Characteristics of Menstrual and Nonmenstrual Attacks in Women with Menstrually Related Migraine Referred to Headache Centres

Abstract

Aim of this study was to determine whether menstrual attacks differ from nonmenstrual attacks (NMA) as regards clinical features or response to abortive treatment in women affected by menstrually related migraine (MRM) referred to tertiary care centres. Sixty-four women with MRM were enrolled in a 2-month diary study. Perimenstrual attacks were split into three groups--premenstrual (PMA), menstrual (MA) and late menstrual (LMA)--and compared to nonmenstrual ones. Perimenstrual attacks were significantly longer than NMA. No other migraine attack features were found to differ between the various phases of the cycle. Migraine work-related disability was significantly greater in PMA and MA than in NMA. Acute attack treatment was less effective in perimenstrual attacks. Pain-free at 2 h after dosage was achieved in 13.5% of MA (OR 0.41; 95% CI 0.22, 0.76) vs. 32.9% of NMA. We concluded that, in MRM, perimenstrual attacks are longer and less responsive to acute attack treatment than NMA.

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

“…Support for this comes from two separate sources. Firstly, several studies have indicated that menstruating women experience migraine attacks both inside and outside the menstrual period [10,11,14]. Secondly, recent studies have demonstrated that severely affected migraine sufferers have multiple clinical presentations of their migraine attacks, from true migraine, through migrainous headache to tension-type headache.…”

“…Population-and casebased studies have indicated that attacks of migraine at the time of menstruation are more severe, of longer duration and more resistant to treatment than attacks at other times of the month [9][10][11]. A small study with sumatriptan indicated that the drug was less effective for attacks occurring during menstruation than for those occurring at other times (56% vs. 81% of patients reporting relief of their migraine headache 4 hours after treatment, when treated during and outside the menstrual period, respectively) [12].…”

Frovatriptan vs. transdermal oestrogens or naproxen sodium for the prophylaxis of menstrual migraine

“…The origin of MM is to be ascribed to the sudden fall of serum oestrogen levels immediately preceding menses, triggering abnormal neurotransmitter and neurohormonal responses or abnormal release of prostaglandins [3][4][5][6].…”

Catamenial migraine: epidemiology, pathogenesis, diagnosis, clinical features

“…Они указали, что из 506 приступов, возникших у 190 пациенток, мигрень с аурой отмечалась в 11,7% случаев менструальной мигрени и в 15% случаев неменструальной мигрени. Эти различия не явля-лись статистически значимыми.Проведенные исследования показали, что прежние ди-агностические критерии МКГБ IHS, устанавливающие в ка-честве одной из границ возникновения менструальной миг-рени окончание кровотечения, не вполне удовлетворитель-ны, так как длительность менструации не всегда напрямую зависит от гормональных изменений и может быть связана с другими факторами [28]. В 1996 г. Е. MacGregor [17], проана-лизировав полученные данные, описала границы перимен-струального окна, когда возникающую мигрень следует тра-ктовать как менструальную, -2 дня до начала менструации и первые 3 дня цикла.…”

“…Приступы, возникающие у паци-енток в течение 2 дней до менструации, протекали в 2,1 раза тяжелее, а приступы в первые 3 дня менструации -в 3,4 раза тяжелее, чем неменструальные приступы у этих же пациенток. F. Granella et al [28] оценивали тяжесть присту-пов менструальной мигрени и их реакцию на лечение у 64 женщин, страдающих мигренью и обратившихся в специа-лизированный центр. Авторы обнаружили, что мигреноз-ные приступы в перименструальный период (особенно в первые 2 дня менструации) длились значительно дольше, сопровождались большей потерей работоспособности и ху-же отвечали на терапию, чем неменструальные приступы.…”