Skip to main content

Advertisement

SpringerLink
Log in

Menstrual migraine

  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

The initial treatment of menstrual migraine (MM) should be the same as that of migraine that occurs at any other time during the month and should include lifestyle modifications and the use of appropriate acute therapies aimed at decreasing attack symptoms, duration, and disability. If results of acute therapy are incomplete or unsatisfactory, then preventive strategies may be required. Comorbidities may, however, influence choice of preventive therapy or accelerate initiation of preventive therapy. Comorbid dysmenorrhea, menometrorrhagia, and endometriosis argue for early use of hormonal therapies. Hormonal strategies may be appropriate because the premenstrual decline in estradiol concentration predictably precipitates MM, and targeting and preventing this decline can decrease headache occurrence. Continuous combined hormonal contraceptives can reduce hormone fluctuations and, for some MM sufferers, can deliver more than contraceptive benefits. Nonsteroidal anti-inflammatory drugs are appropriate for treatment of co-occurring dysmenorrhea or when hormonal strategies are contraindicated; their efficacy may be caused partly by the role of prostaglandins in MM and dysmenorrhea. As with the use of hormonal therapy, use of nonsteroidal anti-inflammatory drugs allows for treatment of breakthrough headache with triptans. Results of clinical trials suggest that daily use of triptans in the menstrual window may bring about as much as 50% reduction in headache frequency, but such use still requires acute treatment of breakthrough headache and adherence to daily triptan limits. Use of this strategy requires that headache occurrence be highly predictable.

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. Silberstein SD, Merriam GR: Sex hormones and headache. J Pain Symptom Manage 1993, 8:243–259.

    Article  Google Scholar 

  2. Lipton RB, Stewart WF, Diamond S, et al.: Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 2001, 41:646–657.

    Article  PubMed  CAS  Google Scholar 

  3. Bille BS: Migraine in school children. A study of the incidence and short-term prognosis, and a clinical, psychological and electroencephalographic comparison between children with migraine and matched controls. Acta Paediatr 1962, 51(suppl 136):1–151.

    Google Scholar 

  4. Waters WE: Epidemiology of headache and migraine in women. J Neurol Neurosurg Psychiatry 1971, 34:148–153.

    Article  PubMed  CAS  Google Scholar 

  5. Stewart WF, Lipton RB, Celentano DD, Reed ML: Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors. JAMA 1992, 267:64–69.

    Article  PubMed  CAS  Google Scholar 

  6. Epstein MT, Hockaday JM, Hockaday TD: Migraine and reporoductive hormones throughout the menstrual cycle. Lancet 1975, 1:543–548.

    Article  PubMed  CAS  Google Scholar 

  7. Neri I, Granella F, Nappi R, et al.: Characteristics of headache at menopause: a clinico-epidemiologic study. Maturitas 1993, 17:31–37.

    Article  PubMed  CAS  Google Scholar 

  8. Lay CL, Newman LC: Menstrual migraine: approaches to management. CNS Drugs 1999, 12:189–195.

    Article  CAS  Google Scholar 

  9. Launer LJ, Terwindt GM, Ferrari MD: The prevalence and characteristics of migraine in a population-based cohort: the GEM study. Neurology 1999, 53:537–542.

    PubMed  CAS  Google Scholar 

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

    Google Scholar 

  11. Edelson RN: Menstrual migraine and other hormonal aspects of migraine. Headache 1985, 25:376–379.

    Article  PubMed  CAS  Google Scholar 

  12. Couturier EG, Bomhof MA, Neven AK, van Duijn NP: Menstrual migraine in a representative Dutch population sample: prevalence, disability and treatment. Cephalalgia 2003, 23:302–308.

    Article  PubMed  CAS  Google Scholar 

  13. 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 

  14. Schoenen J, Sawyer J: Zolmitriptan (Zomig, 311C90), a novel dual central and peripheral 5HT1B/1D agonist: an overview of efficacy. Cephalalgia 1997, 17(suppl 18):28–40.

    PubMed  Google Scholar 

  15. Salonen R, Saiers J: Sumatriptan is effective in the treatment of menstrual migraine: a review of prospective studies and retrospective analysis. Cephalalgia 1999, 19:16–19.

    Article  PubMed  CAS  Google Scholar 

  16. 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 

  17. Loder E: Prophylaxis of menstrual migraine with triptans: problems and possibilities. Neurology 2002, 59:1677–1681. This is a well-considered discussion of pitfalls and possibilities associated with daily use of triptans in migraine management.

