Update on menstrual migraine: from clinical aspects to therapeutical strategies
Update on menstrual migraine: from clinical aspects to therapeutical strategies
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DOI：
10.1007/s10072-004-0292-6
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发表时间：
2004-10-01
影响因子：
3.3
通讯作者：
Benedetto, C
中科院分区：
文献类型：
--
作者：
Allais, G;Benedetto, C
偏头痛的发生受女性生殖周期激素波动的强烈影响；至少60%的女性偏头痛患者认为偏头痛发作的周期性与月经周期有关。所谓的经期偏头痛，发生在经期之前、期间或结束时，在很大程度上是一种不明确的疾病，包括一些临床亚型，也没有很好的定义。在上一版的国际头痛疾病分类（ICHD-II）中，月经期偏头痛在附录中得到了新的关注，其中指出了三种临床模式：纯月经期偏头痛无先兆；无先兆的经期偏头痛和无先兆的非经期偏头痛。经期偏头痛发作强度大，持续时间长（持续时间甚至超过72小时），对药物治疗无反应，与非经期偏头痛发作相比，复发率和工作致残率更高。经期偏头痛的药物治疗可能需要特定的周期性预防方法（非甾体类抗炎药、coxibs、镁、长半衰期曲坦类药物或各种配方的雌激素补充剂），但通常发作频率低，建议首先使用特定的对症药物。应优先考虑曲坦类药物，因为它们在控制偏头痛及其伴随症状方面具有特异性；其中，特别是对于舒马曲坦，许多具体的研究证明了在管理急性经期偏头痛发作的真正有效性。
Migraine occurrence is strongly influenced by the hormonal fluctuations of the female reproductive cycle; at least 60% of women affected by migraine relate the periodicity of their attacks to the menstrual cycle. The so-called menstrual migraine, which occurs immediately before, during or at the end of the menstrual flow, has been a largely undefined condition, including some clinical subtypes which are not well defined. In the last edition of the International Classification of Headache Disorders (ICHD-II), menstrual migraine gained new attention in the Appendix, where three clinical patterns were pointed out: pure menstrual migraine without aura; menstrually related migraine without aura and non-menstrual migraine without aura. Menstrual migraine attacks show severe intensity, long duration (lasting even more than 72 h), marked unresponsiveness to pharmacological treatments, and present higher recurrence rate and work-related disability than non-menstrual attacks. The pharmacological treatment of menstrual migraine can require specific cyclic prophylactic approaches (non-steroidal antiinflammatory drugs, coxibs, magnesium, long half-life triptans or oestrogen supplements in various formulations), but usually the low frequency of attacks suggests a first approach with specific symptomatic drugs. Preference should be given to triptans, due to their specificity in controlling migraine pain and its accompanying symptomatology; among them, in particular for sumatriptan, many specific studies proved a real effectiveness in the management of acute menstrual migraine attack.