Menstrual Migraine Research Articles

Menstrual Migraine

Keeping a diary of your headaches, recording when they occur in relation to the menstrual cycle, as well as their severity and response to usual treatment, will help in determining the presence or absence of menstrual migraine, present in about 60% of women with migraine. Options vary depending on a woman’s overall health and response to treatment. They include stepped-up acute treatment, mini-prevention with NSAIDs, magnesium, triptans or estrogen, or daily prevention with continuous contraception.

Revised French guidelines for the diagnosis and management of migraine in adults and children

Background Sponsor These revised guidelines were prepared at the request of the Societe Francaise d'Etude des Migraines et des Cephalees (SFEMC; French Society for the Study of Migraine Headache). They are a revision of the professional guidance on the “Diagnosis and therapeutic management of migraine in adults and children: clinical and economic aspects” published by the ANAES in 2002 and revised in 2012. Scope of the guidlines. These guidelines concern the overall management of migraine, diagnostic and therapeutic strategies, economic aspects of the disease and its treatments, menstrual (catamenial) migraine, migraine in pregnancy, migraine and oral contraception, migraine and the menopause. Headaches other than migraine will not be discussed except in the context of differential diagnosis. Other subjects not discussed in these guidelines include diseases associated with migraine apart from psychiatric problems, risk factors, migraine and smoking, chronic migraine rare forms and complications of migraine.

Efficacy of naratriptan for patients with menstrual migraine

Efficacy of naratriptan for patients with menstrual migraine

Acupuncture as prophylaxis for menstrual-related migraine: study protocol for a multicenter randomized controlled trial

BackgroundMenstrual-related migraine is a common form of migraine affecting >50% of female migraineurs. Acupuncture may be a choice for menstrual-related migraine, when pharmacological prophylaxis is not suitable. However, the efficacy of acupuncture has not been confirmed. We design and perform a randomized controlled clinical trial to evaluate the efficacy of acupuncture compared with naproxen in menstrual-related migraine patients.Methods/DesignThis is a multicenter, single blind, randomized controlled clinical trial. A total of 184 participants will be randomly assigned to two different groups. Participants will receive verum acupuncture and placebo medicine in the treatment group, while participants in the control group will be treated with sham acupuncture and medicine (Naproxen Sustained Release Tablets). All treatments will be given for 3 months (menstrual cycles).The primary outcome measures are the change of migraine days inside the menstrual cycle and the proportion of responders (defined as the proportion of patients with at least a 50% reduction in the number of menstrual migraine days). The secondary outcome measures are the change of migraine days outside the menstrual cycle, duration of migraine attack, the Visual Analogue Scale (VAS), and intake of acute medication. The assessment will be made at baseline (before treatment), 3 months (menstrual cycles), and 4 months (menstrual cycles) after the first acupuncture session.DiscussionThe results of this trial will be helpful to supply the efficacy of acupuncture for menstrual-related migraine prophylaxis.Trial registrationISRCTN: ISRCTN57133712

Prevalence of menstrual migraine: A population-based study

To present data from a population-based epidemiological study on menstrual migraine. Altogether, 5000 women aged 30-34 years were screened for menstrual migraine. Women with self-reported menstrual migraine in at least half of their menstrual cycles were invited to an interview and examination. We expanded the International Classification of Headache Disorders III beta appendix criteria on menstrual migraine to include both migraine without aura and migraine with aura, as well as probable menstrual migraine with aura and migraine without aura. A total of 237 women were included in the study. The prevalence among all women was as follows: any type of menstrual migraine 7.6%; menstrual migraine without aura 6.1%; menstrual migraine with aura 0.6%; probable menstrual migraine without aura 0.6%; probable menstrual migraine with aura 0.3%. The corresponding figures among female migraineurs were: any type of menstrual migraine 22.0%, menstrual migraine without aura 17.6%, menstrual migraine with aura 1.7%, probable menstrual migraine without aura 1.6% and probable menstrual migraine with aura 1.0%. More than one of every five female migraineurs aged 30-34 years have migraine in ≥50% of menstruations. The majority has menstrual migraine without aura and one of eight women had migraine with aura in relation to their menstruation. Our results indicate that the ICHD III beta appendix criteria of menstrual migraine are not exhaustive.

