Menstrual migraine: A review of prophylactic therapies

Abstract

Menstrual migraine is commonly encountered in women who are experiencing attacks of migraine without aura. It remains controversial whether attacks of menstrually associated migraine are more severe and have a longer duration than non-menstrually associated attacks. The pathogenesis of menstrual migraine is not understood completely, but it may be related to estrogen withdrawal or prostaglandin release. Preventative therapies may be considered in those who have failed abortive medications or have attacks lasting longer than 2 days. They can be administered short-term during the perimenstrual time period or continuously throughout the menstrual cycle. Short-term prophylactics should be tried first because menstrual migraines generally last for 1 to 4 days only. Continuous prophylactics may be considered in those with attacks refractory to short-term therapies.

Perimenstrual headache: Treatment options

“…More recent studies using estradiol gel (1.5 mg) 2 to 7 days before menses have demonstrated improvement in MM [33], and Pringsheim and colleagues [15••] recommended that it be used routinely. Martin [34] notes that there is little evidence to support use of 50-μg transdermal estradiol patches; however, doses of 100 μg have been suggested as necessary for success in treating MM. Evidence that they improve MM is fair, and their benefi t outweighs the risk.…”

“…These include tamoxifen, phytoestrogens, danazol, gonadotropin-releasing hormone, and bromocriptine [34]. These agents are best reserved for women who are refractory to the mainstream approaches to MM.…”

The Clinical Rationale for Menses-Free Contraception

“…Consequently, the cyclic fluctuations in these hormones cause cyclic changes in other body systems as well. Underlying medical conditions that are often aggravated with the onset of menstruation include epilepsy, 32,33 chronic pelvic pain, 34,35 migraine headache, [36][37][38][39][40] and mood disturbances. 41,42 More recently, exacerbations of asthma have been linked to menstruation.…”

Preventative treatment of menstrual migraine

“…In some patients, despite a low frequency of headaches, a severely disabling MM may require preventative therapy [14].…”