Perimenstrual headaches: Unmet needs

Abstract

The risk of migraine is increased among women during a 5-day perimenstrual window that starts 2 days before the onset of menses and continues through the first 3 days of menstruation. For some women with menstrual migraine, headaches that occur at this time are more severe, of longer duration, and more disabling. Although it is recognized that menstrual migraine requires specific management, there remain a number of unmet needs. In particular, comorbidity can result in women with menstrual migraine presenting to obstetrician/gynecologists or psychiatrists rather than primary care physicians or neurologists. Failure to diagnose menstrual migraine will lead to suboptimal management. Accurate diagnosis is insufficient unless it results in effective treatment strategies. Although effective and specific treatments for menstrual migraine have been developed, there is a need to define individual timing and duration of perimenstrual prophylaxis.

Estrogen-dependent effects of 5-hydroxytryptophan on cortical spreading depression in rat: Modelling the serotonin-ovarian hormone interaction in migraine aura

“…One must keep in mind, however, that the E2 levels in pregnancy are much higher than those found in proestrus or during post-oophorectomy replacement treatment. By contrast, the vast majority of menstrual-related migraine attacks are without aura and supposed to be triggered by the premenstrual fall in plasma estrogen levels (52). This is in line with our finding in oophorectomized rats, showing that the increased CSD susceptibility induced by estradiol treatment has disappeared one day after treatment arrest.…”

The Association of Migraine with Menstrually Related Mood Disorders and Childhood Sexual Abuse

“…Menstrual mood disorders are characterized by significant emotional and physical symptoms and functional impairment that is isolated to the luteal phase of the menstrual cycle. 20,21 Additional rationale that women with a MRMD may be a relevant population in which to examine the link between an abuse history and migraine is based on the following evidence: (1) MRMD women are differentially sensitive to the mood destabilizing effects of gonadal steroid hormones; 22 (2) although mood symptoms are a required feature of MRMD, premenstrual headache is among the diagnostic criteria; 20 (3) headache and other somatic symptoms contribute to luteal phase functional impairment; 20,23 and (4) for both MRMDs 24 and MA, 25 polymorphisms in the estrogen receptor alpha (ESR1) may have pathophysiological relevance.…”

Characteristics of Menstrual vs Nonmenstrual Migraine: A Post Hoc, Within‐Woman Analysis of the Usual‐Care Phase of a Nonrandomized Menstrual Migraine Clinical Trial

“…For an official diagnosis of MM, migraines during the days −2 to +3 window must occur in at least 2 of 3 menstrual cycles to establish a relationship that is greater than chance alone 10 . Although the IHS criteria facilitate research diagnosis, there continue to be important unmet needs in the clinical management of women with MM 11 . Improved awareness of the problem of MM is critical for more effective treatment.…”