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Management of Menstrual Migraine

  • Headache (R.B. Halker, Section Editor)
  • Published:
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Abstract

Purpose of Review

Migraine disease is a neurological brain disorder that has been associated with significant disability and socioeconomic burden affecting women three times more commonly than men. Menstrual migraine is a subclass of migraine disease affecting 42–61% of females living with migraine disease. Menstrual migraine is often far more disabling, of longer duration, and more resistant to treatment. It is crucial to gain a deeper understanding of the ongoing biological changes and have a current awareness of the management of this debilitating form of migraine disease to improve the quality of life of these females living with migraine disease.

Recent Findings

In new treatment options such as devices and with large-scale genome-wide association studies in migraine, genes related to migraine are being identified.

Summary

This article will review the current literature regarding the pathophysiology, epidemiology, and treatment of menstrual migraine.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390(10100):1211–59.

    Article  Google Scholar 

  2. Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain. 2012;13(3):177–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. • Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211 This is the international classification of headache disorders which establishes the diagnostic criteria for the different headache disorders including the different types of menstrual migraine using advances in research.

  4. MacGregor EA, Victor TW, Hu X, Xiang Q, Puenpatom RA, Chen W, et al. Characteristics of menstrual vs non-menstrual migraine: a post hoc, within-woman analysis of the usual-care phase of a nonrandomized menstrual migraine clinical trial. Headache. 2010;50(4):528–38.

    Article  PubMed  Google Scholar 

  5. Vetvik KG, MacGregor EA, Lundqvist C, Russell MB. Prevalence of menstrual migraine: a population-based study. Cephalalgia. 2014;34(4):280–8.

    Article  PubMed  Google Scholar 

  6. Broner S, Bobker S, Klebanoff L. Migraine in women. Semin Neurol. 2017;37(06):601–10.

    Article  PubMed  Google Scholar 

  7. Petrovski BÉ, Vetvik KG, Lundqvist C, Eberhard-Gran M. Characteristics of menstrual versus non-menstrual migraine during pregnancy: a longitudinal population-based study. J Headache Pain. 2018;19(1):27.

    Article  PubMed  PubMed Central  Google Scholar 

  8. •• Calhoun AH. Understanding menstrual migraine. Headache. 2018;58(4):626–30 This article goes in-depth regarding the declines in estrogen levels and its relationship with migraine. It reviews evidence regarding the estrogen drop by reviewing a series of studies to show support of this hypothesis from an experimental, clinical, and pathophysiologic perspective.

    Article  PubMed  Google Scholar 

  9. Martin VT. New theories in the pathogenesis of menstrual migraine. Current Science Inc. 2008;12(6):453–62.

    Article  Google Scholar 

  10. Martin VT, Lipton RB. Epidemiology and biology of menstrual migraine. Headache. 2008;48:S124–30.

    Article  PubMed  Google Scholar 

  11. Silberstein S, Merriam G. Sex hormones and headache 1999 (menstrual migraine). Neurology. 1999;53(4 Suppl 1):S3–13.

    CAS  PubMed  Google Scholar 

  12. Mannix LK. Menstrual-related pain conditions: dysmenorrhea and migraine. J Women's Health. 2008;17(5):879–91.

    Article  Google Scholar 

  13. • van den Maagdenberg AMJM, Nyholt DR, Anttila V. Headache Pain. 2019;20(1):5 This article highlights an overview of findings regarding genome-wide association studies and their association with migraine. It provides commentary regarding current disease hypotheses and drawbacks regarding identifying genes and pathways.

    Article  Google Scholar 

  14. •• Pollock CE, Sutherland HG, Maher BH, Lea RA, Haupt LM, Frith A, et al. The NRP1 migraine risk variant shows evidence of association with menstrual migraine. J Headache Pain. 2018;19(1):31 This article reviews single-nucleotide polymorphisms and their association with menstrual migraine. It specifically highlights NRP1 and its potential relationship to menstrual migraine pathophysiology.