    PubMed  CAS  Google Scholar 

  18. Paiva T, Farinha A, Martins A, et al.: Chronic headaches and sleep disorders. Arch Intern Med 1997, 157:1701–1705.

    Article  PubMed  CAS  Google Scholar 

  19. Baker FC, Driver HS: Self-reported sleep across the menstrual cycle in young, healthy women. J Psychosom Res 2004, 56:239–243.

    Article  PubMed  Google Scholar 

  20. Hollander LE, Freeman EW, Sammel MD, et al.: M. Sleep quality, estradiol levels, and behavioral factors in late reproductive age women. Obstet Gynecol 2001, 98:391–397.

    Article  PubMed  CAS  Google Scholar 

  21. Evidence-based guidelines for migraine headache in the primary care setting: pharmacological management of acute attacks. The American Academy of Neurology. Available at: http://www.ahsnet.org/guidelines.php. Accessed June, 2004. This website provides the Review of American Academy of Neurology guidelines for acute treatment of migraine.

  22. Lipton RB, Stewart WF, Ryan RE Jr, et al.: Efficacy and safety of acetaminophen, aspirin, and caffeine in alleviating migraine headache pain: three double-blind, randomized, placebo-controlled trials. Arch Neurol Feb 1998, 55:210–217.

    Article  CAS  Google Scholar 

  23. Silberstein SD, Lipton RB, Goadsby PJ, eds: Headache in Clinical Practice. Oxford: ISIS Medical Media; 1998

    Google Scholar 

  24. Silberstein S, Tepper S, Brandes J, et al.: Randomized, placebo-controlled trial of rofecoxib in the acute treatment of migraine. Neurology 2004, 62:1552–1557.

    PubMed  CAS  Google Scholar 

  25. Rapoport AM, Sheftell FD: Headache Disorders: A management Guide for Practitioners. Philadelphia: WB Saunders Company; 1996.

    Google Scholar 

  26. Rapoport AM, Tepper SJ, Bigal ME, Sheftell FD: The triptan formulations: how to match patients and products. CNS Drugs 2003, 17:431–447.

    Article  PubMed  CAS  Google Scholar 

  27. Axert [prescribing information]. Raritan, NJ: Ortho-McNeil Pharmaceutical Inc.; 2003

  28. Imitrex [prescribing information]. Research Triangle Park, NC: GlaxoSmithKline; 2004

  29. Zomig [prescribing information]. Wilmington, DE: Astra-Zeneca Pharmaceuticals; 2003

  30. Maxalt [prescribing information]. Whitehouse Station, NJ: Merck & Co.,Inc; 2003.

  31. Frova [prescribing information]. Craigavon, United Kingdom: Galen, Limited; 2001.

  32. Amerge [prescribing information]. Research Triangle Park, NC: GlaxoSmithKline; 2003

  33. Relpax [prescribing information]. New York, NY: Pfizer; 2003.

  34. Nett R, Landy S, Shackelford S, Richardson MS, et al.: Pain-free efficacy after treatment with sumatriptan in the mild pain phase of menstrually associated migraine. Obstet Gynecol 2003, 102:835–842. This is a prospective study of oral sumatriptan in migraine management.

    Article  PubMed  CAS  Google Scholar 

  35. Silberstein S: The efficacy of zolmitriptan is unaffected by the relationship to menses. Paper presented at the 10th Congress of the International Headache Society. New York, NY; June 20–July 2, 2001.

  36. 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. This is a prospective study of efficacy and tolerability of oral zolmitriptan in migraine management.

    Article  PubMed  Google Scholar 

  37. Massiou H, Silberstein S, Le Jeunne C, et al.: Efficacy of rizatriptan in menstrual migraine: Freedom from pain and associated symptoms at 2-h and 24-h sustained pain-free status. Cephalalgia 2000, 20:343–344.

    Google Scholar 

  38. Silberstein SD, Massiou H, McCarroll KA, Lines CR: Further evaluation of rizatriptan in menstrual migraine: retrospective analysis of long-term data. Headache 2002, 42:917–923.

    Article  PubMed  Google Scholar 

  39. MacGregor EA, Keywood C: Frovatriptan is effective in menstrually associated migraine (abstract). Cephalalgia 2000, 20:338–357.

    Article  Google Scholar 

  40. Hettiarachi J, Pitei D: Oral Eletriptan is effective in treating menstrually-associated migraine and women on oral contraceptives or hormone replacement therapy. Paper presented at: 42nd Meeting of the American Headache Society. Montreal, Canada; 2002.

  41. Sances G, Martignoni E, Fioroni L, et al.: Naproxen sodium in menstrual migraine prophylaxis: a doubleblind placebo controlled study. Headache 1990, 30:705–709.

    Article  PubMed  CAS  Google Scholar 

  42. Von Seggern RL, Mannix LK, Adelman JU: Rofecoxib in the prevention of perimenstrual migraine: an openlabel pilot trial. Headache 2004, 44:160–165.

