Menstrual migraine: a review of current and developing pharmacotherapies for women

Abstract

Migraine is one of the most common neurological disorders in the general population. It affects 18% of women and 6% of men. In more than 50% of women migraineurs the occurrence of migraine attacks correlates strongly with the perimenstrual period. Menstrual migraine is highly debilitating, less responsive to therapy, and attacks are longer than those not correlated with menses. Menstrual migraine requires accurate evaluation and targeted therapy, that we aim to recommend in this review. Areas covered: This review of the literature provides an overview of currently available pharmacological therapies (especially with triptans, anti-inflammatory drugs, hormonal strategies) and drugs in development (in particular those acting on calcitonin gene-related peptide) for the treatment of acute migraine attacks and the prophylaxis of menstrual migraine. The studies reviewed here were retrieved from the Medline database as of June 2017. Expert opinion: The treatment of menstrual migraine is highly complex. Accurate evaluation of its characteristics is prerequisite to selecting appropriate therapy. An integrated approach involving neurologists and gynecologists is essential for patient management and for continuous updating on new therapies under development.

Prevalence of Primary Headache Disorder Among Primary and middle School students in Kuwait.

“…These findings point to an increased risk of females to develop primary headaches, particularly migraine and tension type headaches, compared to their male counterparts. It has been already established in the literature that women are at increased risk of developing migraine headaches and are 3.25 more likely to suffer from migraine than men [36]. From a pathophysiological perspective, the female brain manifests a sex-specific activity that can be detected via functional neuroimaging in terms of cortical regions involved in pain modulation and affective processing, such as the insula and precuneus, display enhanced activation in women [37].…”

Prevalence of Primary Headache Disorder Among Primary and middle School students in Kuwait.

“…These ndings point to an increased risk of females to develop primary headaches, particularly migraine and tension type headaches, compared to their male counterparts. It has been already established in the literature that women are at increased risk of developing migraine headaches and are 3.25 more likely to suffer from migraine than men [29]. From a pathophysiological perspective, the female brain manifests a sex-speci c activity that can be detected via functional neuroimaging.…”

Approaching the appropriate pharmacotherapy of menstrual migraine

“…It is three times more common in women who go from the beginning of fertility to menopause or immediately after it. The menstrual migraine (MM) subset lasts more than the usual 72 hours and shows a higher acute drug resistance [2]. Additionally, MM preventative treatment is a serious obstacle for the clinician; giving nonsteroidal antiinflammatory drugs (NSAIDs) or triptans as mini-prophylaxis, might limit acute therapeutic options during the menstrual period [3].…”

“…In cases of medium-high frequency migraine, including MM, therapeutic choices are different offering triptans, NSAIDs and other analgesics as acute treatment. Short-term prophylaxis is based on the same acute drugs plus dihydroergotamine, magnesium and estrogen supplementation, while long-term prophylaxis foresees topiramate, combined hormonal contraceptives, progestogen-only contraception and also phytoestrogens [2,4].…”