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许多女性苦于排卵期偏头痛

来源:医源世界 作者:佚名 2007-7-10

摘要: June 20, 2007(芝加哥讯)- 新的临床研究显示,排卵期偏头痛是常见的,且其严重度与发作时间长度都与生理期时的差不多。作者表示,排卵期偏头痛的疼痛程度在三次不同的排卵期后达到最高峰。 Martin医师表示,这些头痛可能于每三次排卵期中的任何一次,每次都代表不同的荷尔蒙环境。因此,作者的结论是,排卵期偏头痛可......


  June 20, 2007(芝加哥讯)- 新的临床研究显示,排卵期偏头痛是常见的,且其严重度与发作时间长度都与生理期时的差不多;作者表示,排卵期偏头痛的疼痛程度在三次不同的排卵期后达到最高峰。
  
  在这里讨论的壁报发表于美国头痛学会第49届年会。
  
  主要研究者俄亥俄州辛辛那提大学医学院医学教授Vincent Martin医师向Medscape表示,这项研究中一个最重要的发现是,这些头痛会在生理期间发生,不是只在生理期时,且与雌性激素有关。
  
  Martin医师表示,这些头痛可能于每三次排卵期中的任何一次,每次都代表不同的荷尔蒙环境;因此,作者的结论是,排卵期偏头痛可能存在且重复发作于女性偏头痛患者。
  
  Martin医师表示,这些女性荷尔蒙的影响是超出我们所想像的。
  
  【排卵期偏头痛的模式】
  作者指出,过去的研究已经证实偏头痛在排卵期时并没有比周期中其他日子来得频繁;然而,Martin医师表示,这样的结论有部份是因为早期的研究是使用14天的计算方法,且这些研究将所有妇女混在一起分析,这样的分析很难勾勒出偏头痛的模式。
  
  Martin医师向Medscape表示,我们这项临床研究的目的在于确认排卵期偏头痛的不同模式,以及研究病患族群中不同偏头痛模式的发作频率;我们也要确认,在排卵期时发生的曲线下面积(AUC)与有排卵期偏头痛的女性偏头痛患者,在生理期时发生的模式是否不同。
  
  这项为期6.5个月的研究,由辛辛那提头痛中心与当地报纸广告共同招募20位病患,研究收纳介于21至45岁且生理期周期正常的女性,所有参与试验者都符合国际头痛学会偏头痛诊断标准。
  
  这些女性被要求连续三次生理期周期、每天三次于头痛日记上纪录头痛严重度,同时收集早晨尿液样本,冷冻后之后用于雌素酮葡萄糖醛酸酐(EIG)分析。
  
  研究者将三次排卵期与一次生理期的时间定义为:后滤泡(LF)期,包括EIG浓度最高时的排卵期前两天与当天;前黄体1(EL1)期,包括EIG浓度最高后三天;前黄体2(EL2)期,包括EIG浓度最高后四至六天;以及生理(M)期,以月经来潮后前三天定义。
  
  作者指出,之后纪录三次排卵期每天的头痛指标、或是以三次每日严重度分数作图,且确认“最高”头痛严重度分数;如果头痛指数的最大值出现在这段时间,则该头痛最大值与特定时间有关。
  
  每次头痛最大值都以三次排卵期中最大AUC决定并同化,以标准化不同个体之间的差异,同时确认出特定偏头痛模式的病患,以三次排卵期中有两次同化后最高AUC高于0.25定义。
  
  接着,排卵期的同化后AUC与生理期时比较。
  
  作者表示,三次排卵期中有两次同化后最高AUC高于0.25的盛行率在M、LF、EL1与EL2期分别是75%、35%、30%与45%;在有排卵期偏头痛的患者,其排卵期同化后最高AUC与生理期时并无显著差异(P>0.33)。
  
  Martin医师的结论是,排卵期偏头痛有三种不同的时间模式,LF期代表血中雌性激素快速上升期;EL1期代表血中雌性激素快速下降期,而EL2期代表血中黄体激素快速上升期。
  
  【与传统说法不同?】
  未参与这项研究的德州休士顿贝勒医学院神经学临床教授Randolph W. Evans医师向Medscape表示,这是一向做得非常好的研究,且与传统说法不同,过去在医学界没有看过这样的研究结果;然而,因为这是项小型研究,在大型样本下是否可以看到同样的结果,令人感兴趣。
  
  这项临床研究的经费由阿斯特捷利康药厂赞助。

Many Women Suffer From Midcycle Migraines

By
Medscape Medical News

June 20, 2007 (Chicago) — New clinical research shows that midcycle migraines are common and have a severity and duration similar to headaches occurring during the menstrual period. Midcycle migraine headaches achieve their pain intensity during 3 distinct midcycle time intervals, the authors say.

