Migräne in speziellen hormonellen Situationen

ZUSAMMENFASSUNG

Bei der menstruellen Migräne gibt es verschiedene spezifische Therapieoptionen. So kann ca. 4–5 Tage vor dem erwarteten Menstruationsbeginn ein Östradiolpflaster mit 50 µg pro Tag für wenigstens 7 Tage als Kurzzeitprophylaxe ausprobiert werden; bei Unwirksamkeit kann dies mit 100 µg pro Tag wiederholt werden. Eine hormonelle Kontrazeption mit einem Mischpräparat oder Mehrphasenpräparat kann probatorisch abgesetzt werden. In besonderen Fällen ist eine durchgehende hormonelle Kontrazeption bis zu 2 Jahre sinnvoll.

Patientinnen mit Migräne und Endometriose zeigen während der Menstruation höhere CGRP-Werte als in der Zyklusmitte, wohingegen dies bei Frauen ohne Migräne und Kontrollprobandinnen umgekehrt ist. Dies deutet auf eine mögliche Rolle von CGRP in den perimenstruellen Schmerzattacken hin. Weiterhin ist die Lebensqualität bei Patientinnen mit Migräne und Endometriose deutlich stärker beeinträchtigt als bei nur einer Erkrankung. Daher ist es klinisch relevant, diese Komorbidität zu berücksichtigen.

Eine hormonelle Frau-zu-Mann-Transition geht mit signifikant mehr Kopfschmerzen einher als die umgekehrte Transition. Bei der Mann-zu-Frau-Transition scheint sich dagegen häufiger eine Migräne zu bilden, insbesondere mit Aura. Die Behandlung der Kopfschmerzen und der Migräne erfolgt wie bei anderen Betroffenen auch, allerdings muss die erhöhte Thromboseneigung durch die Hormonbehandlung berücksichtigt werden.

ABSTRACT

There are different specific treatment options for menstrual migraine. About 4–5 days before the expected onset of menstruation, an estradiol patch (50 µg) can be applied for 7 days as short term prophylaxis; if this is not effective, it can be repeated with a 100 µg patch. Stopping a hormonal contraception with a combination pill or with a biphasic pill can be tried to improve menstrual migraine. In specific situations, an ongoing hormonal contraception for up to 2 years can also be tried.

Women with migraine and endometriosis show elevated CGRP-levels in the middle of the menstrual cycle, whereas women without migraine show a reverse pattern. This points to a role of CGRP in the perimenstrual pain attack. Further, quality of life of patients with migraine and endometriosis is much more impaired than of patients with only one disorder. Therefore, it is clinically relevant to consider endometriosis in the consulting of women with migraine.

A hormonal female-to-male transition shows significantly more headache than vice versa. In people with male-to-female transition, there is evidence for an increased risk for migraine, in particular for migraine with aura. The treatment of headache and migraine in transsexual people follows the normal treatment guidelines but has to consider the increased risk of thrombosis by hormonal treatment.

