Managing migraine headaches experienced by patients who self–report with menstrually related migraine: a prospective, placebo–controlled study with oral sumatriptan

Abstract

IntroductionMigraine is equally common in both genders until puberty, when it becomes approximately three times more prevalent in women than in men [1,2]. This greater prevalence in women is due, in part, to the influence of female sexual hormones. More than 50% of women relate a periodicity of their migraine attacks to their menstrual cycles [3,4], although in most cases they also have migraine attacks outside the menstrual period. It has been proposed that menstrual migraine is due to oestrogen withdrawal in the late luteal phase of the normal menstrual cycle acting as a migraine trigger in predisposed individuals [5], but other factors such as prostaglandin release have also been implicated [6]. However, the true prevalence of menstrual migraine attacks (those occurring during the peri-menstrual period) is unclear due to retrospective reports and variable definitions of menstrual migraine [7].Menstrual migraine attacks are treated with standard acute therapies and with specific prophylactic treatments such as oestrogen supplements taken during the peri-menstrual period [6]. It has been widely considered that menstrual migraine attacks are more severe and less responsive to drug treatments and non-pharmacological approaches than non-menstrual attacks [6,8], but the data to support this J Headache Pain (2005) 6:81-87 DOI 10.1007 Managing migraine headaches experienced by patients who self-report with menstrually related migraine: a prospective, placebo-controlled study with oral sumatriptan Abstract The objective was to evaluate the efficacy and tolerability of oral sumatriptan (100 mg) in patients who self-reported with menstrually related migraine. A prospective, multicentre, randomised, double-blind, placebocontrolled, two-group crossover study was carried out in 20 UK primary and secondary care surgeries. Of 115 patients with a self-reported history of menstrually related migraine that entered the study, 93 patients completed it. Patients treated all migraine attacks for 2 months with sumatriptan (100 mg) and for 2 months with placebo. The primary endpoint was the proportion of patients reporting headache relief at 4 hours for the first treated attack.Only 11% of patients fulfilled the protocol definition of menstrually related migraine. Patients reported a variable pattern of migraine attacks occurring inside and outside the menstrual window. For the first attack, significantly more patients receiving sumatriptan than placebo reported headache relief for attacks occurring inside (67% vs. 33%, p=0.007) and outside (79% vs. 31%, p<0.001) the menstrual period. Sumatriptan was generally well tolerated. Oral sumatriptan (100 mg) is an effective and well tolerated acute treatment for patients who report menstrually related migraine.

Acute treatment and prevention of menstrually related migraine headache

“…[11][12][13][14][15] The remaining 18 studies were included in the analysis: 10 on short-term prevention of MRM [16][17][18][19][20][21][22][23][24][25] and 8 on acute treatment of MRM. [26][27][28][29][30][31][32][33] The repeat search done prior to submission of the final manuscript yielded one further study on acute treatment of MRM. 34 Review of the 2007 abstracts of the IHS, AHS, AAN, and ANA meetings yielded 3 trials.…”

Menstrual migraine: a clinical review

“…13,22,26,27 Of specific relevance to clinical practice is that attacks occurring at the time of menstruation are more severe and disabling, last longer and are less responsive to symptomatic medication. 10,14,18,[28][29][30][31] Within-woman analyses show that compared to migraine at other times of the cycle, migraine in the 2 days before menstruation was 2.1 times more likely to be severe; those occurring on the first 3 days of bleeding were 3.4 times more likely to be severe and almost 5 times more likely to be accompanied by vomiting. 18 In women with menstrually related migraine referred to tertiary care centres, premenstrual (Days -2 and -1), menstrual (Days +1 and +2), and late menstrual (Days +3 to +7) attacks lasted longer than attacks at other times of the cycle.…”

Gender-Based Issues in Headache

“…12,23,30 As noted in the study by Marcus et al, 27 the results will also be influenced by the method of obtaining information À whether by interview (selfreporting) or diary analysis. 31 Some patients will report a relationship between migraine attacks and ovulation. However, this link has not been confirmed by any epidemiological studies.…”