This poster presentation was discussed here at the American Headache Society 49th Annual Scientific Meeting.

"One of the significant findings of this study is that these headaches were provoked throughout the cycle — not just around the menstrual period — by female hormones," Vincent Martin, MD, principal researcher and professor of medicine at the University of Cincinnati College of Medicine, in Ohio, told Medscape.

"They may arise during any 1 of 3 midcycle time intervals, with each representing a different hormonal milieu," Dr. Martin noted. "Therefore, midcycle migraines likely exist and occur reproducibly within subgroups of female migraineurs," the authors conclude.

"These female hormones have a greater influence than we thought," Dr. Martin added.

Patterns of Midcycle Migraine

Past studies have suggested that migraine headaches are no more frequent during midcycle time periods than other times of the month, the authors point out. However, in part, this conclusion was due to earlier research that used a 14-day count and "lumped" all women together, which depicted no pattern, Dr. Martin said.

"The objective of our clinical study was to define different patterns of midcycle migraine headache and to determine the frequency of the different migraine patterns within the patient population," Dr. Martin told Medscape. "We also wanted to ascertain if the area under the curve occurring during midcycle time periods differs from those during menstrual time periods in female migraineurs with midcycle headache patterns."

For the 6.5-month study, 20 patients were selected from the Cincinnati Headache Center and local newspaper advertisements. Women were between the ages of 21 and 45 years with regular menstrual cycles. All participants had an International Headache Society diagnosis of migraine headache.

The women were asked to record the severity of their headaches 3 times per day in a headache diary for 3 consecutive menstrual cycles. Early-morning urine samples were collected and frozen and later assayed for estrone glucuronide (EIG).

The researchers defined 3 midcycle and 1 menstrual time period: the late follicular (LF) phase, including 2 days before and the day of the midcycle peak in EIG; the early luteal 1 (EL1) phase, including the 3 days following the EIG peak; the early luteal 2 (EL2) phase, including days 4 to 6 after the EIG peak; and the menstrual (M) phase, including the first 3 days after the onset of menstrual bleeding.

The headache index, or sum of the 3 daily severity scores, was graphed during each day of the 3 menstrual cycles, and "peaks" of headache severity scores were identified, the authors write. A headache peak was linked to a particular time period if the maximum value of the headache index for that peak occurred during that time.

The area under the curve of each headache peak was determined and normalized to the maximum AUC of any peak within the 3 menstrual cycles to standardize values between subjects. Subgroups with a given midcycle headache pattern were identified, defined as a normalized AUC of a midcycle peak of greater than 0.25 in 2 of 3 menstrual cycles.

The normalized AUCs from midcycle time periods were then compared with those from menstrual time periods.

"The prevalence of headache peaks with a normalized AUC greater than 0.25 occurring in 2 of the 3 cycles was 75%, 35%, 30%, and 45% within M, LF, EL1, and EL2 intervals, respectively," the authors write. "The normalized AUCs of peaks from midcycle time periods did not differ statistically from menstrual time periods (P > .33) in subgroups of patients with midcycle headache patterns."

Dr. Martin concluded there are 3 distinctive time periods for midcycle migraines. The LF interval represents a rapid rise in serum estradiol levels; the EL1 interval represents a decline in serum estradiol levels, while the EL2 interval represents a rapid rise in serum progesterone levels.

Against Conventional Wisdom?

"This is a well-done study that goes against conventional wisdom," Randolph W. Evans, MD, clinical professor of neurology at Baylor College of Medicine, in Houston, Texas, who was not involved in the study, told Medscape. "The medical community has not seen these results reported before. However, because this was a small study, it will be interesting to see whether the results concur with a larger sample."

A grant for this clinical study was provided by AstraZeneca.

American Headache Society 49th Annual Scientific Meeting: Abstract 150. June 7-10, 2007.




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