P.3.f.024 Increased slow waves in electroencephalogram (EEG) but not daytime sleepiness in schizophrenic patients during antipsychotic treatment

Migraine is a common, disabling headache disorder, which is influenced by multiple genes and environmental triggers. After puberty, the prevalence of migraine in women is three times higher than in men and > 50% of females suffering from migraine report a menstrual association, suggesting hormonal fluctuations can influence the risk of migraine attacks. It has been hypothesized that the drop in estrogen during menses is an important trigger for menstrual migraine. Catechol-O-methyltransferase (COMT) and Cytochrome P450 (CYP) enzymes are involved in estrogen synthesis and metabolism. Functional polymorphisms in these genes can influence estrogen levels and therefore may be associated with risk of menstrual migraine. In this study we investigated four single nucleotide polymorphisms in three genes involved in estrogen metabolism that have been reported to impact enzyme levels or function, in a specific menstrual migraine cohort. 268 menstrual migraine cases and 142 controls were genotyped for rs4680 in COMT (Val158Met), rs4646903 and rs1048943 in CYP1A1 (T3801C and Ile462Val) and rs700519 in CYP19A1 (Cys264Arg). Neither genotype nor allele frequencies for the COMT and CYP SNPs genotyped were found to be significantly different between menstrual migraineurs and controls by chi-square analysis (P > 0.05). Therefore we did not find association of functional polymorphisms in the estrogen metabolism genes COMT, CYP1A1 or CYP19A1 with menstrual migraine. Further studies are required to assess whether menstrual migraine is genetically distinct from the common migraine subtypes and identify genes that influence risk.

A survey of female students with migraine: what is the influence of family history and lifestyle?

Objectives: To compare characteristics of migraine and some lifestyle habits in migraineurs with and without a positive family history for migraine. Method: The prevalence study was combined with a case-control study and comprised 245 female students with migraine. Results: Out of 245 female students with migraine, 132 (53.9%) had a positive family history for migraine. In comparison with migraineurs who had not, those with a positive family history were younger at the onset of migraine and significantly more frequently reported menstrual migraine (p < 0.001), unilateral pain ( p < 0.05) and pulsate pain ( p < 0.05) as well as severe headache ( p < 0.01). In comparison to migraineurs with a positive family history for migraine, those who did not report a significantly higher frequency of average number of meals per day of <3 ( p < 0.001), missed meals ( p < 0.05) and an average sleep duration of ≤6 h ( p < 0.05). Conclusions: The results of the present study are in line with literature showing a high frequency of positive family history for migraine among migraineurs. They also suggest that subjects with a positive family history have a lower “migrainous threshold” for the development of migraine and that environmental factors are more important for the occurrence of migraine in subjects without a positive family history. Accordingly, the conclusions of this study are limited to reproductive aged women.

Pharmacological Acute Migraine Treatment Strategies: Choosing the Right Drug for a Specific Patient

Background:In our targeted review (Section 2), 12 acute medications received a strong recommendation for use in acute migraine therapy while four received a weak recommendation for use. Strong recommendations were made to avoid use of two other medications, except for exceptional circumstances. Two anti-emetics received strong recommendations for use as needed.Objective:To organize the available acute migraine medications into acute migraine treatment strategies in order to assist the practitioner in choosing a specific medication(s) for an individual patient.Methods:Acute migraine treatment strategies were developed based on the targeted literature review used for the development of this guideline (Section 2), and a general literature review. Expert consensus groups were used to refine and validate these strategies.Results:Based on evidence for drug efficacy, drug side effects, migraine severity, and coexistent medical disorders, our analysis resulted in the formulation of eight general acute migraine treatment strategies. These could be grouped into four categories: 1) two mild-moderate attack strategies, 2) two moderate-severe attack or NSAID failure strategies, 3) three refractory migraine strategies, and 4) a vasoconstrictor unresponsive-contraindicated strategy. In addition, strategies were developed for menstrual migraine, migraine during pregnancy, and migraine during lactation. The eight general treatment strategies were coordinated with a “combined acute medication approach” to therapy which used features of both the “stratified” and the “step care across attacks” approaches to acute migraine management.Conclusions:The available medications for acute migraine treatment can be organized into a series of strategies based on patient clinical features. These strategies may help practitioners make appropriate acute medication choices for patients with migraine.

