Skip to main content

Advertisement

SpringerLink
Log in

Menstrual migraine

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Migraine is a common disorder that is disproportionately prevalent in women, especially during the reproductive years. Hormonal changes may play a role in the etiology of migraine, as many women note that their migraine attacks occur in temporal relationship with their menses. The Headache Classification Subcommittee of the International Headache Society has recently defined menstrual and menstrually related migraine. We review the most relevant and recent literature on menstrual migraine, with a special focus on pathophysiology and therapy. Although the pathogenesis of menstrual and menstrually related migraine is not well understood, estrogen withdrawal seems to play an important role as a trigger for menstrual migraine attacks. The therapeutic approach also may differ from the treatment of nonmenstrual migraine. Some patients do not require prophylaxis when they can abort their attacks effectively, whereas others may benefit from perimenstrual prophylaxis or standard migraine prophylaxis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Loder E, Marcus DA: Migraine in Women. Hamilton, Ontario: Decker BC; 2004:102–111.

    Google Scholar 

  2. MacGregor EA: “Menstrual” migraine: towards a definition. Cephalalgia 1996, 16:11–21.

    Article  PubMed  CAS  Google Scholar 

  3. Headache Classification Subcommittee of the International Headache Society (IHS). The International Classification of Headache Disorders (2nd edition). Cephalalgia 2004, 24(Suppl 1):9–160.

  4. Couturier EG, Bomhof MA, Knuistingh Neven A, et al.: Menstrual migraine in a representative Dutch population sample: prevalence, disability and treatment. Cephalalgia 2003, 23:302–308.

    Article  PubMed  CAS  Google Scholar 

  5. Dzoljic E, Sipetic S, Vlajinac H, et al.: Prevalence of menstrually related migraine and nonmigraine primary headache in female students of Belgrade University. Headache 2002, 42:185–193.

    Article  PubMed  CAS  Google Scholar 

  6. Solbach P, Sargent J, Coyne L: Menstrual migraine headache: results of a controlled, experimental, outcome study of non-drug treatments. Headache 1984, 24:75–78.

    Article  PubMed  CAS  Google Scholar 

  7. Somerville BW: The role of progesterone in menstrual migraine. Neurology 1971, 21:853–859.

    PubMed  CAS  Google Scholar 

  8. Somerville BW: The role of estradiol in the etiology of menstrual migraine. Neurology 1972, 22:355–365.

    PubMed  CAS  Google Scholar 

  9. Somerville BW: Estrogen-withdrawal migraine. I. Duration of exposure required and attempted prophylaxis by premenstrual estrogen administration. Neurology 1975, 25:239–244.

    PubMed  CAS  Google Scholar 

  10. Welch KM, Darnley D, Simkins R: The role of estrogen in migraine: a review and hypothesis. Cephalalgia 1984, 4:227–236.

    Article  PubMed  CAS  Google Scholar 

  11. Fioroni L, Martignoni E, Facchinetti F: Changes of neuroendocrine axes in patients with menstrual migraine. Cephalalgia 1995, 15:297–300.

    Article  PubMed  CAS  Google Scholar 

  12. Fioroni L, D’Andrea G, Alecci M, et al.: Platelet serotonin pathway in menstrual migraine. Cephalalgia 1996, 16:427–430.

    Article  PubMed  CAS  Google Scholar 

  13. Brun J, Claustrat B, Saddier P, et al.: Nocturnal melatonin excretion is decreased in patients with migraine without aura associated with menses. Cephalalgia 1995, 15:136–139.

    Article  PubMed  CAS  Google Scholar 

  14. Murialdo G, Fonzi S, Costelli P, et al.: Urinary melatonin excretion throughout the ovarian cycle in menstrually related migraine. Cephalalgia 1994, 14:205–209.

    Article  PubMed  CAS  Google Scholar 

  15. MacGregor EA: Oestrogen and attacks of migraine with and without aura. Lancet Neurol 2004, 3:354–361. This is a recent review of hormonal factors in menstrual migraine.

    Article  PubMed  CAS  Google Scholar 

  16. Massiou H: Is menstrually associated migraine difficult to treat? Cephalalgia 1999, 19(Suppl 24):13–18.

    PubMed  Google Scholar 

  17. Stewart WF, Lipton RB, Chee E, et al.: Menstrual cycle and headache in a population sample of migraineurs. Neurology 2000, 55:1517–1523.

    PubMed  CAS  Google Scholar 

  18. Mattsson P: Hormonal factors in migraine: a population-based study of women aged 40 to 74 years. Headache 2003, 43:27–35.

    Article  PubMed  Google Scholar 

  19. Facchinetti F, Neri I, Martignoni E, et al.: The association of menstrual migraine with the premenstrual syndrome. Cephalalgia 1993, 13:422–425.

    Article  PubMed  CAS  Google Scholar 

  20. Gupta VK: Menstrual migraine is not pathogenetically related to premenstrual syndrome. Cephalalgia 1994, 14:411–412.

    Article  PubMed  CAS  Google Scholar 

  21. Facchinetti F: The premenstrual syndrome belongs in the diagnostic criteria for menstrual migraine. Cephalalgia 1994, 14:413–414.

