John R. Graham Headache Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Headache. 2020 Jan;60(1):200-216. doi: 10.1111/head.13665. Epub 2019 Oct 3.
The peak prevalence of migraine occurs in women of reproductive age, and women experience a higher burden of migraine symptoms and disability compared to men. This increased burden of migraine in women is related to both developmental and temporally variable activational effects of female sex hormones. Changing levels of female sex hormones affect the expression of migraine during pregnancy, and, to a lesser degree, lactation, and are the mechanism underlying menstrual migraine. This review describes the evidence for sex differences in the expression of migraine across the reproductive epoch; reviews the epidemiology of migraine during pregnancy, lactation, and menses; and summarizes the available evidence for safety and efficacy of acute treatments during pregnancy and lactation and for menstrual migraine. Areas of controversy in treatment of migraine during pregnancy, including the use of magnesium, triptans vs butalbital combination medications, and onabotulinum toxin, are also explored.
偏头痛的发病高峰出现在生育年龄的女性中，与男性相比，女性偏头痛症状和残疾的负担更重。女性偏头痛负担加重与女性性激素的发育和时变激活作用有关。女性性激素水平的变化会影响怀孕期间偏头痛的表现，在一定程度上也会影响哺乳期偏头痛的表现，而这正是月经性偏头痛的发病机制。本综述描述了偏头痛在生殖期的表现存在性别差异的证据；综述了怀孕期间、哺乳期和月经期偏头痛的流行病学；并总结了怀孕期间和哺乳期急性治疗以及月经性偏头痛的安全性和有效性的现有证据。还探讨了怀孕期间偏头痛治疗方面的争议领域，包括镁的使用、曲坦类药物与含可待因复方制剂的比较，以及肉毒毒素的应用。