Canadian Headache Society Guideline: Acute Drug Therapy for Migraine Headache

The primary objective of this guideline is to assist the practitioner in choosing an appropriate acute medication for an individual with migraine, based on current evidence in the medical literature and expert consensus. It is focused on patients with episodic migraine ( headache on ≤ 14 days a month). A detailed search strategy was used to find a relevant meta-analyses, systematic reviews and randomized double-blind controlled trials. Recommendations were graded with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group, using a consensus group. In addition, a general literature review and expert consensus were used for aspects of acute therapy for which randomized controlled trials were not available. Twelve acute medications received a strong recommendation for use in acute migraine therapy (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zomitriptan, ASA, ibuprofen, naproxen sodium, diclofenac potassium, and acetaminophen). Four received a weak recommendation for use (dihydroergotamine, ergotamine, codeine-containing combination analgesics, and tramadol- containing medications). Three of these were NOT recommended for routine use (ergotamine and codeine- and tramadol- containing medications). Strong recommendations were made to avoid use of butorphanol and butalbital- containing medications. Metoclopramide and domperidone were strongly recommended for use when necessary. Our analysis also resulted in the formulation of eight general acute migraine management strategies. These were grouped into: 1) two mild-moderate attack strategies, 2) two moderate-severe attack or NSAID failure strategies, 3) three refractory migraine strategies, and 4) a vasoconstrictor unresponsive-contraindicated strategy. Additional were developed for menstrual migraine during pregnancy, and migraine during lactation. This guideline provides evidence-based advice on acute pharmacological migraine therapy, and should be helpful to both health professionals and patients, The available medications have been organized into a series of strategies based on patient clinical features. These strategies may help practitioners make appropriate acute medication choices for patients with migraine.

Pharmacological Acute Migraine Treatment Strategies: Choosing the Right Drug for a Specific Patient

ABSTRACT:Background:In our targeted review (Section 2), 12 acute medications received a strong recommendation for use in acute migraine therapy while four received a weak recommendation for use. Strong recommendations were made to avoid use of two other medications, except for exceptional circumstances. Two anti-emetics received strong recommendations for use as needed.Objective:To organize the available acute migraine medications into acute migraine treatment strategies in order to assist the practitioner in choosing a specific medication(s) for an individual patient.Methods:Acute migraine treatment strategies were developed based on the targeted literature review used for the development of this guideline (Section 2), and a general literature review. Expert consensus groups were used to refine and validate these strategies.Results:Based on evidence for drug efficacy, drug side effects, migraine severity, and coexistent medical disorders, our analysis resulted in the formulation of eight general acute migraine treatment strategies. These could be grouped into four categories: 1) two mild-moderate attack strategies, 2) two moderate-severe attack or NSAID failure strategies, 3) three refractory migraine strategies, and 4) a vasoconstrictor unresponsive-contraindicated strategy. In addition, strategies were developed for menstrual migraine, migraine during pregnancy, and migraine during lactation. The eight general treatment strategies were coordinated with a “combined acute medication approach” to therapy which used features of both the “stratified” and the “step care across attacks” approaches to acute migraine management.Conclusions:The available medications for acute migraine treatment can be organized into a series of strategies based on patient clinical features. These strategies may help practitioners make appropriate acute medication choices for patients with migraine.

