BACKGROUND: This article was just published a few days ago and is relevant if you are a woman who gets migraines or if you are the parent of a girl with migraines. It is a Review article that does not present any original data, but instead aims to summarize the currently published work on the topic of menstrual migraine and treatment options.

Some facts:

  • Menstrual migraine (MM) occurs in 22% of female migraineurs and 7.6% of the general population.
  • MM is more severe, lasts longer, and is not as responsive to conventional treatments as other types of migraine. It also usually appears without aura.
  • There are two types of MM: Menstrually Related Migraines (MRM) and Pure Menstrual Migraines (PMM).
    • The first day of menstruation is labeled Day 1 of the menstrual cycle.
    • Migraines categorized as PMM occur between days -2 and +3.
    • MRM can occur at anytime during the cycle, including days -2 and +3.
  • It is thought that MM is caused by the natural drop in estrogen that happens during the luteal phase of the menstrual cycle.
  • The FDA has not approved any medications specifically for the treatment of MM.

RESULTS: The authors reviewed acute treatment of MM (treatment after the migraine has started) and short-term prophylactic treatment (preventing the migraine from coming) separately.

  • The authors found that rizatriptan had the best evidence in the literature for efficacy against an acute MM attack, followed by naratriptan and sumatriptan.
  • For short-term prophylactic treatment (preventing the MM from coming), the authors found studies using both triptans and non-triptans.
    • They found that frovatriptan taken twice daily was effective as a prophylactic regimen followed by naratriptan and zolmitriptan.
    • Estrogen and naproxen were also found to be beneficial.

STRENGTHS OF THIS STUDY: Very thorough review

MY TWO CENTS/QUESTIONS
FOR AUTHORS: I was
surprised by one thing in this article. When I think of treatments for MM the first thing that comes to my mind is prevention via hormone regulation of the estrogen drop in the luteal phase that usually causes the MM in the first place. This has been accomplished in a small number of studies using treatments such as continuous use of oral contraceptives or add-back estrogen during the menstrual window etc. I am happy that these authors carried out such a thorough review on this important and under-studied topic, and they included four hormone studies in their paper. However, I felt that this hormone data may not have been given its due attention in their conclusions and I am wondering why. I believe it is likely because so much more work has been carried out on triptans than on hormone therapies. One physician/scientist publishing very interesting work in  this area is Anne Calhoun, MD. I will be blogging on some of her work in the coming weeks.