Migräne und Hormonbehandlung

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

• Literatur

• 1 Westhoff CL, Heartwell SF, Edwards S. et al Oral contraceptive discontinuation: do side effects matter?. American journal of obstetrics and gynecology 2007; 196 (04) 412.e411-416
• 2 Loder EW, Buse DC, Golub JR. Headache and combination estrogen-progestin oral contraceptives: integrating evidence, guidelines, and clinical practice. Headache 2005; 45: 224-231 DOI: 10.1111/j.1526-4610.2005.05049.x.
• 3 MacGregor EA. Contraception and headache. Headache 2013; 53: 247-276 DOI: 10.1111/head.12035.
• 4 Aegidius K, Zwart JA, Hagen K. et al Oral contraceptives and increased headache prevalence: the Head-HUNT Study. Neurology 2006; 66: 349-353 DOI: 10.1212/01.wnl.0000196481.57994.09.
• 5 Granella F, Sances G, Pucci E. et al Migraine with aura and reproductive life events: a case control study. Cephalalgia 2000; 20: 701-707 DOI: 10.1111/j.1468-2982.2000.00112.x.
• 6 Cupini LM, Matteis M, Troisi E. et al Sex-hormone-related events in migrainous females. A clinical comparative study between migraine with aura and migraine without aura. Cephalalgia 1995; 15: 140-144 DOI: 10.1046/j.1468-2982.1995.015002140.x.
• 7 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 DOI: 10.1016/j.ejogrb.2014.05.016.
• 8 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 DOI: 10.1186/1129-2377-14-66.
• 9 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
• 10 Sulak PJ, Willis SA, Kuehl TJ. et al Headaches and Oral Contraceptives: Impact of Eliminating the Standard 7-Day Placebo Interval. Headache 2007: 47
• 11 Archer DF, Jensen JT, Johnson JV. et al Evaluation of a continuous regimen of levonorgestrel/ethinyl estradiol: phase 3 study results. Contraception 2006; 74 (06) 439-445
• 12 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 DOI: 10.1186/s10194-017-0815-1.
• 13 Donaghy M, Chang CL, Poulter NR. Duration, frequency, recency, and type of migraine and the risk of ischaemic stroke in women of childbearing age. Journal of Neurology, Neurosurgery & Psychiatry 2002; 73: 747-750
• 14 Weill A, Dalichampt M, Raguideau F. et al Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study. BMJ 2016; 353: i2002 DOI: 10.1136/bmj.i2002.
• 15 Gillum LA, Mamidipudi SK, Johnston SC. Ischemic stroke risk with oral contraceptives: A meta-analysis. JAMA 2000; 284: 72-78 DOI: 10.1001/jama.284.1.72.
• 16 Lidegaard O, Lokkegaard E, Jensen A. et al Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med 2012; 366: 2257-2266 DOI: 10.1056/NEJMoa1111840.
• 17 Hormonal Contraception. Guideline of the DGGG, SGGG and OEGGG (S3-Level, AWMF Registry No. 015/015, January 2020).. https://pubmed.ncbi.nlm.nih.gov/33623171/ (Abruf am 5.5.2023)
• 18 Stewart WF, Lipton RB, Celentano DD. et al Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors. Jama 1992; 267: 64-69
• 19 Sacco S, Merki-Feld GS, Ægidius KL. et al Effect of exogenous estrogens and progestogens on the course of migraine during reproductive age: a consensus statement by the European Headache Federation (EHF) and the European Society of Contraception and Reproductive Health (ESCRH). J Headache Pain 2018; 19: 76 DOI: 10.1186/s10194-018-0896-5.
• 20 Mattsson P. Hormonal factors in migraine: a population-based study of women aged 40 to 74 years. Headache 2003; 43: 27-35 DOI: 10.1046/j.1526-4610.2003.03005.x.
• 21 Neri I, Granella F, Nappi R. et al Characteristics of headache at menopause: a clinico-epidemiologic study. Maturitas 1993; 17: 31-37 DOI: 10.1016/0378-5122(93)90121-w.
• 22 Nattero G. Menstrual headache. Adv Neurol 1982; 33: 215-226
• 23 Cull RE. Investigation of late-onset migraine. Scott Med J 1995; 40: 50-52 DOI: 10.1177/003693309504000205.