    Article  PubMed  PubMed Central  Google Scholar 

  15. MacGregor EA. Classification of perimenstrual headache: clinical relevance. Curr Pain Headache Rep. 2012;16(5):452–60.

    Article  PubMed  Google Scholar 

  16. • Maasumi K, Tepper SJ, Kriegler JS. Menstrual migraine and treatment options: review. Headache. 2017;57(2):194–208 This article reviews the published studies from 1970 to 2016 providing an overview of treatment options for menstrual migraine. It provides the authors’ perspective and commentary on the different treatment options for menstrual migraine based on a summary of historically important literature and relevant evidence-based studies.

    Article  PubMed  Google Scholar 

  17. Lichten EM. Menstrual migraine and treatment options: review. Headache. 2018;58(1):145–6.

    Article  PubMed  Google Scholar 

  18. Allais G, Tullo V, Omboni S, Benedetto C, Sances G, Zava D, et al. Frovatriptan vs other triptans in the treatment of menstrual migraine: pooled analysis of three double-blind, randomized, cross-over studies. J Headache Pain. 2013;14(S1):P191 1129-2377-14-S1-P191.

    Article  PubMed Central  Google Scholar 

  19. Dasgupta A, Krasowski MD. Therapeutic drug monitoring data: a concise guide. London, United Kingdom; San Diego, CA: Academic Press; 2020.

  20. Allais G, Castagnoli Gabellari I, Rolando S, Benedetto C. Evaluation of the use of sumatriptan–naproxen sodium for menstrual migraine and dysmenorrhea. Expert Rev Neurother. 2011;11(10):1383–7.

    Article  CAS  PubMed  Google Scholar 

  21. Marcus DA, Bernstein CD, Sullivan EA, Rudy TE. Perimenstrual eletriptan prevents menstrual migraine: an open-label study. Headache. 2010;50(4):551–62.

    Article  PubMed  Google Scholar 

  22. Newman LC, Lipton RB, Lay CL, Solomon S. A pilot study of oral sumatriptan as intermittent prophylaxis of menstruation-related migraine. Neurology. 1998;51(1):307–9.

    Article  CAS  PubMed  Google Scholar 

  23. Newman L, Mannix LK, Landy S, Silberstein S, Lipton RB, Putnam DGP, et al. Naratriptan as short-term prophylaxis of menstrually associated migraine: a randomized, double-blind, placebo-controlled study. Headache. 2001;41(3):248–56.

    Article  CAS  PubMed  Google Scholar 

  24. Tuchman MM, Hee A, Emeribe U, Silberstein S. Oral zolmitriptan in the short-term prevention of menstrual migraine: a randomized, placebo-controlled study. CNS Drugs. 2008;22(10):877–86.

    Article  CAS  PubMed  Google Scholar 

  25. Brandes J, Poole A, Kallela M, Schreiber C, MacGregor E, Silberstein S, et al. Short-term frovatriptan for the prevention of difficult-to-treat menstrual migraine attacks. Cephalalgia. 2009;29(11):1133–48.

    Article  CAS  PubMed  Google Scholar 

  26. Sances G, Martignoni E, Fioroni L, Blandini F, Facchinetti F, Nappi G. Naproxen sodium in menstrual migraine prophylaxis: a double-blind placebo controlled study. Headache. 1990;30(11):705–9.

    Article  CAS  PubMed  Google Scholar 

  27. Al-Waili NS. Treatment of menstrual migraine with prostaglandin synthesis inhibitor mefenamic acid: double-blind study with placebo. Eur J Med Res. 2000;5(4):176–82.

    CAS  PubMed  Google Scholar 

  28. Burch R. Epidemiology and treatment of menstrual migraine and migraine during pregnancy and lactation: a narrative review. Headache. 2020;60(1):200–16.

    Article  PubMed  Google Scholar 

  29. Facchinetti F, Sances G, Borella P, Genazzani AR, Nappi G. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache. 1991;31(5):298–301.