Schlüsselwörter

Menstruelle Migräne - Kurzzeitprophylaxe - Endometriose - Transsexualität

Key words

Menstrual migraine - short term prophylaxis - endometriosis - transsexual

Publication History

Article published online:
31 May 2023

• Literatur

• 1 Victor TW, Hu X, Campbell JC. et al Migraine prevalence by age and sex in the United States: a life-span study. Cephalalgia 2010; 30: 1065-1072
• 2 Abu-Arafeh I, Razak S, Sivaraman B. et al Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol 2010; 52: 1088-1097
• 3 Martin VT, Behbehani M. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis – part I. Headache 2006; 46: 3-23
• 4 Böttcher B, Kyprianou A, Lechner C. et al Manifestation of migraine in adolescents: Does it change in puberty?. Eur J Paediatr Neurol 2020; 26: 29-33
• 5 Silberstein SD. The role of sex hormones in headache. Neurology 1992; 42: 37-42
• 6 Welch KM. Migraine and ovarian steroid hormones. Cephalalgia 1997; 17 (Suppl. 20) 12-16
• 7 MacGregor EA, Victor TW, Hu X. et al Characteristics of menstrual vs nonmenstrual migraine: a post hoc, within-woman analysis of the usual-care phase of a nonrandomized menstrual migraine clinical trial. Headache 2010; 50: 528-538
• 8 Kim M, Blanchard EB. Two studies of the non-pharmacological treatment of menstrually-related migraine headaches. Headache 1992; 32: 197-202
• 9 de Lignieres B, Vincens M, Mauvais-Jarvis P. et al Prevention of menstrual migraine by percutaneous oestradiol. Br Med J (Clin Res Ed) 1986; 293: 1540
• 10 Dennerstein L, Morse C, Burrows G. et al Menstrual migraine: a double-blind trial of percutaneous estradiol. Gynecol Endocrinol 1988; 02: 113-120
• 11 Smite MG, Meer YGvd, Pfeil J. et al Perimenstrual Migraine: Effect of Estraderm TTS(r) and the Value of Contingent Negative Variation and Exteroceptive Temporalis Muscle Suppression Test. Headache 1994: 34
• 12 Murray SC, Muse KN. Effective treatment of severe menstrual migraine headaches with gonadotropin-releasing hormone agonist and „add-back“ therapy. Fertil Steril 1997; 67: 390-393
• 13 Martin V, Wernke S, Mandell K. et al Medical oophorectomy with and without estrogen add-back therapy in the prevention of migraine headache. Headache 2003; 43: 309-321
• 14 Facchinetti F, Bonellie G, Kangasniemi P. et al The efficacy and safety of subcutaneous sumatriptan in the acute treatment of menstrual migraine. The Sumatriptan Menstrual Migraine Study Group. Obstet Gynecol 1995; 86: 911-916
• 15 Solbach MP, Waymer RS. Treatment of menstruation-associated migraine headache with subcutaneous sumatriptan. Obstet Gynecol 1993; 82: 769-772
• 16 Gross M, Barrie M, Bates D, Dowson A, Elrington G. The efficacy of sumatriptan in menstrual migraine. Eur J Neurol. 1995; 02: 144-5
• 17 Savi L, Omboni S, Lisotto C. et al Efficacy of frovatriptan in the acute treatment of menstrually related migraine: analysis of a double-blind, randomized, cross-over, multicenter, Italian, comparative study versus rizatriptan. J Headache Pain 2011; 12: 609-615
• 18 Bartolini M, Giamberardino MA, Lisotto C. et al Frovatriptan versus almotriptan for acute treatment of menstrual migraine: analysis of a double-blind, randomized, cross-over, multicenter, Italian, comparative study. J Headache Pain 2012; 13: 401-406
• 19 Cady RK, Diamond ML, Diamond MP. et al Sumatriptan-naproxen sodium for menstrual migraine and dysmenorrhea: satisfaction, productivity, and functional disability outcomes. Headache 2011; 51: 664-673
• 20 Mannix LK, Savani N, Landy S. et al Efficacy and tolerability of naratriptan for short-term prevention of menstrually related migraine: data from two randomized, double-blind, placebo-controlled studies. Headache 2007; 47: 1037-1049
• 21 Allais G, Bussone G, Tullo V. et al Frovatriptan 2.5 mg plus dexketoprofen (25 mg or 37.5 mg) in menstrually related migraine. Subanalysis from a double-blind, randomized trial. Cephalalgia 2015; 35: 45-50
• 22 Bigal M, Sheftell F, Tepper S. et al A randomized double-blind study comparing rizatriptan, dexamethasone, and the combination of both in the acute treatment of menstrually related migraine. Headache 2008; 48: 1286-1293