• 24 Lichten EM, Lichten JB, Whitty A. et al The confirmation of a biochemical marker for women’s hormonal migraine: the depo-estradiol challenge test. Headache 1996; 36: 367-371 DOI: 10.1046/j.1526-4610.1996.3606367.x.
• 25 Kudrow L. The relationship of headache frequency to hormone use in migraine. Headache 1975; 15: 36-40 DOI: 10.1111/j.1526-4610.1975.hed1501036.x.
• 26 Stryker JC. Use of hormones in women over forty. Clin Obstet Gynecol 1977; 20: 155-164 DOI: 10.1097/00003081-197703000-00019.
• 27 Granella F, Sances G, Zanferrari C. et al Migraine without aura and reproductive life events: a clinical epidemiological study in 1300 women. Headache 1993; 33: 385-389 DOI: 10.1111/j.1526-4610.1993.hed3307385.x.
• 28 Nappi RE, Sances G, Sommacal A. et al Different effects of tibolone and low-dose EPT in the management of postmenopausal women with primary headaches. Menopause 2006; 13: 818-825 DOI: 10.1097/01.gme.0000227399.53192.f5.
• 29 Misakian AL, Langer RD, Bensenor IM. et al Postmenopausal hormone therapy and migraine headache. J Womens Health (Larchmt) 2003; 12: 1027-1036 DOI: 10.1089/154099903322643956.
• 30 Aegidius KL, Zwart JA, Hagen K. et al Hormone replacement therapy and headache prevalence in postmenopausal women. The Head-HUNT study. Eur J Neurol 2007; 14: 73-78 DOI: 10.1111/j.1468-1331.2006.01557.x.
• 31 Facchinetti F, Nappi RE, Tirelli A. et al Hormone supplementation differently affects migraine in postmenopausal women. Headache 2002; 42: 924-929 DOI: 10.1046/j.1526-4610.2002.02215.x.
• 32 Nappi RE, Cagnacci A, Granella F. et al Course of primary headaches during hormone replacement therapy. Maturitas 2001; 38: 157-163 DOI: 10.1016/s0378-5122(00)00215-2.
• 33 Glaser R, Dimitrakakis C, Trimble N. et al Testosterone pellet implants and migraine headaches: a pilot study. Maturitas 2012; 71: 385-388 DOI: 10.1016/j.maturitas.2012.01.006.
• 34 Kurth T, Winter AC, Eliassen AH. et al Migraine and risk of cardiovascular disease in women: prospective cohort study. BMJ 2016; 353: i2610 DOI: 10.1136/bmj.i2610.
• 35 Tietjen GE, Maly EF. Migraine and Ischemic Stroke in Women. A Narrative Review. Headache 2020; 60: 843-863 DOI: 10.1111/head.13796.
• 36 Hu X, Zhou Y, Zhao H. et al Migraine and the risk of stroke: an updated meta-analysis of prospective cohort studies. Neurol Sci 2017; 38: 33-40 DOI: 10.1007/s10072-016-2746-z.
• 37 Champaloux SW, Tepper NK, Monsour M. et al Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke. Am J Obstet Gynecol 2017; 216: 489.e481-489.e487 DOI: 10.1016/j.ajog.2016.12.019.
• 38 Schürks M, Rist PM, Bigal ME. et al Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ 2009; 339: b3914 DOI: 10.1136/bmj.b3914.
• 39 Stute P. NAMS-Positionspapier zur Hormonersatztherapie 2022. Journal für Gynäkologische Endokrinologie/Schweiz 2022; 25: 205-206 DOI: 10.1007/s41975-022-00271-x.
• 40 Anonym WHO Guidelines Approved by the Guidelines Review Committee. In: Medical Eligibility Criteria for Contraceptive Use. Geneva: World Health Organization; 2015
• 41 Serfaty D. Update on the contraceptive contraindications. J Gynecol Obstet Hum Reprod 2019; 48: 297-307 DOI: 10.1016/j.jogoh.2019.02.006.
• 42 Diener HC, Förderreuther S, Kropp P. et al Therapie der Migräneattacke und Prophylaxe der Migräne. S1-Leitlinie, 2022, DGN und DMKG. In: Deutsche Gesellschaft für Neurologie (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie. www.dgn.org/leitlinien (abgerufen am 5.5.2023)
• 43 Øie LR, Kurth T, Gulati S. et al Migraine and risk of stroke. J Neurol Neurosurg Psychiatry 2020; 91: 593-604 DOI: 10.1136/jnnp-2018-318254.
• 44 Sheikh HU, Pavlovic J, Loder E. et al Risk of Stroke Associated With Use of Estrogen Containing Contraceptives in Women With Migraine: A Systematic Review. Headache 2018; 58: 5-21 DOI: 10.1111/head.13229.