Menstrual migraine: a clinical review

Abstract

OverviewMigraine attacks are often associated with menstruation in many, but not all, women with migraine. To date, no hormonal abnormalities have been identified in these women and it appears that normal hormonal fluctuations are associated with an abnormal central nervous system response. Diagnosis of migraine and confirmation of menstrual association is clinical, based on headache history and review of diary cards. Tests of hormone levels are rarely useful. Standard drugs to treat the acute symptoms suffice for the majority of women with monthly attacks. If acute therapy alone is inadequate, pre-emptive treatment of the expected menstrual headache with perimenstrual estradiol, triptans or non-steroidal anti-inflammatory drugs (NSAIDs) may be effective. Suppression of the menstrual cycle with anovulatory contraceptive agents is an additional option, particularly for women who also require contraception. A variety of other treatments have been studied, but the quality of evidence for their use is generally poor. Search strategyData for this review were identified by a MEDLINE search using the following search terms: estrogen, estradiol, menstruation, menstrual cycle, menstrual migraine, menstrually related migraine, menstrually associated migraine, migraine and progesterone. The resultant search identified 554 publications. The Cochrane search strategy for identifying reports of randomised controlled trials was run on this database. 1 The search strategy identified 103 publications, which were scrutinised for relevancy to this review.In addition, references from the author's own files, a hand search of the journals Cephalalgia and Headache, and peer-reviewed presentations at international congresses were considered. How common is migraine?The two most frequently encountered types of migraine differ only in their presence or absence of 'aura' (Box 1). 2 About 70-80% of migraineurs experience attacks of migraine without aura (formerly known as common or simple migraine), 10% have migraine with aura (formerly known as classical or focal migraine) and 15-20% have both types of attacks. Less than 1% of attacks are of aura alone, with no ensuing headache.Migraine is equally common in both sexes before puberty, with increased female prevalence following menarche. 3 At puberty, the incidence of migraine without aura rises in females, 4 with 10% to 20% of women reporting migraine with menarche. 5 This sex difference becomes greater with increasing age, peaking during the early 40s and declining thereafter. The lifetime prevalence of migraine is around 25% in women compared to only 8% in men. [6][7][8]

Consensus formalisé: recommandations de pratiques cliniques pour la prise en charge de la migraine du patient adulte africain

“…Les crises peuvent survenir à des moments particuliers du cycle menstruel. On définit alors deux types de migraines en fonction du moment de leur survenue [49, 50]: la migraine menstruelle (24 à 56% des cas), caractérisée par des crises survenant à n'importe quel moment du cycle, mais dont la fréquence augmente au cours de la menstruation; la migraine menstruelle pure ou migraine cataméniale (7,2% des cas), lorsque les crises surviennent régulièrement et exclusivement entre 2 jours avant et 3 jours après les règles. La migraine menstruelle est probablement liée à la chute brutale du taux d’œstrogène lors de la menstruation et à une prédisposition génétique, mais le mécanisme précis n'est pas encore élucidé [50, 51].…”

Headache frequency and intensity in female migraineurs using desogestrel-only contraception: A retrospective pilot diary study

“…The incidence of migraine in women is highest during the reproductive years, and more than 50% of women report an association between their migraine and menstruation (14,15). The reproductive phase is also the life period during which most women need efficient contraception.…”

Almotriptan 12.5 mg in menstrually related migraine: A randomized, double-blind, placebo-controlled study

“…There is, therefore, a clear need for effective acute treatment over and above the benefits of short-term preventive treatment. The selective 5-hydroxytryptamine 1B/1D receptor agonists (triptans) are generally the most effective agents available (7) and may therefore be preferable for MRM in view of its difficult-to-treat nature (1). …”