围绝经期偏头痛治疗:“进攻”还是“防守”?
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摘要
偏头痛是临床最常见的原发性头痛,其临床表现主要为中重度搏动性头痛。围绝经期内,妇女卵巢功能逐渐衰退,雌激素水平下降,更易罹患偏头痛。因此,在围绝经期对此类人群进行雌激素替代治疗,逐渐成为临床治疗妇女围绝经期偏头痛的新方式。一般来说,雌激素的治疗剂量一般都控制在"最小有效剂量",从而最大程度避免其副作用。外用治疗,如经皮雌激素贴片或凝胶,是治疗偏头痛的首选给药路径。此外,围绝经期偏头痛妇女也接受镇痛治疗,一般根据患者的头痛程度选择镇痛药:轻中度偏头痛通常使用对乙酰氨基酚或非甾体抗炎药;而中重度或难以缓解的偏头痛患者,一般使用麦角类制剂,或曲普坦类药物。此外,现代治疗理念强调患者心理干预与生活方式的自我管理,既可单独使用,也可结合镇痛药物一起使用。而对患者来说,选择更个体化的治疗方式可以更好地缓解偏头痛所带来的痛苦。
Migraine is the most common primary headache clinically. The manifestation is mainly moderate or severe pulsating headache. In perimenopause, the decreased ovary function may cause migraine in those women who are susceptive to estrogen decline. Consequently, hormone replace therapy is becoming a novel method to deal with this disease. To avoid severe unpleasant complications caused by hormone, those women should be given the lowest effective dose of medication,and transdermal estrogen patches or gel is often preferred. The selection of analgesic depends on the headache degree and accompanying symptoms. For patients with moderate headache, therapy is usually started with acetaminophen or NSAID's.For patients with severe headache or when migraine relief is not achieved, ergotamine or triptans should be prescribed.Meanwhile, psychological and behavioral self-management could be combined with medication or not to treat migraine. For the migraineurs, a more specialized treatment could release their suffering to a better extent.
Migraine is the most common primary headache clinically. The manifestation is mainly moderate or severe pulsating headache. In perimenopause, the decreased ovary function may cause migraine in those women who are susceptive to estrogen decline. Consequently, hormone replace therapy is becoming a novel method to deal with this disease. To avoid severe unpleasant complications caused by hormone, those women should be given the lowest effective dose of medication,and transdermal estrogen patches or gel is often preferred. The selection of analgesic depends on the headache degree and accompanying symptoms. For patients with moderate headache, therapy is usually started with acetaminophen or NSAID's.For patients with severe headache or when migraine relief is not achieved, ergotamine or triptans should be prescribed.Meanwhile, psychological and behavioral self-management could be combined with medication or not to treat migraine. For the migraineurs, a more specialized treatment could release their suffering to a better extent.
引文
[1]Dodick DW. Migraine[J]. Lancet, 2018, 391(10127):1315-1330.
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[3]ChaiNC,PeterlinBL,CalhounAH.Migraineand estrogen[J]. Curr Opin Neurol, 2014, 27(3):315-324.
[4]Allais G, Chiarle G, Bergandi F, et al. Migraine in perimenopausal women[J]. Neurol Sci, 2015, 36(Suppl1):79-83.
[5]Amandusson A, Blomqvist A. Estrogenic influences in pain processing[J]. Front Neuroendocrinol, 2013, 34(4):329-349.
[6]MicevychPE,MermelsteinPG.Membraneestrogen receptors acting through metabotropic glutamate receptors:an emerging mechanism of estrogen action in brain[J]. Mol Neurobiol, 2008, 38(1):66-77.
[7]Ibrahimi K, Couturier EG, Brink AM. Migraine and perimenopause[J]. Maturitas, 2014,78(4):277-280.
[8]Zhao XH, Zhao YQ, Zhu C, et al. Different analgesic effects of intrathecal endomorphin-2 on thermal hyperalgesia and evoked inflammatory pain in ovariectomized rats[J]. Pain Physician, 2015, 18(2):195-205.
[9]Ceccarelli I, Fiorenzani P, Massafra C, et al. Long-term ovariectomy changes formalin-induced licking in female rats:the role of estrogens[J]. Reprod Biol Endocrinol, 2003, 1:24.
[10]Szoeke CE, Cicuttini FM, Guthrie JR, et al. The relationship of reports of aches and joint pains to the menopausal transition:a longitudinal study[J]. Climacteric, 2008, 11(1):55-62.
[11]LeRL,ManclL,ShermanJJ,etal.Changesin temporomandibular pain and other symptoms across the menstrual cycle[J]. Pain, 2003, 106(3):253-261.
[12]Silberstein SD. Sex hormones and headache[J]. Rev Neurol(Paris), 2000, 156(Suppl 4):30-41.
[13]ShusterLT,FaubionSS,SoodR,etal.Hormonal manipulation strategies in the management of menstrual migraine and other hormonally related headaches[J]. Curr Neurol Neurosci Rep, 2011, 11(2):131-138.
[14]Mac Gregor EA, Frith A, Ellis J, et al. Prevention of menstrual attacks of migraine:a double-blind placebo-controlled crossover study[J]. Neurology, 2006, 67(12):2159-2163.
[15]Gadducci A, Biglia N, Cosio S, et al. Progestagen component in combined hormone replacement therapy in postmenopausal women and breast cancer risk:a debated clinical issue[J].Gynecol Endocrinol, 2009, 25(12):807-815.
