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Nervenheilkunde 2023; 42(06): 349-355
DOI: 10.1055/a-2066-9219
Schwerpunkt

Migräne und Hormonbehandlung

Migraine and hormone treatment
Sabine Segerer
1   amedes MVZ Hamburg
,
Stefan Evers
2   Klinik für Neurologie, Krankenhaus Lindenbrunn, Coppenbrügge
3   Medizinische Fakultät, Universität Münster
,
Dagny Holle-Lee
4   Westdeutsches Kopfschmerzzentrum, Klinik für Neurologie, Universitätsklinikum Essen
,
Christoph Keck
5   Medicover Laborgruppe Berlin
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ZUSAMMENFASSUNG

Migräne mit Aura erhöht bei Frauen unter 45 Jahren das Risiko für einen Schlaganfall um ca. das Doppelte. Diese Information sollte in die Beratung dieser Frauen einfließen, insbesondere wenn sie weitere behandelbare vaskuläre Risikofaktoren aufweisen. Frauen mit Migräne mit Aura sollten dementsprechend hormonale Kontrazeptiva mit einem Estradiolanteil von >35 µg nicht einnehmen. Häufigkeit und Intensität von Migräneattacken bei Frauen werden maßgeblich durch Östradiolschwankungen im Serum beeinflusst. In der fertilen Lebensphase kommt es durch die physiologischen zyklischen Schwankungen häufig zu Migräne, ebenso in der Perimenopause. In der Postmenopause liegen konstant niedrige Östradiolserumspiegel vor, dies führt eher zur Abnahme der Häufigkeit und Intensität der Migräne. Die transdermale Östrogentherapie ist im Vergleich zur oralen Östrogengabe mit einem geringeren Migränerisiko assoziiert. Bei der Indikationsstellung zur Hormontherapie bei Frauen mit Migräne muss vor allem das erhöhte Thrombembolierisiko beachtet und bei der Auswahl des Hormon-Präparates sowie der Wahl der Applikationsweise (oral versus transdermal) berücksichtigt werden. Eine generelle Kontraindikation zur Hormontherapie bei Frauen mit Migräne besteht nicht. Migräne stellt möglicherweise einen leichtgradigen Risikofaktor für einen Herzinfarkt dar. Hierbei gibt es keine Hinweise, dass das Vorliegen einer Migräneaura oder die Einnahme einer hormonalen Kontrazeption eine Rolle spielen.

ABSTRACT

Migraine with aura increases the risk for ischemic strokes in women under the age of 45 about twofold. This information should be given to these women during consulting, in particular if these women show other vascular risk factors. Women with migraine with aura should not receive a hormonal contraception with more than 35 µg estradiol. Frequency and intensity of migraine attacks in women is influenced by fluctuating levels of estradiol. In the fertile period of life, these changes often induce migraine attacks, also in the perimenopausal period an increase of migraine frequency can occur. In the postmenopausal period, low and constant levels of estradiol lead to a low frequency of migraine. The transdermal treatment with estrogen is associated with a lower risk for migraine attacks than the oral application. For the indication of a hormone replacement therapy in women with migraine, the increased risk for thrombemboilic events should be considered. There is no general contraindication for a hormonal replacement therapy in women with migraine. Possibly, migraine also increases the risk for myocardial infarction. There is some evidence that migraine with aura and hormonal replacement therapy contributes to this increased risk.

Schlüsselwörter

Hormontherapie - Östradiol - Schlaganfall - Herzinfarkt - Kontrazeption

Key words

Hormone therapy - estradiol - stroke - myocardial infarction - contraception


Publication History

Article published online:
31 May 2023

© 2023. Thieme. All rights reserved.

© Georg Thieme Verlag KG
Stuttgart · New York

 

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