Naproxen sodium in short-term prophylaxis of pure menstrual migraine: pathophysiological and clinical considerations

Abstract

We investigated the biological and clinical effects of naproxen sodium (NxS) in the short-term prophylaxis of pure menstrual migraine (PMM) in 25 women suffering from migraine without aura, occurring exclusively from 2 days before to 5 days after menstruation onset. Daily oral NxS (550 mg) from 7 days before menstruation to 7 days after menstruation onset was given for 3 menstrual cycles, and 5 days before menstruation to 5 days after menstruation onset over the next 3 menstrual cycles. In the month before initiation of treatment and in the third month of treatment, 6-keto-PGF1_α, TXB₂ and PGE₂ were measured in plasma before menstruation (day –2) and on the second day (day +2) after bleeding onset. In the 20 women analysed, 6-keto-PGF1_α was 17% lower (p<0.0001) and TXB₂ was 30% lower (p<0.0001) on day –2 during treatment than the same day pretreatment; TXB₂ was also lower (p<0.02) on day +2 during treatment than day +2 pretreatment. The 6-keto-PGF1_α/TXB₂ ratio was higher (p<0.01) on day –2 treatment than day –2 pretreatment. PGE₂ levels were significantly lower (p<0.002) on day +2 than pre-treatment values on the same day. The number of attacks reduced from 1.7±0.11 pretreatment to 1.2±0.10 at the 3rd month (p<0.001), to 1.1±0.06 at the 6th month (p<0.0001). The duration reduced from 25.6±4.42 h pretreatment to 15.5±4.43 h in the 3rd month (p<0.02), to 13.35±4.26 h in the 6th month (p<0.001). The intensity reduced from 2.4±0.11 pretreatment, to 1.2±0.10 in the 3rd month of treatment (p<0.0001), and 1.1±0.07 in the 6th month (p<0.0001).