Menstrual migraine: clinical and therapeutical aspects

Abstract

Estrogens fluctuations, particularly their premenstrual fall, are currently regarded as the main triggers of menstrual migraine (MM). MM presents in two clinical forms: pure MM, where attacks are confined to the perimenstrual period (PMP), and menstrually related migraine, where attacks always occur during, but are not confined to, the PMP. MM episodes are usually longer, more intense, more disabling and more refractory than nonmenstrual attacks. Acute management of MM should initially be abortive and primarily sought with triptans. If this fails, short-term perimenstrual prophylaxis with NSAIDs, coxibs, triptans or ergotamine derivatives can be considered. Hormone manipulations, mainly application of percutaneous estradiol gel in PMP or administration of oral contraceptives in extended cycles, constitute an alternative approach for nonresponders.

Clinical experience with the combined contraceptive vaginal ring in Switzerland, including a subgroup analysis of previous hormonal contraceptive use

“…Many women experience symptoms during their reproductive years, resulting from fluctuations in hormone levels during the cycle [17][18][19][20] . It is estimated that PMS affects up to 80-90% of women, while dysmenorrhoea can affect 50-90% of young women and causes regular absenteeism from school or work 18 .…”

“…For these women it is recommended to use the lowest possible EE dosage together with a method that achieves constant serum hormone levels. Shortening of the hormone-free interval or use of an extended or continuous regimen aiming at suppressing oestrogen fluctuations may also be helpful 17,20 .…”

Efficacy of frovatriptan in the acute treatment of menstrually related migraine: analysis of a double-blind, randomized, cross-over, multicenter, Italian, comparative study versus rizatriptan

“…Menstrually related migraine leads to substantial disability and attacks are more severe, longer in duration, and have a poorer response to analgesics than episodes occurring in other time of the month [2]. Drug prophylaxis may be useful for menstrual migraine [3].…”

Efficacy of frovatriptan in the acute treatment of menstrually related migraine: analysis of a double-blind, randomized, multicenter, Italian, comparative study versus zolmitriptan

“…Menstrually related migraine (MRM) is associated with substantial disability and attacks are more severe, longer in duration, and have a poorer response to analgesics than non-menstrual ones [2]. Drug prophylaxis may be useful for menstrual migraine [3].…”