Migraine associated with the menstrual cycle afflicts most women
Menstrual migraine is common to approximately 60% of women with migraine. Fluctuating hormonal levels account to some extent for the higher prevalence of migraine among women than among men. Two-thirds to three-fourths of all migraine sufferers are female.
However, the incidence of migraine in the pediatric population is higher among boys than girls. With puberty, the percent of boys with migraine decreases, whereas that of females with migraine increases.
Some researchers and clinicians make a distinction between “menstrually associated migraine” (MAM – sometimes called menstrually related migraine) and ‘true’ menstrual migraine. In the former, migraine may occur at any time of the month, but is more frequent at or around the time of menstruation. In the latter, migraine exclusively occurs at or around the time of menstruation.
The distinction does not appear to be clinically relevant. In either case, migraine at time of menstruation is widely recognized as being more difficult to treat, of longer duration, and generally more painful than migraine not associated with menstruation.
The publication:
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Med Pregl. 2007 Sep-Oct;60(9-10):449-52.
Menstrual migraine
[Article in Serbian]
Simić S, Slankamenac P, Cvijanović M, Banić-Horvat S, Jovin Z, Ilin M.
Summary of the abstract
INTRODUCTION: The prevalence of migraine increases in adolescence, especially in female adolescents.
MENSTRUAL MIGRAINE–DEFINITION: There are two types of menstrual migraine: true menstrual migraine and menstrually related migraine. True menstrual migraine occurs predominantly around menstruation, whereas menstrually related migraine occurs during menstruation, but also at other times during the month.
CAUSES: Exaggerated or abnormal neurotransmitter responses to normal cyclic changes in the ovarian hormones are probably the basic cause of menstrual migraines. The fall in estrogen levels during menstrual cycle is a trigger for the menstrual migraine.
SYMPTOMS: Menstrual migraine has the same symptoms as other types of migraine, but the pain is stronger, it lasts longer, and it is more frequent than other types of migraines.
DIAGNOSIS: In order to make a diagnosis, women are asked to keep a headache diary for three months. If the migraine headache is severe and occurs regularly between two days before and three days after the start of menstrual bleeding, it is true menstrual migraine.
THERAPY: Menstrual migraines are more difficult to treat than other types of migraines. Treatment principles for menstrual migraine are the same as for migraines in general, with certain particularities.
CONCLUSION: Hormonally associated migraine is a specific clinical entity. A decline in estrogen level at the end of menstrual cycle triggers migraine, so it can be treated by low levels of estrogen.
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