Effective treatment of severe menstrual migraine headaches with gonadotropin-releasing hormone agonist and “add-back” therapy

Murray, Shona; Muse, Ken N.

doi:10.1016/s0015-0282(97)81928-0

Cited by 77 publications

(54 citation statements)

References 4 publications

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“…'Add-back' continuous combined oestrogen and progestogen can be given to counter these concerns. 55,56 Given these limitations, in addition to increased cost, such treatment should be instigated only in specialist departments.…”

Section: Nsaidsmentioning

confidence: 99%

Diagnosis and management of menstrual migraine

MacGregor¹

2011

Prog Neurol Psychiatry

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Despite affecting one in seven of the UK population, migraine is underdiagnosed and undertreated. 1 Prevalence is highest during the peak reproductive years with a female predilection, affecting one in five women compared with one in 13 men. 1 The diagnosis of migraine is based on recurrent episodic headaches lasting between four and 72 hours associated with photophobia, nausea and limitation of normal function in an otherwise healthy person. 2 Prevalence of menstrual migraineMenstruation is a significant risk factor for attacks of migraine without aura, with 50-60 per cent of women reporting a link between their menstrual periods and migraine. [3][4][5] Most women with menstrual exacerbation of migraine also experience attacks at other times of the month ('menstrually-related' migraine). 6,7 Fewer than 10 per cent of women report migraine exclusively with menstruation ('pure' menstrual migraine). [5][6][7][8][9] Characteristics of menstrual migraine Timing of attacks Compared with all other phases of the menstrual cycle, attacks of migraine without aura are most likely to occur during a five-day window that starts two days before the onset of menses and continues through the first three days of menstruation. 8,10-12 Studies suggest that women are over 70 per cent more likely to have migraine in the two days before menstruation and more than 2.5 times more likely to have attacks during the first three days of bleeding. 12 How attacks differ from non-menstrual attacks Menstrual attacks last longer, are more severe, are more likely to relapse, are less responsive to treatment, and are associated with greater disability when compared with attacks at other times of the cycle. 5,[11][12][13][14][15][16][17][18][19] DiagnosisThe International Headache Society (IHS) recognises two types of menstrual migraine: menstrually-related migraine, which is migraine without aura that regularly occurs on or between two days before menstruation and third day of bleeding (days -2 to +3), with additional attacks of migraine with or without aura at other times of the cycle; and pure menstrual migraine, which is migraine without aura that occurs only on or between days -2 to +3, ie with no attacks at any other time during the cycle. 6,20 To confirm the diagnosis, migraine attacks during the day -2 to +3 window must occur in at least two of three menstrual cycles to establish a relationship that is greater than chance alone. Relying on the history to confirm the diagnosis can be misleading. 21 Use of a three-month diar y to record migraine patterns can reveal the predictable patterns associated with menstrual migraine, aiding diagnosis. PathophysiologyResearch has found an increased risk of migraine associated with oestrogen 'withdrawal'. This occurs during the late luteal phase of the natural menstrual cycle and also during the hormone-free interval of combined hormonal contraceptives. 17,22 Prostaglandins have also been implicated in menstrual migraine. There is a three-fold increase in prostaglandin levels in the uterine endometriu...

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Section: Nsaidsmentioning

confidence: 99%

Diagnosis and management of menstrual migraine

MacGregor¹

2011

Prog Neurol Psychiatry

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“…In a small open-label study, the dopamine receptor agonist bromocriptine, an inhibitor of prolactin release, administered three times daily during the luteal phase, also showed moderate effect [33]. GnRH analogs, which induce a medical menopause, also have been effective; however, they are generally limited to short (6-month) courses [34,35]. These methods have not been subjected to clinical trials and therefore are not universally recommended for therapy of MM.…”

Section: Hormonalmentioning

confidence: 99%

Preventative treatment of menstrual migraine

Lay

Broner²

2007

Curr Pain Headache Rep

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More than 20 million US women suffer with migraine, two thirds of whom experience menstrually related migraine. Estrogen plays an important role in triggering migraine, and given the numerous hormonal fluctuations throughout a woman's lifetime, there are many opportunities for a hormonal impact. Accurate diagnosis is key to initiating effective treatment, and when acute therapy fails, the unique predictability of menstrual migraine lends itself to preventative treatment.

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“…Leuprolide, a gonadotropin-releasing hormone agonist, was found to provide sustained improvement in five selected patients with refractory menstrual migraines in a prospective, nonrandomized study by Murray and Muse [41]. Martin et al [42] studied the effect of medical oophorectomy and transdermal estradiol in the prevention of migraine.…”

Section: Clinical Presentationmentioning

confidence: 99%

Menstrual migraine

Recober

Geweke

2005

Curr Neurol Neurosci Rep

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Migraine is a common disorder that is disproportionately prevalent in women, especially during the reproductive years. Hormonal changes may play a role in the etiology of migraine, as many women note that their migraine attacks occur in temporal relationship with their menses. The Headache Classification Subcommittee of the International Headache Society has recently defined menstrual and menstrually related migraine. We review the most relevant and recent literature on menstrual migraine, with a special focus on pathophysiology and therapy. Although the pathogenesis of menstrual and menstrually related migraine is not well understood, estrogen withdrawal seems to play an important role as a trigger for menstrual migraine attacks. The therapeutic approach also may differ from the treatment of nonmenstrual migraine. Some patients do not require prophylaxis when they can abort their attacks effectively, whereas others may benefit from perimenstrual prophylaxis or standard migraine prophylaxis.

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Effective treatment of severe menstrual migraine headaches with gonadotropin-releasing hormone agonist and “add-back” therapy

Cited by 77 publications

References 4 publications

Diagnosis and management of menstrual migraine

Diagnosis and management of menstrual migraine

Preventative treatment of menstrual migraine

Menstrual migraine

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