Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
J Headache Pain. 2024 Sep 4;25(1):143. doi: 10.1186/s10194-024-01848-6.
About a quarter of migraine cases among women have menstrual migraine (MM), which is usually more severe, longer lasting, and less responsive to treatment than typical migraine. Randomized controlled trials (RCTs) have evaluated the efficacy of several medication in the acute and preventive treatment of MM; this meta-analysis compared the effectiveness of these treatments.
We conducted systematic searches in the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase databases. The primary outcomes of acute treatment trials were pain relief at 2 and 24 h after treatment compared with placebo or another treatment. The three endpoints we checked for studying MM prevention were: no recurrence of headaches each month, a 50% reduction in monthly migraine days from baseline, and a decrease in the mean number of headache days per month.
Out of 342 studies, 26 RCTs met the criteria. Triptans, combined with or without other analgesics, were superior to placebo in providing pain relief in the acute treatment and prevention of MM. Among the treatments, sumatriptan and lasmiditan demonstrated superior pain relief at 2 h (OR: 4.62) and 24 h (OR: 4.81). Frovatriptan exhibited effectiveness in preventing headache recurrence, whereas galcanezumab and erenumab displayed significant preventive benefits in reducing headache days per month.
Sumatriptan and lasmiditan are effective first-line treatments for acute MM. For prevention, frovatriptan may be the more effective of triptans. Compared with triptans, CGRP monoclonal antibodies, here including erenumab and galcanezumab, are more effective in reducing headache days, and therefore, in preventing MM.
大约四分之一的女性偏头痛病例为经期偏头痛（MM），其通常比典型偏头痛更严重、持续时间更长且对治疗的反应较差。随机对照试验（RCT）已经评估了几种药物在 MM 的急性和预防性治疗中的疗效；本荟萃分析比较了这些治疗方法的效果。
我们在 Cochrane 对照试验中心注册数据库、MEDLINE 和 Embase 数据库中进行了系统检索。急性治疗试验的主要结局是与安慰剂或其他治疗相比，治疗后 2 小时和 24 小时的疼痛缓解情况。我们检查的用于研究 MM 预防的三个终点分别是：每月头痛不复发、从基线开始每月偏头痛天数减少 50%以及每月头痛天数平均减少。
在 342 项研究中，有 26 项 RCT 符合标准。曲普坦类药物与或不与其他镇痛药联合使用，在 MM 的急性治疗和预防中，与安慰剂相比，能更好地缓解疼痛。在这些治疗中，舒马曲坦和拉米曲坦在 2 小时（OR：4.62）和 24 小时（OR：4.81）时显示出更好的止痛效果。夫罗曲坦在预防头痛复发方面有效，而加奈徳珠单抗和依瑞奈珠单抗在减少每月头痛天数方面显示出显著的预防益处。
舒马曲坦和拉米曲坦是 MM 急性发作的有效一线治疗药物。对于预防，夫罗曲坦可能是曲普坦类药物中更有效的药物。与曲普坦类药物相比，CGRP 单克隆抗体，包括依瑞奈珠单抗和加奈徳珠单抗，在减少头痛天数方面更有效，因此更能预防 MM。
