Hormonas y migraña, una aproximación clínica

Hormones and migraine, a clinical approach

La migraña es la cefalea primaria más frecuente en las mujeres y si se suman las diversas fluctuaciones hormonales en el transcurso de la vida, la prevalencia es hasta tres veces más que en los hombres. Varía según la edad sexual siendo muchas veces la menarquia el inicio de la misma, así como la presentación exclusiva o facilitada por el período menstrual, la posmenopausia o el verdadero reto, el embarazo. Cuando mujeres de diferentes edades y tipos de cefalea, consultan, es la experticia y la adecuada orientación clínica inicial las que pueden lograr un diagnóstico oportuno y acertado. La migraña es un dolor de cabeza en los servicios de urgencias, no solo por la complejidad de su manejo en las pacientes gestantes, sino por las pocas opciones terapéuticas disponibles que sean seguras más para el feto que para la madre. El médico se ve obligado a tomar decisiones terapéuticas acertadas, generando mejoría del cuadro clínico y confianza en su paciente. Abordamos entonces el dolor de cabeza migrañoso en las mujeres durante las diversas edades en que la fluctuación de hormonas sexuales genera este trastorno, desde los puntos de vista fisiopatológico, enfoque diagnóstico y principales opciones terapéuticas estudiadas hasta el momento. Abreviaturas: MG, migraña (s); ACV, accidente cerebrovascular.

1. Goadsby PJ, Lipton RB, Ferrari MD. Migraine--current understanding and treatment. N Engl J Med. 2002; 346(4):257-70.

2. Nagel-Leiby S, Welch KM, Grunfeld S, D’Andrea G. Ovarian steroid levels in migraine with and without aura. Cephalalgia 1990; 10(3):147-52.

3. Somerville BW. The role of progesterone in menstrual migraine. Neurology. 1971; 21(8):853-9.

4. MacGregor EA, Frith A, Ellis J, Aspinall L, Hackshaw A. Incidence of migraine relative to menstrual cycle phases of rising and falling estrogen. Neurology. 2006; 67(12):2154-8.

5. MacGregor EA. M Menstruation, sex hormones, and migraine. Neurol Clin. 1997; 15(1):125-41.

6. Somerville BW. Estrogen-withdrawal migraine. II. Attempted prophylaxis by continuous estradiol administration. Neurology. 1975; 25(3):245-50.

7. Somerville BW. Estrogen-withdrawal migraine. I. Duration of exposure required and attempted prophylaxis by premenstrual estrogen administration. Neurology. 1975; 25(3):239-44.

8. Somerville BW. The role of estradiol withdrawal in the etiology of menstrual migraine. Neurology. 1972; 22(4):355-65.

9. Puri V, Puri S, Svojanovsky SR, Mathur S, Macgregor RR, Klein RM, et al. Effects of oestrogen on trigeminal ganglia in culture: implications for hormonal effects on migraine. Cephalalgia. 2006; 26(1):33-42.

10. Martin V, Behbehani M. Fos expression of trigeminal nucleus caudalis neurons after dural activation during different states of the rat estrous cycle [abstract]. Headache. 2005; 45:788.

11. Gangula PR, Zhao H, Wimalawansa SJ, Supowit SC, DiPette DJ, Yallampalli C. Pregnancy and steroid hormones enhance the systemic and regional hemodynamic effects of calcitonin gene-related peptide in rats. Biol Reprod. 2001; 64(6):1776-83.

12. Kim GM, Jin KS, Chung CS. Differential effects of corticosteroids on the expression of cyclooxygenase-2, tumour necrosis factor-alpha and matrix metalloproteinase-9 in an animal model of migraine. Cephalalgia. 2008; 28(11):1179-87.

13. Sicuteri F. Opioids, pregnancy and the disappearance of headache. Headache. 1980; 20(4):220-1.

14. Sakai Y, Dobson C, Diksic M, Aube M, Hamel E. Sumatriptan normalizes the migraine attack-related increase in brain serotonin synthesis. Neurology. 2008; 70(6):431-9.

15. Bethea CL, Lu NZ, Gundlah C, Streicher JM. Diverse actions of ovarian steroids in the serotonin neural system. Front Neuroendocrinol. 2002; 23(1):41-100.

16. Finocchi C, Ferrari M. Female reproductive steroids and neuronal excitability. Neurol Sci. 2011; 32 Suppl 1:S31-5.

17. Theoharis TC, Donelan J, Kandere-Grzybowska K, Konstantinidou A. The role of mast cells in migraine pathophysiology. Brain Res Brain Res Rev. 2005; 49(1):65-76.

18. Boes T, Levy D. Influence of sex, estrous cycle and estrogen on intracranial dural mast cells. Cephalalgia 2012; 32(12):924-31.

19. Magos A, Brincat M, Zilkha KJ, Studd JW. Serum dopamine beta-hydroxylase activity in menstrual migraine. J Neurol Neurosurg Psychiatry. 1985; 48(4):328-31.

