摘要： 目的 评价偏头痛患者发生脑卒中风险的证据，以为脑卒中一级预防提供循证依据。方法 分别以migraine or migraine with aura、prevention and control、ischemia、hemorrhagic stroke、treatment or therapy 等英文词组作为检索词，检索美国国立医学图书馆、ScienceDirect 等数据库，并辅助手工检索获得临床指南、系统评价、Meta分析、随机对照试验、临床对照试验、回顾性病例分析、病例观察研究和综述等相关文献，采用Jadad 量表对文献质量进行评价。结果 经筛选共纳入偏头痛与脑卒中相关文献24 篇（临床指南5 篇、系统评价2 篇、Meta 分析4 篇、随机对照试验2 篇、病例观察研究10 篇、综述1 篇），其中20 篇为高质量文献，4 篇为低质量文献。结果显示：（1）偏头痛，尤其是先兆性偏头痛患者缺血性卒中风险明显增加，且女性高于男性；吸烟、口服避孕药使风险进一步增加。（2）偏头痛患者出血性卒中风险高于普通人群，尤以女性突出，且为颅内动脉瘤破裂的独立危险因素。（3）偏头痛发作频率与缺血性卒中风险呈正相关，以先兆性偏头痛更为明显。（4）卵圆孔未闭在病因不明的年轻脑卒中和偏头痛患者中更为常见，但卵圆孔未闭封堵术不推荐作为偏头痛患者预防脑卒中的措施。（5）由于偏头痛急性期治疗药物曲普坦类具有收缩血管作用，可能增加脑卒中风险。结论 女性偏头痛患者应戒烟并行口服避孕药替代疗法，目前尚无证据显示减少偏头痛发作的治疗措施能够有效降低首次脑卒中风险。由于曲普坦类药物的收缩血管作用可能增加脑卒中风险，因此偏头痛患者应以预防性治疗为主。

关键词: 先兆偏头痛, 卒中, 一级预防, 循证医学

Abstract: Objective  To evaluate the evidence of migraine increasing the risk of stroke, so as to provide evidence-based foundation for primary prevention of stroke in patients with migraine.  Methods  Taking migraine or migraine with aura, prevention and control, ischemia, hemorrhagic stroke, treatment or therapy as search terms, retrieve in databases such as PubMed and ScienceDirect, assisted by manual searching, in order to collect relevant literatures including clinical guidelines, systematic reviews, Meta-analysis, randomized controlled trials, clinical controlled trials, retrospective case analysis, case-observation studies and reviews. Jadad Scale was used to evaluate the quality of literature.  Results  Twenty-four related articles were finally selected, including 5 clinical guidelines, 2 systematic reviews, 4 Meta-analyses, 2 randomized controlled trials, 10 case-observation studies and 1 review. Among them 20 were of high quality, while 4 were of low quality. The results were as follows: 1) migraine, particularly migraine with aura, significantly increased the risk of ischemic stroke, and the risk of women was higher than men. Smoking and oral contraceptives further increased the risk of stroke. 2) The risk of hemorrhagic stroke in migraine with aura patients was higher than that in general population. Migraine without aura did not appear to increase the risk of hemorrhagic stroke, and migraine was an independent risk factor for aneurysm rupture. 3) Frequency of migraine attacks, especially migraine with aura, and risk of ischemic stroke was positively correlated. 4) Patent foramen ovale (PFO) was more common in young patients with cryptogenic stroke and migraineurs. However, closure of PFO was not indicated for preventing stroke in migraineurs. 5) Triptans, which was used to treat acute migraine, with a vasoconstrictor effect, may increase the risk of stroke, therefore prophylactic treatment of migraine was very important.  Conclusions  Smoking cessation and alternatives to oral contraceptives are recommended in women with migraine. Treatment to reduce migraine frequency might be reasonable, however, there is no evidence showing that this treatment approach would reduce the risk of first stroke. Due to the vasoconstrictor effect of triptans, prophylactic treatment should be the priority of migraineurs.

Key words: Migraine with aura, Stroke, Primary prevention, Evidence-based medicine