Efficacy and Tolerability of Naratriptan for Short‐Term Prevention of Menstrually Related Migraine: Data From Two Randomized, Double‐Blind, Placebo‐Controlled Studies

Mannix, Lisa K.; Savani, N.; Landy, Steve; Valade, Dominique; Shackelford, S. D.; Ames, Michael; Jones, Martin

doi:10.1111/j.1526-4610.2007.00855.x

Cited by 79 publications

(66 citation statements)

References 23 publications

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“…Post-treatment migraine has been reported following naratriptan but not frovatriptan [Mannix et al 2007;Brandes et al (in press)] A small pilot, open-label, nonrandomized, parallel group study assessed the efficacy of 2.5 mg frovatriptan against 25 mg transdermal oestrogen or 50 mg naproxen sodium each taken once daily for 6 days, beginning 2 days before the expected onset of menstrual headache [Guidotti et al 2007]. The baseline median headache severity score severity was 4.6, 4.2 and 4.3 in the group subsequently treated with frovatriptan, transdermal oestrogen and naproxen sodium, respectively (p ¼ 0.819) compared with scores of 2.5, 3.0 and 3.0 during treatment (p ¼ 0.049).…”

Section: Estradiolmentioning

confidence: 95%

Review: Menstrual migraine: therapeutic approaches

MacGregor

2009

Ther Adv Neurol Disord

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The development of diagnostic criteria has enabled greater recognition of menstrual migraine as a highly prevalent and disabling condition meriting specific treatment. Although few therapeutic trials have yet been undertaken in accordance with the criteria, the results of those published to date confirm the efficacy of acute migraine drugs for symptomatic treatment. If this approach is insufficient, the predictability of attacks provides the opportunity for perimenstrual prophylaxis. Continuous contraceptive strategies provide an additional option for management, although clinical trial data are limited. Future approaches to treatment could explore the genomic and nongenomic actions of sex steroids.

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Section: Estradiolmentioning

confidence: 95%

Review: Menstrual migraine: therapeutic approaches

MacGregor

2009

Ther Adv Neurol Disord

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“…The body of evidence supports that naratriptan can be considered potentially advantageous for some women with MRM and PMM [22][23][24]. However, an extended conversation for patient-informed consent should be considered, given the increased post-treatment headache attacks, naratriptan's cost and frequent disadvantageous insurance formulary status, limited pregnancy exposure and category C listing, risk for FDA off-label mixing with other triptans, controversy amongst experts of rebound potential in women with MRM with signifi cant amounts of other non-MM, contraindications (including the likelihood of combination with selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors), and somewhat limited differentiation from placebo.…”

Section: Triptan Mini-prophylaxismentioning

confidence: 98%

“…Naratriptan was administered twice daily for 5 days starting 2 days before the expected onset of menses for the short-term prevention of MRM across four perimenstrual period (PMPs). This led to the design of the studies by Mannix et al [23] (two large, identically designed RDBPCTs). They evaluated the effi cacy and tolerability of naratriptan for MRM (defi ned as any migraine beginning during the PMP-days -2, -1, 1, 2, 3, and 4, with day 1 the fi rst day of menstrual fl ow).…”

Section: Triptan Mini-prophylaxismentioning

confidence: 98%

Clinical aspects of perimenstrual headaches

Taylor

2009

Current Science Inc

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Menstrual migraine (MM) is either pure, if attacks are limited solely during the perimenstrual window (PMW), or menstrually related (MRM), if two of three PMWs are associated with attacks with additional migraine events outside the PMW. Acute migraine specific therapy is equally effective in MM and non-MM. Although the International Classification of Headache Disorders-II classifies MM without aura, data suggest this needs revision. The studies on extended-cycle oral contraceptives suggest benefits for headache-prone individuals. Triptan mini-prophylaxis outcomes are positive, but a conclusion of "minimal net benefit compared to placebo" is not entirely unwarranted. In a 2008 evidence-based review, grade B recommendations exist for sumatriptan (50 and 100 mg), mefenamic acid (500 mg), and riza-triptan (10 mg) for the acute treatment of MRM. For the preventive mini-prophylactic treatment of MRM, grade B recommendations are provided for transcutaneous estrogen (1.5 mg), frovatriptan (2.5 mg twice daily), and naratriptan (1 mg twice daily).

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“…Trials of frovatriptan, naratriptan, sumatriptan and zolmitriptan for perimenstrual prophylaxis show efficacy. [43][44][45][46][47][48][49][50][51] The most extensive data are available for naratriptan and frovatriptan. The regimen for naratriptan is 1mg twice daily, starting two days before menstruation, continuing for six days in total.…”

Section: Triptansmentioning

confidence: 99%

“…'Rebound' migraine following treatment with naratriptan, but not with frovatriptan, has been noted. 44,47 There are no data reported on rebound following treatment with sumatriptan or zolmi triptan.…”

Section: Triptansmentioning

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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Efficacy and Tolerability of Naratriptan for Short‐Term Prevention of Menstrually Related Migraine: Data From Two Randomized, Double‐Blind, Placebo‐Controlled Studies

Abstract: Naratriptan 1 mg twice daily for 6 days per month is effective and well tolerated when used for short-term prevention of MRM. More patients receiving naratriptan than placebo were satisfied with treatment. The observed increase in posttreatment attacks needs further study.

Cited by 79 publications

References 23 publications

Review: Menstrual migraine: therapeutic approaches

Review: Menstrual migraine: therapeutic approaches

Clinical aspects of perimenstrual headaches

Diagnosis and management of menstrual migraine

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