Menstrual migraine is migraine that consistently occurs at the same time each month, either before, during or immediately after the menstrual period.
Approximately 60% of women with migraine experience menstrual migraines. Many such migraines resist effective treatment.
60% of women with migraine consistently experience acute migraine in association with menstration.
In 10-15% of women with migraine, acute attacks only occur during their menstrual period.
Menstrual migraines, or menstrual associated migraines tend to be:
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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.
[Article in Serbian]
Simić S, Slankamenac P, Cvijanović M, Banić-Horvat S, Jovin Z, Ilin M.
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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Study 1: active drug = 42%; placebo = 23%
Study 2: active drug = 52%; placebo = 22%
Study 1: active drug = 29%; placebo = 18%
Study 2: active drug = 38%; placebo = 10%
The publication:
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Obstet Gynecol. 2009 Jul;114(1):106-13.
Mannix LK, Martin VT, Cady RK, Diamond ML, Lener SE, White JD, Derosier FJ, McDonald SA.
OBJECTIVE: To evaluate the efficacy and tolerability of sumatriptan-naproxen during the mild pain phase of a single menstrual migraine attack associated with dysmenorrhea.
METHODS: Participants treated their menstrual migraine attack during the mild pain phase (within 1 hour of onset) with sumatriptan 85 mg and naproxen sodium 500 mg in a single fixed-dose formulation (sumatriptan-naproxen) or placebo. The primary endpoint was 2-hour pain-free response.
RESULTS: Sumatriptan-naproxen was statistically superior to placebo in both studies (n=311, Study 1; n=310, Study 2) for 2-hour and, 2- to 24-hour sustained pain-free response, use of headache and menstrual rescue medications, and several nonpain menstrual symptom categories.
Two-hour pain-free rates were Study 1, 42% compared with 23%, and Study 2, 52% compared with 22%, P<.001.
Two- to 24-hour sustained pain-free rates were Study 1, 29% compared with 18%, P=.022; Study 2, 38% compared with 10%, P<.001.
Headache and menstrual medication rates were Study 1, 37% compared with 53%, P=.005; Study 2, 31% compared with 69%, P<.001.
Women treated with sumatriptan-naproxen continued to be pain free through 48 hours compared with placebo: Study 1, 26% compared with 17%, P=.040; Study 2, 28% compared with 8%, P<.001.
No serious adverse events were reported.
CONCLUSION: Sumatriptan-naproxen provided an effective pain-free response at 2 hours, which was maintained up to 48 hours in menstrual migraineurs with dysmenorrhea. Sumatriptan-naproxen was well-tolerated and resulted in decreased rescue medication use and relief of nonpainful menstrual symptoms.
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