Prevention of menstrual migraine by percutaneous oestradiol.

Lignières, B. De; Vincens, M; Mauvais-Jarvis, P; Mas, Jean‐Louis; Touboul, Pierre‐Jean; Bousser, Marie Germaine

doi:10.1136/bmj.293.6561.1540

Cited by 171 publications

(112 citation statements)

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“…Because estrogen withdrawal seems to be the trigger of menstrual migraine, peri-menstrual (days -4 to +4) estrogen replacement is a logical approach. The best results have been obtained by de Lignieres et al [20] with percutaneous estradiol gel (1.5 mg estradiol in 2.5 g gel) in women with regular menstrual cycles. The most practical way of administering estrogen is by means of transdermal patches.…”

Section: Preventive Treatmentmentioning

confidence: 66%

Menstrual migraine

Moschiano¹,

Grazzi

D’Amico

et al. 2001

J Headache Pain

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An association between migraine and menstruation can be ascertained by use of a diary for a minimum of three cycles. The pathophysiological and clinical peculiarities of menstrual migraine indicate that its management should differ from that of non–menstrual migraine. NSAIDS or migraine-specific medications (e.g. triptans) are often effective for the acute management of menstrual migraine. Preventive treatment is indicated when the attacks are long–lasting, severe and disabling and do not respond to acute treatments. Short–term prophylaxis (at the time of headache vulnerability) employs standard drugs such as magnesium, ergotamine or NSAIDs; triptans are currently being evaluated for short–term prophylaxis. If severe menstrual migraine attacks cannot be controlled by these, hormone therapy (percutaneous or transdermal estrogen) may be indicated. Antiestrogen agents (danazol, tamoxifen) are indicated only in rare resistant cases.

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Section: Preventive Treatmentmentioning

confidence: 66%

Menstrual migraine

Moschiano¹,

Grazzi

D’Amico

et al. 2001

J Headache Pain

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“…The prevention of menstrual migraine requires estrogen-based hormone therapy [2,33], because there is a link between this form of migraine and the decrease of the level of this hormone [2]. This prevention is confirmed by studies through the essential role of percutaneous estrogens at the dose of 1.5 mg per day started 2 days before the expected date of the crisis and continued 7 days [33].…”

Section: Therapeutic Aspectsmentioning

confidence: 84%

Migraine in Women: What Specificities? A Review

Boubacar¹,

Seck²,

Assadeck³

et al. 2017

J Women's Health Care

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The migraine is a chronic neurological disease that affects 10 to 12% of the population, with a clear preponderance females and this from puberty. The women report a longer attack duration. Presence and severity of associated symptoms, such as photophobia, phonophobia, nausea, vomiting, and cutaneous allodynia are more prevalent in women. Some clinical forms are well described as catamenial migraine. Several comorbidities have been described in migraine women. Among these diseases associated with migraine: vascular diseases, asthma, allergies, epilepsy, restless legs syndrome, and various chronic pain syndromes and psychiatric disorders. Treatment of migraine in women raises the difficulty of managing seizures and during pregnancy and the period of menstruation. The therapeutic difference mainly concerns menstrual migraine. In women with migraine, it is therefore recommended to be particularly attentive to comorbidities, the presence of which significantly increases the risk of arterial vascular events. Migraine is very common with a particular impact on the quality of life of women. These various specificities and their evolution over time must lead to continuous training of general practitioners, other specialists in women's health including gynecologists in order to reduce the morbidity of the disease by better prevention of crises through the harmonization of research by scientific societies from different continents.

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“…The women in our study were treated during a prolonged time (14 days, starting seven days before estimated start of the menstrual bleeding) in order to maintain a higher serum concentration of estradiol and to avoid influence of a variation in cycle length, whereas other studies generally treated women for seven days totally (7,8,13). The aim of this regimen was to make sure that serum concentrations of estradiol would be stable at the time of the anticipated start of the bleeding and migraine attacks.…”

mentioning

confidence: 99%

“…whereas 100g estradiol/24h have been reported to be effective (11). Also studies using 1,5mg estradiol transdermal gel have reported good effects (7,8,13). The serum concentrations of estradiol in women using patches with 100g estradiol may produce even higher serum concentrations of estradiol (14,15,16) than 1,5mg estradiol gel and the lack of difference in results between estradiol and placebo could most probably not be explained by an insufficient dose of estradiol.…”

mentioning

confidence: 99%

“…In women with menstrual migraine the stability rather than the concentrations of estradiol might be crucial to avoid and prevent attacks. Treatment may cause stability at low estrogen concentrations either by use of GnRH analogues or danazole (5,6) or at higher concentrations using combined oral contraceptives or estrogen supplementation perimenstrually (7,8,9,10). There seems to be a dose-response pattern as better results have been reported with use of a higher estradiol dose witch also suggest a critical concentration (11).…”

mentioning

confidence: 99%

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