• 23 Mathew NT. Cyclic prophylactic treatment of menstrual migraine using naproxen and ergotamine. Headache 1986; 26: 314
• 24 Sances G, Martignoni E, Fioroni L. et al Naproxen sodium in menstrual migraine prophylaxis: a double-blind placebo controlled study. Headache 1990; 30: 705-709
• 25 Facchinetti F, Sances G, Borella P. et al Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache 1991; 31: 298-301
• 26 Brandes JL, Poole A, Kallela M. et al Short-term frovatriptan for the prevention of difficult-to-treat menstrual migraine attacks. Cephalalgia 2009; 29: 1133-1148
• 27 MacGregor EA, Brandes JL, Silberstein S. et al Safety and tolerability of short-term preventive frovatriptan: a combined analysis. Headache 2009; 49: 1298-1314
• 28 Moschiano F, Allais G, Grazzi L. et al Naratriptan in the short-term prophylaxis of pure menstrual migraine. Neurol Sci 2005; 26 (Suppl. 02) s162-166
• 29 Newman L, Mannix LK, Landy S. et al Naratriptan as short-term prophylaxis of menstrually associated migraine: a randomized, double-blind, placebo-controlled study. Headache 2001; 41: 248-256
• 30 Silberstein SD, Berner T, Tobin J. et al Scheduled short-term prevention with frovatriptan for migraine occurring exclusively in association with menstruation. Headache 2009; 49: 1283-1297
• 31 Silberstein SD, Elkind AH, Schreiber C. et al A randomized trial of frovatriptan for the intermittent prevention of menstrual migraine. Neurology 2004; 63: 261-269
• 32 Brandes JL, Smith T, Diamond M. et al Open-label, long-term tolerability of naratriptan for short-term prevention of menstrually related migraine. Headache 2007; 47: 886-894
• 33 Tuchman MM, Hee A, Emeribe U. et al Oral zolmitriptan in the short-term prevention of menstrual migraine: a randomized, placebo-controlled study. CNS Drugs 2008; 22: 877-886
• 34 Pringsheim T, Davenport WJ, Dodick D. Acute treatment and prevention of menstrually related migraine headache: evidence-based review. Neurology 2008; 70: 1555-1563
• 35 MacGregor EA, Frith A, Ellis J. et al Prevention of menstrual attacks of migraine: a double-blind placebo-controlled crossover study. Neurology 2006; 67: 2159-2163
• 36 Smits MG, van der Meer YG, Pfeil JP. et al Perimenstrual migraine: effect of Estraderm TTS and the value of contingent negative variation and exteroceptive temporalis muscle suppression test. Headache 1994; 34: 103-106
• 37 Pfaffenrath V. Efficacy and safety of percutaneous estradiol vs placebo in menstrual migraine. Cephalalgia 1993; 13 (Suppl. 13) 244
• 38 Pradalier A, Vincent D, Beaulieu P. et al Correlation between oes-tradiol plasma level and therapeutic effect on menstrual migraine. In: Clifford Rose F, ed. New advances in headache research. Vol 4. London: Smith-Gordon; 1994: 129-132
• 39 Almén-Christensson A, Hammar M, Lindh-Åstrand L. et al Prevention of menstrual migraine with perimenstrual transdermal 17-β-estradiol: a randomized, placebo-controlled, double-blind crossover study. Fertil Steril 2011; 96: 498-500.e491
• 40 Magos AL, Zilkha KJ, Studd JW. Treatment of menstrual migraine by oestradiol implants. J Neurol Neurosurg Psychiatry 1983; 46: 1044-1046
• 41 Ornello R, Frattale I, Caponnetto V. et al Menstrual Headache in Women with Chronic Migraine Treated with Erenumab: An Observational Case Series. Brain Sci 2021: 11
• 42 Nelles G, Schmitt L, Humbert T. et al Prevention of episodic migraines with topiramate: results from a non-interventional study in a general practice setting. J Headache Pain 2010; 11: 33-44
• 43 Pavlovic JM, Paemeleire K, Göbel H. et al Efficacy and safety of erenumab in women with a history of menstrual migraine. J Headache Pain 2020; 21: 95
• 44 Reid RL, Fortier MP, Smith L. et al Safety and bleeding profile of continuous levonorgestrel 90 mcg/ethinyl estradiol 20 mcg based on 2 years of clinical trial data in Canada. Contraception 2010; 82: 497-502
• 45 Teichmann A, Apter D, Emerich J. et al Continuous, daily levonorgestrel/ethinyl estradiol vs. 21-day, cyclic levonorgestrel/ethinyl estradiol: efficacy, safety and bleeding in a randomized, open-label trial. Contraception 2009; 80: 504-511
• 46 Coffee AL, Sulak PJ, Kuehl TJ. Long-term assessment of symptomatology and satisfaction of an extended oral contraceptive regimen. Contraception 2007; 75: 444-449