20. Facchinetti F, Martignoni E, Fioroni L, Sances G, Genazzani AR. Opioid control of the hypothalamus- pituitary adrenal axis cyclically fails in menstrual migraine. Cephalalgia 1990; 10(1):51-6.

21. Facchinetti F, Sances G, Borella P, Genazzani AR, Nappi G. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache. 1991; 31(5):298-301.

22. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders. 3rd ed. (beta version). Cephalalgia. 2013; 33(9):629-808.

23. Granella F, Sances G, Allais G, Nappi RE, Tirelli A, Benedetto C, et al. Characteristics of menstrual and nonmenstrual attacks in women with menstrually related migraine referred to headache centres. Cephalalgia. 2004; 24(9):707-16.

24. Boyle CA. Management of menstrual migraine. Neurology 1999; 53(4 Suppl 1):S14-8.

25. Keenan PA, Lindamer LA. Non-migraine headache across the menstrual cycle in women with and without premenstrual syndrome. Cephalalgia. 1992; 12(6):356-9; discussion 339.

26. MacGregor EA, Chia H, Vohrah RC, Wilkinson M. Migraine and menstruation: a pilot study. Cephalalgia 1990; 10(6):305-10.

27. MacGregor EA, Igarashi H, Wilkinson M. Headaches and hormones: subjective versus objective assessment. Headache Q 1997 b;8:126-36.

28. Maggioni F, Alessi C, Maggino T, Zanchin G. Headache during pregnancy. Cephalalgia. 1997; 17(7):765-9.

29. Sances G, Granella F, Nappi RE, Fignon A, Ghiotto N, Polatti F et al. Course of migraine during pregnancy and postpartum prospective study. Cephalalgia. 2003; 23(3):197-205.

30. Bousser MG. Estrogens, migraine, and stroke. Stroke. 2004; 35(11 Suppl 1):2652-6.

31. Melhado E, Maciel JA Jr, Guerreiro CA. Headaches during pregnancy in women with a prior history of menstrual headaches. Arq Neuropsiquiatr. 2005; 63(4):934-40.

32. MacGregor EA. Menstruation, sex hormones, and migraine. Neurol Clin. 1997; 15(1):125-41.

33. Wall VR. Breastfeeding and migraine headaches. J Hum Lact. 1992; 8(4):209-12.

34. Meriggiola MC, Nanni M, Bachiocco V, Vodo S, Aloisi AM. Menopause affects pain depending on pain type and characteristics. Menopause 2012; 19(5):517-23.

35. Fettes I. Migraine in the menopause. Neurology. 1999; 53(4 Suppl 1):S29-33.

36. Neri I, Granella F, Nappi R, Manzoni GC, Facchinetti F, Genazzani AR. Characteristics of headache at menopause: a clinico-epidemiologic study. Maturitas. 1993; 17(1):31-7.

37. Mueller L. Predictability of exogenous hormone effect on subgroups of migraineurs. Headache. 2000; 40(3):189-93.

38. Greendale GA, Reboussin BA, Hogan P, et al. Symptom relief and side effects of postmenopausal hormones: results from the postmenopausal Estrogen/Progestin Interventions Trial. Obstet Gynecol. 1998; 92(6):982-8.

39. Misakian AL, Langer RD, Bensenor IM, Cook NR, Manson JE, Buring JE, Rexrode KM. Postmenopausal hormone therapy and migraine headache. J Womens Health (Larchmt). 2003; 12(10):1027-36.

40. Martin VT, Behbehani M. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis, part I. Headache. 2006; 46(1):3-23.

41. Martin VT, Behbehani M. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis, part 2. Headache. 2006; 46(3):365-86.

42. Becker WJ. Use of oral contraceptives in patients with migraine. Neurology 1999; 53(4 Suppl 1):S19-25.

43. Kurth T1, Slomke MA, Kase CS, Cook NR, Lee IM, Gaziano JM, et al. Migraine, headache, and the risk of stroke in women: a prospective study. Neurology. 2005; 64(6):1020-6.

44. Katsarava Z, Rabe K, Diener HC. From migraine to stroke. Intern Emerg Med. 2008; 3 Suppl 1:S9-16.

45. Scher AI, Terwindt GM, Picavet HS, Verschuren WM, Ferrari, MD, Launer LJ. Cardiovascular risk factors and migraine: the GEM population-based study. Neurology. 2005; 64(4):614-20.

46. Kruit MC, van Buchem MA, Hofman PA, Bakkers JT, Terwindt GM, Ferrari MD, et al. Migraine as a risk factor for subclinical brain lesions. JAMA. 2004; 291(4):427-34.

47. World Health Organization. Ischemic stroke and combined oral contraceptives: results of an international, multicenter, case-control study. Lancet. 1996; 348(9026):498-505.

