasted longer than 24 h, despite the use of rescue medication.
MRM in CHC users starts on bleeding days -1 to 4, what differs from findings in the natural cycle. Referring to the HFI interval migraine started mostly on days 1-5. According to these data, it seems to be reasonable to initiate short-term prevention at the last day of pill use or the first day of the HFI and continue for 5 days.
根据国际头痛疾病分类（ICHD）的定义，复方激素避孕药（CHC）无激素间期（HFI）出现的与月经相关的偏头痛（MRM）也属于雌激素撤药性偏头痛（EWH）。MRM对急性药物治疗反应较差。因此，建议在预期出血开始前1 - 2天开始进行短期预防，并持续6天。对于同时患有非月经性偏头痛的女性，长期预防性使用曲坦类药物可能会增加药物过量使用性头痛的风险。在CHC使用者中，激素下降的开始是可预测的。然而，尚不清楚EWH是与激素撤药的开始还是与出血的开始更相关。对这种关系的深入理解可能有助于更好地确定和缩短预防的时间间隔。
在这项基于观察日记的前瞻性研究中，我们收集了2009年至2015年期间至少三个周期中有MRM的CHC使用者的每日头痛日记数据。我们分析了每个无激素日的偏头痛频率、偏头痛发作时间、出血发作时间以及雌激素撤药后7天内偏头痛与出血发作的关系。此外，我们还确定了持续超过1天的偏头痛发作（发作期）的开始时间。
40份患者病历符合纳入标准，这使我们能够分析103个周期。HFI期间偏头痛的平均天数为2.2±1.6天。偏头痛通常在第1 - 5天开始，出血在第3 - 5天开始。相对于出血的第一天，偏头痛在第 - 1至4天开始。尽管使用了急救药物，但几乎一半的偏头痛发作持续超过24小时。
CHC使用者的MRM在出血前第1至4天开始，这与自然周期中的发现不同。关于HFI间期，偏头痛大多在第1 - 5天开始。根据这些数据，在停药的最后一天或HFI的第一天开始进行短期预防并持续5天似乎是合理的。
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