• 47 Sulak P, Willis S, Kuehl T. et al Headaches and oral contraceptives: impact of eliminating the standard 7-day placebo interval. Headache 2007; 47: 27-37
• 48 Lichten EM, Bennett RS, Whitty AJ. et al Efficacy of danazol in the control of hormonal migraine. J Reprod Med 1991; 36: 419-424
• 49 O‘Dea JP, Davis EH. Tamoxifen in the treatment of menstrual migraine. Neurology 1990; 40: 1470-1471
• 50 Bulun SE. Endometriosis. N Engl J Med 2009; 360: 268-279
• 51 Simoens S, Dunselman G, Dirksen C. et al The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod 2012; 27: 1292-1299
• 52 Ferrero S, Pretta S, Bertoldi S. et al Increased frequency of migraine among women with endometriosis. Hum Reprod 2004; 19: 2927-2932
• 53 Tietjen GE, Conway A, Utley C. et al Migraine is associated with menorrhagia and endometriosis. Headache 2006; 46: 422-428
• 54 Adewuyi EO, Sapkota Y, International Endogene Consortium I. et al Shared Molecular Genetic Mechanisms Underlie Endometriosis and Migraine Comorbidity. Genes (Basel) 2020: 11
• 55 Gupta D, Hull ML, Fraser I. et al Endometrial biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; 04: Cd012165
• 56 Yan D, Liu X, Guo SW. Neuropeptides Substance P and Calcitonin Gene Related Peptide Accelerate the Development and Fibrogenesis of Endometriosis. Sci Rep 2019; 09: 2698
• 57 Raffaelli B, Overeem LH, Mecklenburg J. et al Plasma calcitonin gene-related peptide (CGRP) in migraine and endometriosis during the menstrual cycle. Ann Clin Transl Neurol 2021; 08: 1251-1259
• 58 Aloisi AM, Bachiocco V, Costantino A. et al Cross-sex hormone administration changes pain in transsexual women and men. Pain 2007; 132 (Suppl. 01) S60-s67
• 59 Hranilovich JA, Kaiser EA, Pace A. et al Headache in transgender and gender-diverse patients: A narrative review. Headache 2021; 61: 1040-1050
• 60 Pringsheim T, Gooren L. Migraine prevalence in male to female transsexuals on hormone therapy. Neurology 2004; 63: 593-594
• 61 Yalinay Dikmen P, Ertas M, Kosak S. et al Primary headaches among gender dysphoric female-to-male individuals: A cross-sectional survey on gender transition experience. Headache 2021; 61: 1194-1206
• 62 Nguyen HV, Gilbert AL, Fortin E. et al Elevated Intracranial Pressure Associated With Exogenous Hormonal Therapy Used for Gender Affirmation. J Neuroophthalmol 2021; 41: 217-223
• 63 Sacco S, Ricci S, Degan D. et al Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain 2012; 13: 177-189
• 64 Diener HC, Gaul C, Kropp P.. Therapie der Migräneattacke und Prophylaxe der Migräne, S1-Leitlinie, 2018. In: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie. www.dgn.org/leitlinien (abgerufen am 5.5.2023)
• 65 Aegidius K, Zwart JA, Hagen K. et al Oral contraceptives and increased headache prevalence: the Head-HUNT Study. Neurology 2006; 66: 349-353
• 66 Nappi RE, Terreno E, Sances G. et al Effect of a contraceptive pill containing estradiol valerate and dienogest (E2V/DNG) in women with menstrually-related migraine (MRM). Contraception 2013; 88: 369-375
• 67 Sulak PJ, Willis SA, Kuehl TJ. et al Headaches and Oral Contraceptives: Impact of Eliminating the Standard 7-Day Placebo Interval. Headache: The Journal of Head and Face Pain 2007: 47
• 68 Morotti M, Remorgida V, Venturini PL. et al Progestogen-only contraceptive pill compared with combined oral contraceptive in the treatment of pain symptoms caused by endometriosis in patients with migraine without aura. Eur J Obstet Gynecol Reprod Biol 2014; 179: 63-68
• 69 Nappi RE, Merki-Feld GS, Terreno E. et al Hormonal contraception in women with migraine: is progestogen-only contraception a better choice?. J Headache Pain 2013; 14: 66
• 70 Somerville BW. The role of progesterone in menstrual migraine. Neurology 1971; 21: 853-859
• 71 Sacco S, Merki-Feld GS, Ægidius KL. et al Hormonal contraceptives and risk of ischemic stroke in women with migraine: a consensus statement from the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESC). J Headache Pain 2017; 18: 108
• 72 Burch R. Epidemiology and Treatment of Menstrual Migraine and Migraine During Pregnancy and Lactation: A Narrative Review. Headache 2020; 60: 200-216