From the Departments of Neurology (D.S.C., I.E.V., B.W.H.A., G.M.T.) and Medical Statistics (E.W.Z.), Leiden University Medical Center; and Division of Vascular Medicine and Pharmacology (D.S.C., I.E.V., B.W.H.A., A.M.V.D.B.), Erasmus University Medical Center, Rotterdam, the Netherlands.
Neurology. 2021 Oct 26;97(17):e1661-e1671. doi: 10.1212/WNL.0000000000012723. Epub 2021 Sep 7.
Endogenous and exogenous female sex hormones are considered important contributors to migraine pathophysiology. Previous studies have cautiously suggested that perimenstrual migraine attacks have a longer duration and are associated with higher disability compared to nonperimenstrual attacks, but they showed conflicting results on acute therapy efficacy, pain intensity, and associated symptoms. We compared perimenstrual and nonperimenstrual migraine attack characteristics and assessed premenstrual syndrome (PMS) in women with migraine.
Women with migraine were invited to complete a headache e-diary. Characteristics of perimenstrual attacks and nonperimenstrual attacks were compared. The primary outcome was attack duration. Secondary outcomes were headache intensity, accompanying symptoms, acute medication intake, and pain coping. Mixed effects models were used to account for multiple attacks within patients. PMS was assessed in patients without hormonal contraceptives. Subgroup analyses were performed for women with menstrually related migraine (MRM) and nonmenstrually related migraine (non-MRM) and women with a natural menstrual cycle and women using hormonal contraceptives.
A representative group of 500 participants completed the e-diary for at least 1 month. Perimenstrual migraine attacks (n = 998) compared with nonperimenstrual attacks (n = 4097) were associated with longer duration (20.0 vs 16.1 hours, 95% confidence interval 0.2-0.4), higher recurrence risk (odds ratio [OR] 2.4 [2.0-2.9]), increased triptan intake (OR 1.2 [1.1-1.4]), higher headache intensity (OR 1.4 [1.2-1.7]), less pain coping (mean difference -0.2 [-0.3 to -0.1]), more pronounced photophobia (OR 1.3 [1.2-1.4]) and phonophobia (OR 1.2 [1.1-1.4]), and less aura (OR 0.8 [0.6-1.0]). In total, 396/500 women completed the diary for ≥3 consecutive menstrual cycles, of whom 56% (221/396) fulfilled MRM criteria. Differences in attack characteristics became more pronounced when focusing on women with MRM and women using hormonal contraceptives. Prevalence of PMS was not different for women with MRM compared to non-MRM (11% vs 15%).
The longer duration of perimenstrual migraine attacks in women (with MRM) is associated with higher recurrence risk and increased triptan use. This may increase the risk of medication overuse and emphasizes the need to develop female-specific prophylactic treatment.
内源性和外源性女性性激素被认为是偏头痛病理生理学的重要因素。先前的研究谨慎地表明，与非经期偏头痛发作相比，经前期偏头痛发作持续时间更长，且与更高的残疾程度相关，但它们在急性治疗效果、疼痛强度和相关症状方面的结果相互矛盾。我们比较了经前期和非经期偏头痛发作的特征，并评估了偏头痛患者的经前期综合征（PMS）。
邀请偏头痛女性填写头痛电子日记。比较经前期发作和非经期发作的特征。主要结局是发作持续时间。次要结局是头痛强度、伴随症状、急性药物摄入和疼痛应对。混合效应模型用于解释患者内的多次发作。在没有激素避孕药的患者中评估 PMS。对与月经相关的偏头痛（MRM）和非月经相关的偏头痛（non-MRM）女性以及自然月经周期和使用激素避孕药的女性进行亚组分析。
500 名有代表性的参与者完成了至少 1 个月的电子日记。与非经期偏头痛发作（n=4097）相比，经前期偏头痛发作（n=998）持续时间更长（20.0 小时 vs. 16.1 小时，95%置信区间 0.2-0.4），复发风险更高（比值比[OR] 2.4 [2.0-2.9]），曲坦类药物摄入增加（OR 1.2 [1.1-1.4]），头痛强度更高（OR 1.4 [1.2-1.7]），疼痛应对能力降低（平均差异-0.2[-0.3 至-0.1]），畏光（OR 1.3 [1.2-1.4]）和畏声（OR 1.2 [1.1-1.4]）更明显，先兆（OR 0.8 [0.6-1.0]）更少。共有 500 名女性中的 396 名完成了至少 3 个连续的月经周期日记，其中 56%（221/396）符合 MRM 标准。当聚焦于有 MRM 的女性和使用激素避孕药的女性时，发作特征的差异更加明显。与 non-MRM 相比，有 MRM 的女性 PMS 的患病率没有差异（11% vs. 15%）。
女性经前期偏头痛发作时间较长（伴 MRM）与复发风险增加和曲坦类药物使用增加有关。这可能会增加药物过度使用的风险，并强调需要开发女性特异性预防治疗。
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