    Article  CAS  PubMed  Google Scholar 

  30. von Luckner A, Riederer F. Magnesium in migraine prophylaxis-is there an evidence-based rationale? A Systematic Review. Headache. 2018;58(2):199–209.

    Article  Google Scholar 

  31. Grazzi L, Egeo G, Calhoun AH, McClure CK, Liebler E, Barbanti P. Non-invasive vagus nerve stimulation (nVNS) as mini-prophylaxis for menstrual/menstrually related migraine: an open-label study. J Headache Pain. 2016;17(1):91.

    Article  PubMed  PubMed Central  Google Scholar 

  32. • Dima L, Bălan A, Moga MA, Dinu CG, Dimienescu OG, Varga I, et al. Botulinum toxin a valuable prophylactic agent for migraines and a possible future option for the prevention of hormonal variations-triggered migraines. Toxins (Basel). 2019;11(8):465 This article highlighted the fact onabotulinum toxin is used for chronic migraine; however, there are no population-based studies that look at onabotulinum toxin treatment for menstrual migraine.

  33. • Champaloux SW, Tepper NK, Monsour M, Curtis KM, Whiteman MK, Marchbanks PA, et al. Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke. Am J Obstet Gynecol. 2017;216(5):489.e1–7 This article examined the association of hormonal contraceptive use and migraine with aura showing an association of 6-fold increase risk of ischemic stroke in women of childbearing age.

    Article  Google Scholar 

  34. • Lichten EM. Menstrual migraine and treatment options: review hormonal therapy in the prevention of menstrual migraine. 2018;2(1):1049 This article highlights various published studies on stabilizing estradiol levels above and below 50 pg/ml threshold to prevent menstrual migraine.

  35. MacGregor EA, Frith A, Ellis J, Aspinall L, Hackshaw A. Prevention of menstrual attacks of migraine: a double-blind placebo-controlled crossover study. Neurology. 2006;67(12):2159–63.

    Article  CAS  PubMed  Google Scholar 

  36. Calhoun A, Ford S, Pruitt A. The impact of extended-cycle vaginal ring contraception on migraine aura: a retrospective case series. Headache. 2012;52(8):1246–53.

    Article  PubMed  Google Scholar 

  37. Vetvik KG, MacGregor EA, Lundqvist C, Russell MB. Contraceptive-induced amenorrhoea leads to reduced migraine frequency in women with menstrual migraine without aura. J Headache Pain. 2014;15:30.

    Article  PubMed  PubMed Central  Google Scholar 

  38. MacGregor EA. Migraine management during menstruation and menopause. Continuum (Minneap Minn). 2015;21(4 Headache):990–1003.

    Google Scholar 

  39. Murray SC, Muse KN. Effective treatment of severe menstrual migraine headaches with gonadotropin-releasing hormone agonist and ‘add-back’ therapy. Fertil Steril. 1997;67(2):390–3.

    Article  CAS  PubMed  Google Scholar 

  40. Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E, et al. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of neurology and the American Headache Society. Neurology. 2012;78(17):1337–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Arumugam M, Parthasarathy V. Increased incidence of migraine in women correlates with obstetrics and gynaecological surgical procedures. Int J Surg. 2015;22:105–9.

    Article  PubMed  Google Scholar 

  42. Ripa P, Ornello R, Degan D, Tiseo C, Stewart J, Pistoia F, et al. Migraine in menopausal women: a systematic review. Int J Women's Health. 2015;7:773–82.

    Google Scholar 

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Correspondence to Tasjeel Ansari.

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Tasjeel Ansari, Ana Marissa Lagman-Bartolome, Christine Lay, and Danny Monsour each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Ansari, T., Lagman-Bartolome, A.M., Monsour, D. et al. Management of Menstrual Migraine. Curr Neurol Neurosci Rep 20, 45 (2020). https://doi.org/10.1007/s11910-020-01067-x

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  • DOI: https://doi.org/10.1007/s11910-020-01067-x

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