    Article  Google Scholar 

  43. Newman LC, Lipton RB, Lay CL, Solomon S. A pilot study of oral sumatriptan as intermittent prophylaxis of menstruation-related migraine. Neurology 1998;51:307–309.

    PubMed  CAS  Google Scholar 

  44. Newman LC, Mannix LK, Sandy S, et al.: Naratriptan as short-term prophylaxis of menstrually-associated migraine: A randomized, double-blind, placebo-controlled study. Headache 2001, 41:248–256. This is a prospective study of the use of naratriptan in shortterm prophylaxis of migraine management.

    Article  PubMed  CAS  Google Scholar 

  45. Brandes JL, Smith T: Naratriptan 1 mg BID in the prophylactic treatment of menstrually-associated migraine. Paper presented at the 44th Annual Meeting of the American Headache Society. Seattle, WA; June 18–22, 2002.

  46. Savani N, Loftus J, Mansbach H, Scot A: A randomised, double-blind, placebo-controlled, parallel group evaluation of oral naratriptan 1 mg twice daily as prophylactic treatment for menstrually-associated migraine. Paper presented at the 6th European Headache Congress. Istanbul, Turkey; June 17–22, 2002.

  47. Nett R, Mannix L, Sandy S, et al.: Randomized, doubleblind, placebo-controlled parallel group evaluation of oral naratriptan 1 mg twice daily as prophylactic treatment for menstrually-associated migraine. Paper presented at the 55th Annual Meeting of the American Academy of Neurology. Honolulu, HI; March 29–April 5, 2003.

  48. Silberstein SD, Elkind AH, Schreiber C: Frovatriptan, a selective HT1B/1D agonist, is effective for prophylaxis of menstrually associated migraine (abstract). Neurology 2003, 60(Suppl 1):A94.

    Google Scholar 

  49. Smith T, Nett R: Frovatriptan is well tolerated during repeated use for prophylaxis of menstrually associated migraine (abstract). Headache 2003, 43:586.

    Google Scholar 

  50. Spierings ELH, Couch R, Blumenthal HJ: Clinical characteristics of menstrually associated migraine: a review of results from a study of the use of frovatriptan for prophylaxis of menstrually associated migraine (abstract). Neurology 2003, 60(suppl 1):A493.

    Google Scholar 

  51. Tepper S, Freitag F: Prophylactic use of frovatriptan for menstrually associated migraine is effective and does not cause rebound migraine in the postdosing period (abstract). Headache 2003, 43:585.

    Article  Google Scholar 

  52. Goldstein J, Ninan M, Rapoport AM: The safety and tolerability of frovatriptan, a selective 5HT1B/1D agonist, used for prophylaxis of menstrually associated migraine (abstract). Neurology 2003, 60 (Suppl 1):A494.

    Google Scholar 

  53. Singer R, Schim J: Frovatriptan for prophylaxis of menstrually associated migraine: efficacy and tolerability in patients using oral contraceptives compared to nonusers (abstract). Headache 2003, 43:587.

    Google Scholar 

  54. Calhoun A: Four hypotheses for understanding menstrual migraine. The Female Patient 2004, 29:38–44. This is a comprehensive current review of the theories about menstrual migraine and their relevance to clinical management of these headaches.

    Google Scholar 

  55. WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception: Ischaemic stroke and combined oral contraceptives: results of an international, multicentre, case-control study. Lancet 1996, 348:498–505.

    Article  Google Scholar 

  56. Petitti DB, Sidney S, Bernstein A, et al.: Stroke in users of low-dose oral contraceptives. N Engl J Med 1996, 335:8–15.

    Article  PubMed  CAS  Google Scholar 

  57. Chan WS, Ray J, Wai EK, et al.: Risk of stroke in women exposed to low-dose oral contraceptives: a critical evaluation of the evidence. Arch Intern Med 2004, 164:741–747.

    Article  PubMed  Google Scholar 

  58. Calhoun AH: Migraine and menopause. Headache 2004, 44:106.

    Article  PubMed  Google Scholar 

  59. Facchinetti F, Sances G, Borella P, et al.: Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache 1991, 31:298–301.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Headache Associates, 7908 Cincinnati-Dayton Road, Suite J, 45069, West Chester, OH, USA

    Lisa K. Mannix MD

Authors
  1. Lisa K. Mannix MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anne H. Calhoun 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

Mannix, L.K., Calhoun, A.H. Menstrual migraine. Curr Treat Options Neurol 6, 489–498 (2004). https://doi.org/10.1007/s11940-004-0006-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-004-0006-7

Keywords

Search

Navigation