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Premenstrual syndrome and migraine


Premenstrual syndrome (PMS) includes a wide variety of physical, psychological, and cognitive symptoms that occur recurrently and cyclically during the luteal phase of the menstrual cycle and disappear soon after the onset of menstruation. Headache, often of migrainous type, is one of physical symptoms often reported in the diagnostic criteria for PMS. Menstrual migraine (MM) is a particular subtype of migraine occurring within the 2 days before and the 3 days after the onset of menses. According to this definition, therefore, some attacks of MM certainly occur in conjunction with the period of maximum exacerbation of PMS symptoms. The relationship between MM and PMS has been investigated through diary-based studies which have confirmed the possible correlation between these two conditions. In this paper we provide indications for the treatment of MM, making particular reference to those therapies that may be useful in the treatment of PMS symptoms. Even if triptans are the gold standard for the acute treatment, if symptomatic treatment is not sufficient one can resort to a short-term perimenstrual prophylaxis. Non-steroidal anti-inflammatory drugs have been demonstrated effective in MM prophylaxis. Among natural products there is some evidence of efficacy for magnesium, phytoestrogens, and ginkgolide B. Finally, also a combined oral contraceptive containing drospirenone, taken continuously for 168 days, has shown promising results.

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Combined oral contraceptive


Diagnostic and Statistical Manual of Mental Disorders


Menstrual Distress Questionnaire




Menstrual migraine


Non-steroidal anti-inflammatory drugs


Premenstrual dysphoric disorder


Premenstrual syndrome


Randomized controlled trial


Tension-type headache


World Health Organization


  1. Martin VT, Wernke S, Mandell K et al (2006) Symptoms of premenstrual syndrome and their association with migraine headache. Headache 46(1):125–137

    Article  PubMed  Google Scholar 

  2. Johnson SR (2004) Premenstrual syndrome, premenstrual dysphoric disorder, and beyond: a clinical primer for practitioners. Obstet Gynecol 104(4):845–859

    Article  PubMed  Google Scholar 

  3. Halbreich U, Backstrom T, Eriksson E et al (2007) Clinical diagnostic criteria for premenstrual syndrome and guidelines for their quantification for research studies. Gynecol Endocrinol 23(3):123–130

    Article  PubMed  Google Scholar 

  4. World Health Organization (WHO) (1996) International classification of diseases, 10th revision. WHO, Geneva

  5. American College of Obstetricians and Gynecologists (2000) Premenstrual syndrome. National Guideline Clearinghouse, Washington, DC

    Google Scholar 

  6. American Psychiatric association (APA) (1994) Diagnostic and statistical manual of mental disorders, 4th edn. Washington, DC, pp 714–718

  7. Royal College of Obstetricians and Gynaecologists (2007) Management of premenstrual syndrome. Green-top Guideline No. 48

  8. Fragoso YD, Guidoni AC, de Castro LB (2009) Characterization of headaches in the premenstrual tension syndrome. Arq Neuropsiquiatr 67(1):40–42

    Article  PubMed  Google Scholar 

  9. Beckham JC, Krug LM, Penzien DB et al (1992) The relationship of ovarian steroids, headache activity and menstrual distress: a pilot study with female migraineurs. Headache 32(6):292–297

    Article  PubMed  CAS  Google Scholar 

  10. Facchinetti F, Neri I, Martignoni E et al (1993) The association of menstrual migraine with the premenstrual syndrome. Cephalalgia 13(6):422–425

    Article  PubMed  CAS  Google Scholar 

  11. Sances G, Martignoni E, Fioroni L et al (1990) Naproxen sodium in menstrual migraine prophylaxis: a double-blind placebo controlled study. Headache 30(11):705–709

    Article  PubMed  CAS  Google Scholar 

  12. Al-Waili NS (2000) Treatment of menstrual migraine with prostaglandin synthesis inhibitor mefenamic acid: double-blind study with placebo. Eur J Med Res 5(4):176–182

    PubMed  CAS  Google Scholar 

  13. Facchinetti F, Fioroni L, Sances G et al (1989) Naproxen sodium in the treatment of premenstrual symptoms. A placebo-controlled study. Gynecol Obstet Invest 28(4):205–208

    Article  PubMed  CAS  Google Scholar 

  14. Wood C, Jakubowicz D (1980) The treatment of premenstrual symptoms with mefenamic acid. Br J Obstet Gynaecol 87(7):627–630

    Article  PubMed  CAS  Google Scholar 

  15. Mira M, McNeil D, Fraser IS et al (1986) Mefenamic acid in the treatment of premenstrual syndrome. Obstet Gynecol 68(3):395–398

    PubMed  CAS  Google Scholar 

  16. Facchinetti F, Sances G, Borella P et al (1991) Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache 31(5):298–301

    Article  PubMed  CAS  Google Scholar 

  17. Facchinetti F, Borella P, Sances G et al (1991) Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol 78(2):177–181

    PubMed  CAS  Google Scholar 

  18. Fathizadeh N, Ebrahimi E, Valiani M et al (2010) Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res 15(Suppl 1):401–405

    PubMed  Google Scholar 

  19. De Souza MC, Walker AF, Robinson PA et al (2000) A synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for the relief of anxiety-related premenstrual symptoms: a randomized, double-blind, crossover study. J Womens Health Gend Based Med 9(2):131–139

    Article  PubMed  Google Scholar 

  20. Burke BE, Olson RD, Cusack BJ (2002) Randomized, controlled trial of phytoestrogen in the prophylactic treatment of menstrual migraine. Biomed Pharmacother 56(6):283–288

    Article  PubMed  CAS  Google Scholar 

  21. Ferrante F, Fusco E, Calabresi P et al (2004) Phyto-oestrogens in the prophylaxis of menstrual migraine. Clin Neuropharmacol 27(3):137–140

    Article  PubMed  CAS  Google Scholar 

  22. Bryant M, Cassidy A, Hill C et al (2005) Effect of consumption of soy isoflavones on behavioural, somatic and affective symptoms in women with premenstrual syndrome. Br J Nutr 93(5):731–739

    Article  PubMed  CAS  Google Scholar 

  23. Ozgoli G, Selselei EA, Mojab F et al (2009) A randomized, placebo-controlled trial of Ginkgo biloba L. in treatment of premenstrual syndrome. J Altern Complem Med 15(8):845–851

    Article  Google Scholar 

  24. D’Andrea G, Bussone G, Allais G et al (2009) Efficacy of Ginkgolide B in the prophylaxis of migraine with aura. Neurol Sci 30(Suppl 1):S121–S124

    Article  PubMed  Google Scholar 

  25. Esposito M, Carotenuto M (2011) Ginkgolide B complex efficacy for brief prophylaxis of migraine in school-aged children: an open-label study. Neurol Sci 32(1):79–81

    Article  PubMed  Google Scholar 

  26. Lopez LM, Kaptein AA, Helmerhorst FM (2012) Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane database of systematic reviews 2. Art. No.:CD006586. doi:10.1002/14651858.CD006586.pub4

  27. Sulak PJ, Kuehl TJ, Ortiz M et al (2002) Acceptance of altering the standard 21-day/7-day oral contraceptive regimen to delay menses and reduce hormone withdrawal symptoms. Am J Obstet Gynecol 186(6):1142–1149

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Gianni Allais.

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Allais, G., Castagnoli Gabellari, I., Burzio, C. et al. Premenstrual syndrome and migraine. Neurol Sci 33 (Suppl 1), 111–115 (2012).

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  • Menstrual migraine
  • Premenstrual disphoric disorder
  • Premenstrual syndrome