    Article  PubMed  CAS  Google Scholar 

  22. Granella F, Sances G, Allais G, et al.: Characteristics of menstrual and nonmenstrual attacks in women with menstrually related migraine referred to headache centres. Cephalalgia 2004, 24:707–716. This is a study comparing the differences in clinical features and response to abortive therapy of menstrual and non-menstrual migraine.

    Article  PubMed  CAS  Google Scholar 

  23. MacGregor EA, Hackshaw A: Prevalence of migraine on each day of the natural menstrual cycle. Neurology 2004, 63:351–353.

    PubMed  Google Scholar 

  24. Johannes CB, Linet MS, Stewart WF, et al.: Relationship of headache to phase of the menstrual cycle among young women: a daily diary study. Neurology 1995, 45:1076–1082.

    PubMed  CAS  Google Scholar 

  25. Silberstein SD, Armellino JJ, Hoffman HD, et al.: Treatment of menstruation-associated migraine with the nonprescription combination of acetaminophen, aspirin and caffeine: results from three randomized, placebo-controlled studies. Clin Ther 1999, 21:475–491.

    Article  PubMed  CAS  Google Scholar 

  26. Loder E, Silberstein SD, Abu-Shakra S, et al.: Efficacy and tolerability of oral zolmitriptan in menstrually associated migraine: a randomized, prospective, parallel-group, double-blind, placebo-controlled study. Headache 2004, 44:120–130.

    Article  PubMed  Google Scholar 

  27. Facchinetti F, Bonellie G, Kangasniemi P, and the Sumatriptan Menstrual Migraine Study Group: The efficacy and safety of subcutaneous sumatriptan in the acute treatment of menstrual migraine. Obstet Gynecol 1995, 86:911–916.

    Article  PubMed  CAS  Google Scholar 

  28. Silberstein SD, Massiou H, Le Jeunne C, et al.: Rizatriptan in the treatment of menstrual migraine. Obstet Gynecol 2000, 96:237–242.

    Article  PubMed  CAS  Google Scholar 

  29. Loder E: Menstrual migraine: timing is everything. Neurology 2004, 63:202–203.

    PubMed  Google Scholar 

  30. Loder E: Prophylaxis of menstrual migraine with triptans: problems and possibilities. Neurology 2002, 59:1677–1681.

    PubMed  CAS  Google Scholar 

  31. Silberstein SD, Elkind AH, Schreiber C, et al.: A randomized trial of frovatriptan for the intermittent prevention of menstrual migraine. Neurology 2004, 63:261–269.

    PubMed  CAS  Google Scholar 

  32. Newman L, Mannix LK, Landy S, et al.: Naratriptan as short-term prophylaxis of menstrually associated migraine: a randomized, double-blind, placebo-controlled study. Headache 2001, 41:248–256.

    Article  PubMed  CAS  Google Scholar 

  33. ChavanuKJ, O’Donnell DC: Hormonal interventions for menstrual migraines. Pharmacotherapy 2002, 22:1442–1457. This is a thorough review of the literature on hormonal therapy for menstrual migraine, with detailed tables comparing the studies discussed.

    Article  Google Scholar 

  34. Silberstein SD: The role of sex hormones in headache. Neurology 1992, 42(Suppl 2):37–42.

    PubMed  CAS  Google Scholar 

  35. de Lignieres B, Vincens M, Mauvais-Jarvis P, et al.: Prevention of menstrual migraine by percutaneous oestradiol. BMJ 1986, 293:1540.

    Article  PubMed  Google Scholar 

  36. Smits MG, Meer YG, Pfeil JP, et al.: Perimenstrual migraine: effect of Estraderm TTS (r) and the value of contingent negative variation and exteroceptive temporalis muscle suppression test. Headache 1993, 34:103–106.

    Article  Google Scholar 

  37. MacGregor A: Effects of oral and transdermal estrogen replacement on migraine. Cephalalgia 1999, 19:124–125.

    Article  PubMed  CAS  Google Scholar 

  38. O’Dea JP, Davis EH: Tamoxifen in the treatment of menstrual migraine. Neurology 1990, 40:1470–1471.

    PubMed  CAS  Google Scholar 

  39. Lichten EM, Bennett RS, WhittyAJ, et al.: Efficacy of danazol in the control of hormonal migraine. J Reprod Med 1991, 36:419–424.

    PubMed  CAS  Google Scholar 

  40. Herzog AG: Continuous bromocriptine therapy in menstrual migraine. Neurology 1997, 48:101–102.

    PubMed  CAS  Google Scholar 

  41. Murray SC, Muse KN: Effective treatment of severe menstrual migraine headaches with gonadotropin-releasing hormone agonist and “add-back” therapy. Fertil Steril 1997, 67:390–393.

    Article  PubMed  CAS  Google Scholar 

  42. Martin V, Wernke S, Mandell K, et al.: Medical oophorectomy with and without estrogen add-back therapy in the prevention of migraine headache. Headache 2003, 43:309–321.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Division of Head and Facial Pain, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 2 RCP, 52242, Iowa City, IA, USA

    Ana Recober MD & Lynne O. Geweke MD

Authors
  1. Ana Recober MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lynne O. Geweke MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Recober, A., Geweke, L.O. Menstrual migraine. Curr Neurol Neurosci Rep 5, 93–98 (2005). https://doi.org/10.1007/s11910-005-0005-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-005-0005-4

Keywords

Search

Navigation