[16]Ouyang P, Michos ED, Karas RH. Hormone replacement therapy and the cardiovascular system lessons learned and unanswered questions[J]. J Am Coll Cardiol, 2006, 47(9):1741-1753.
[17]贾建平,陈生弟.神经病学[M]. 7版.北京:人民卫生出版社, 2013:158-163.
[18]Negro A, Lionetto L, Simmaco M, et al. CGRP receptor antagonists:an expanding drug class for acute migraine?[J].Expert Opin Investig Drugs, 2012, 21(6):807-818.
[19]Levin M. The international classification of headache disorders,3rdedition (ICHDIII)—Changesand Challenges[J]. Headache, 2014, 53(8):1383-1395.
[20]周冀英.药物过度使用性头痛[J].国际神经病学神经外科学杂志, 2013, 40(4):345-349.
[21]Probyn K, Bowers H, Mistry D, et al. Non-pharmacological self-management for people living with migraine or tensiontype headache:a systematic review including analysis of intervention components[J]. BMJ Open, 2017, 7(8):e016670.
[22]Kruif M, Spijker AT, Molendijk ML. Depression during the perimenopause:a meta-analysis[J]. J Affect Disord, 2016,206:174-180.
[23]RothrockJF.Headachediary[J].Headache,2006,46(5):831-832.
[2]Yu S, Zhang M, Zhou J, et al. Headache care in China[J].Headache, 2014, 54(4):601-609.
[3]ChaiNC,PeterlinBL,CalhounAH.Migraineand estrogen[J]. Curr Opin Neurol, 2014, 27(3):315-324.
[4]Allais G, Chiarle G, Bergandi F, et al. Migraine in perimenopausal women[J]. Neurol Sci, 2015, 36(Suppl1):79-83.
[5]Amandusson A, Blomqvist A. Estrogenic influences in pain processing[J]. Front Neuroendocrinol, 2013, 34(4):329-349.
[6]MicevychPE,MermelsteinPG.Membraneestrogen receptors acting through metabotropic glutamate receptors:an emerging mechanism of estrogen action in brain[J]. Mol Neurobiol, 2008, 38(1):66-77.
[7]Ibrahimi K, Couturier EG, Brink AM. Migraine and perimenopause[J]. Maturitas, 2014,78(4):277-280.
[8]Zhao XH, Zhao YQ, Zhu C, et al. Different analgesic effects of intrathecal endomorphin-2 on thermal hyperalgesia and evoked inflammatory pain in ovariectomized rats[J]. Pain Physician, 2015, 18(2):195-205.
[9]Ceccarelli I, Fiorenzani P, Massafra C, et al. Long-term ovariectomy changes formalin-induced licking in female rats:the role of estrogens[J]. Reprod Biol Endocrinol, 2003, 1:24.
[10]Szoeke CE, Cicuttini FM, Guthrie JR, et al. The relationship of reports of aches and joint pains to the menopausal transition:a longitudinal study[J]. Climacteric, 2008, 11(1):55-62.
[11]LeRL,ManclL,ShermanJJ,etal.Changesin temporomandibular pain and other symptoms across the menstrual cycle[J]. Pain, 2003, 106(3):253-261.
[12]Silberstein SD. Sex hormones and headache[J]. Rev Neurol(Paris), 2000, 156(Suppl 4):30-41.
[13]ShusterLT,FaubionSS,SoodR,etal.Hormonal manipulation strategies in the management of menstrual migraine and other hormonally related headaches[J]. Curr Neurol Neurosci Rep, 2011, 11(2):131-138.
[14]Mac Gregor EA, Frith A, Ellis J, et al. Prevention of menstrual attacks of migraine:a double-blind placebo-controlled crossover study[J]. Neurology, 2006, 67(12):2159-2163.
[15]Gadducci A, Biglia N, Cosio S, et al. Progestagen component in combined hormone replacement therapy in postmenopausal women and breast cancer risk:a debated clinical issue[J].Gynecol Endocrinol, 2009, 25(12):807-815.
[16]Ouyang P, Michos ED, Karas RH. Hormone replacement therapy and the cardiovascular system lessons learned and unanswered questions[J]. J Am Coll Cardiol, 2006, 47(9):1741-1753.
[17]贾建平,陈生弟.神经病学[M]. 7版.北京:人民卫生出版社, 2013:158-163.
[18]Negro A, Lionetto L, Simmaco M, et al. CGRP receptor antagonists:an expanding drug class for acute migraine?[J].Expert Opin Investig Drugs, 2012, 21(6):807-818.
[19]Levin M. The international classification of headache disorders,3rdedition (ICHDIII)—Changesand Challenges[J]. Headache, 2014, 53(8):1383-1395.
[20]周冀英.药物过度使用性头痛[J].国际神经病学神经外科学杂志, 2013, 40(4):345-349.
[21]Probyn K, Bowers H, Mistry D, et al. Non-pharmacological self-management for people living with migraine or tensiontype headache:a systematic review including analysis of intervention components[J]. BMJ Open, 2017, 7(8):e016670.
[22]Kruif M, Spijker AT, Molendijk ML. Depression during the perimenopause:a meta-analysis[J]. J Affect Disord, 2016,206:174-180.
[23]RothrockJF.Headachediary[J].Headache,2006,46(5):831-832.