48. Siritho S, Thrift AG, McNeil JJ, You RX, Davis SM, Donnan GA, et al. Risk of ischemic stroke among users of the oral contraceptive pill: The Melbourne Risk Factor Study (MERFS) Group. Stroke. 2003; 34(7):1575-80.

49. Bousser MG, Kittner SJ. Oral contraceptives and stroke. Cephalalgia. 2000; 20(3):183-9.

50. Johnston SC, Colford JM, Gress DR. Oral contraceptives and the risk of subarachnoid hemorrhage: a meta-analysis. Neurology. 1998; 51(2):411-8.

51. Hall GC, Brown MM, Mo J, MacRae KD. Triptans in migraine: the risks of stroke, cardiovascular disease, and death in practice. Neurology. 2004; 62(4):563-8.

52. Wainscott G, Sullivan FM, Volans GN, Wilkinson M. The outcome of pregnancy in women suffering from migraine. Postgrad Med J. 1978; 54(628): 98–102.

53. Aube M. Migraine in pregnancy. Neurology. 1999; 53(4 Suppl 1):S26-8.

54. Silberstein SD. Headaches in pregnancy. Neurol Clin. 2004; 22(4):727-56.

55. Facchinetti F, Allais G, D’Amico R, Benedetto C, Volpe A. The relationship between headache and preeclampsia: a case-control study. Eur J Obstet Gynecol Reprod Biol. 2005; 121(2):143-8.

56. Delmas PD, Bjarnason NH, Mitlak BH, Ravoux AC, Shah AS, Huster WJ, et al. Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med. 1997; 337(23):1641-7.

57. Young WB, Silberstein SD, Nahas SJ, Marmura MJ. Jefferson Headache Manual. New York: Demos Medical; 2011.

58. Marcus DA, Bain PA. Treatment of pregnant and breastfeeding patients with acute headache in the ED. Practical assessment and treatment of the patient with headaches in the Emergency Department and Urgent Care Clinic: New York: Springer; 2011. p. 133-54.

59. Beers MH, Berkow R. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station: Merck Research Laboratories, 2006.

60. Li DK, Liu L, Odouli R. Exposure to non-steroidal anti-inflammatory drugs during 
pregnancy and risk of miscarriage: population based cohort study. BMJ. 2003; 327(7411):368.

61. Levin M, Comprehensive review of headache medicine. New York: Oxford University Press; 2008.

62. Cete Y, Dora B, Ertan C, Ozdemir C, Oktay C. A randomized prospective placebo-controlled study of intravenous magnesium sulphate vs. metoclopramide in the management of acute migraine attacks in the Emergency Department. Cephalalgia. 2005; 25(3):199-204.

63. Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, et al. EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force. Eur J Neurol. 2009; 16(9):968-81.

64. Peroutka SJ, Lyon JA, Swarbrick J, Liption RB, Kolodner K, Goldstein J. 
Efficacy of diclofenac sodium softgel 100 mg with or without caffeine 100 mg in migraine without aura: a randomized, double-blind, crossover study. Headache. 2004; 44(2):136-41.

65. Browne ML. Maternal exposure to caffeine and risk of congenital anomalies: a systematic review. Epidemiology. 2006; 17(3):324-31.

66. Browne ML, Bell EM, Druschel CM, Gensburg LJ, Mitchell AA, Lin AE, et al. Maternal caffeine consumption and risk of cardiovascular malformations. Birth Defects Res A Clin Mol Teratol. 2007; 79(7):533-43.

67. Lance JW, Goadsby PJ. Mechanism and Management of Headache. 7th ed. Philadelphia : Elsevier; 2005.

68. Loder E. Safety of sumatriptan in pregnancy: a review of the data so far. CNS Drugs. 2003; 17(1):1-7.

69. Maizels M, Scott B, Cohen W, Chen W. Intranasal lidocaine for treatment of migraine: a 
randomized, double-blind, controlled trial. JAMA. 1996; 276(4):319- 21.

70. Blanda M, Rench T, Gerson LW, Weigand JV. Intranasal lidocaine for the treatment of migraine headache: a randomized, controlled trial. Acad Emerg Med. 2001; 8(4):337-42.

71. Tornabene SV, Deutsch R, Davis DP, Chan TC, Vilke GM. Evaluating the use and timing of opioids for the treatment of migraine headaches in the emergency department. J Emerg Med. 2009; 36(4):333-7.

72. Lane R, Davies P. Migraine. New York: Taylor & Francis Group; 2006.

73. Lipton RB, Bigal ME. Migraine and other headache disorders. New York: Informa Healthcare; 2006.

74. Olesen J, Silberstein SD, Tfelt-Hansen P. Preventive pharmacotherapy of headache disorders. New York: Oxford University Press; 2004.

75. Schulman EA, Levin M. Refractory Migraine: Mechanisms and Management. New York: Oxford University Press; 2010.