University of South Dakota Sanford School of Medicine.
Sanford Fertility and Reproductive Medicine, Sioux Falls, South Dakota.
S D Med. 2021 Dec;74(12):570-575.
"Menstrual" or "catamenial" migraine (MM) is separated into two categories in the International Classification of Headache Disorders pure menstrual migraine and menstrually-related migraine. Pure menstrual migraine is defined as a migraine occurring exclusively on day 1 ± 2 of menstruation in at least two out of three menstrual cycles and at no other time in the cycle. Menstrually-related migraine is defined as the same but may occur at other times in the menstrual cycle, not just around menstruation. The withdrawal of estrogen has been correlated with the onset of MM, providing an opportunity for specific treatment with hormone therapies. Traditionally, MM has been treated with nonspecific treatments such as abortive and prophylactic non-steroidal anti-inflammatory drugs and triptans. While this is first line, evidence suggests that nonspecific treatments can be used in combination with specific hormone treatments. The hormone treatment recommended is either continuous combined hormonal contraceptives (CHCs) with no placebo pills or using just two days of placebo pills to avoid the estrogen withdrawal trigger. Although MM with aura is uncommon, when referring to using CHCs for MM with aura, the U.S. Medical Eligibility Criteria for Contraceptive Use 2016 categorizes MM with aura as "A condition that represents an unacceptable health risk if the contraceptive method is used." Therefore, the current recommendation is not to use CHCs with a history of menstrual migraine with aura, especially when other risk factors such as smoking are present. Other treatments such as GnRH agonists, selective estrogen receptor modulators, and bilateral oophorectomy have limited evidence.
“月经”或“月经相关”偏头痛（MM）在国际头痛疾病分类中分为两类：单纯月经性偏头痛和与月经相关的偏头痛。单纯月经性偏头痛定义为至少在三个月经周期中的两个周期中，仅在月经第 1 天±2 天发生偏头痛，且在周期的其他时间不发生偏头痛。与月经相关的偏头痛的定义相同，但可能在月经周期的其他时间发生，而不仅仅是在月经期间。雌激素的撤退与 MM 的发作有关，为激素治疗提供了特定的治疗机会。传统上，MM 采用非特异性治疗方法，如发作性和预防性非甾体抗炎药和曲普坦类药物治疗。虽然这是一线治疗方法，但有证据表明非特异性治疗方法可以与特定的激素治疗联合使用。推荐的激素治疗方法是连续使用复方激素避孕药（CHC）而没有安慰剂片，或者仅使用两天的安慰剂片以避免雌激素撤退触发。虽然有先兆的 MM 并不常见，但在提到使用 CHC 治疗有先兆的 MM 时，美国 2016 年避孕方法医学资格标准将有先兆的 MM 归类为“如果使用避孕方法，代表不可接受的健康风险的一种情况”。因此，目前的建议是对于有月经性偏头痛先兆病史的患者，特别是当存在其他危险因素如吸烟时，不建议使用 CHC。其他治疗方法，如 GnRH 激动剂、选择性雌激素受体调节剂和双侧卵巢切除术，证据有限。
