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

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