Sumatriptan/Naproxen Sodium: A Review of Its Use in Adult Patients with Migraine

A fixed-dose combination of sumatriptan/naproxen sodium (Treximet(®)) has been approved in the US for the acute treatment of migraine in adults. In two randomized trials, sumatriptan/naproxen sodium demonstrated significantly better efficacy than sumatriptan alone, naproxen sodium alone, or placebo as late-intervention therapy for a single migraine episode in adults, as assessed by co-primary efficacy endpoints evaluating pain and other migraine-related symptoms, as well as health-related quality of life (HR-QOL) endpoints. In four other randomized trials, the drug combination was also effective as early intervention in adults with migraine (including those with menstrual migraine and dysmenorrhoea, or those with poor response or intolerance to triptan therapy) according to various pain-related primary efficacy and HR-QOL endpoints. Data from longer-term, non-randomized studies support these findings, and the drug combination appears to be beneficial in patients with migraine and cutaneous allodynia. In clinical trials, sumatriptan/naproxen sodium was generally well tolerated, with an overall tolerability profile similar to that of sumatriptan. The most common adverse events were in line with those expected for sumatriptan and naproxen sodium. Current data indicate that sumatriptan/naproxen sodium is a useful option in the treatment of adult migraine.

Epidemiology of Migraine and Headache in Children and Adolescents

Migraine and headache are global disabling conditions causing considerable individual suffering and impaired quality of life in adults as well as in children and adolescents. Therefore, epidemiological studies are essential to assess the scope of the problem. This review covers epidemiological studies on migraine and headache in children and adolescents published in the past 25 years. A total of 64 cross-sectional studies have been identified, published in 32 different countries and including a total of 227,249 subjects. The estimated overall mean prevalence of headache was 54.4% (95% CI 43.1-65.8) and the overall mean prevalence of migraine was 9.1% (95% CI 7.1-11.1). There is a lack of population-based studies from low and low-middle income countries. In addition, there is very little information about the prevalence of probable migraine and chronic migraine and no information about menstrual migraine in the young.

Frovatriptan vs. other triptans for the acute treatment of oral contraceptive-induced menstrual migraine: pooled analysis of three double-blind, randomized, crossover, multicenter studies

Oral contraceptive-induced menstrual migraine (OCMM) is a particularly severe form of migraine triggered by the cyclic hormone withdrawal. To review the efficacy of frovatriptan vs. other triptans, in the acute treatment of OCMM through a pooled analysis of three individual randomized Italian studies. With or without aura migraineurs were randomized to frovatriptan 2.5 mg or rizatriptan 10 mg (study 1), frovatriptan 2.5 mg or zolmitriptan 2.5 mg (study 2), frovatriptan 2.5 mg or almotriptan 12.5 mg (study 3). All studies had a multicenter, randomized, double-blind, crossover design. After treating 1–3 episodes of migraine in 3 months with the first treatment, patients switched to the other treatment for the next 3 months. In this analysis, the subset of 35 of the 280 women of the intention-to-treat population taking combined oral contraceptives and experiencing a migraine attack during the withdrawal phase, were analyzed. The proportion of pain free and pain relief at 2 h were 25 and 51 % with frovatriptan and 28 and 48 % with comparators (p = NS). At 24 h, 71 and 83 % of frovatriptan-treated patients and 60 and 76 % of comparator-treated patients were pain free (p < 0.05 between treatments) and had pain relief (p = NS), respectively. Relapse at 24 and 48 h was significantly (p < 0.05) lower with frovatriptan (17 and 21 %) than with the comparators (27 and 31 %). Our results suggest that, due to its sustained antimigraine effect, frovatriptan may be particularly suitable for the management of OCMM than other triptans.

Pharmacokinetic evaluation of almotriptan for the treatment of migraines

Introduction: Migraine is a multifactorial neurovascular disorder characterized by recurrent episodes of disabling pain attacks, accompanied with gastrointestinal, neurological systems dysfunction. The pharmacologic treatment of migraine is classically divided in the management of the acute attack and preventive strategies. Triptans represent a powerful pharmacological tool in acute migraine treatment. However, a significant portion of treated patients cannot have access to this class due to possible adverse affects. Today, a total of seven triptan molecules are available, representing a commonly prescribed migraine treatment.Areas covered: The authors take a systematic approach to discuss the pharmacodynamic and pharmacokinetic aspects of almotriptan. They consider the emerging data on the clinical efficacy in the treatment of migraine and menstrual-related migraine. The data were obtained by searching the following key words in MEDLINE: pharmacokinetic, pharmacodynamic, triptans, almotriptan, migraine, menstrual migraine, relatively to the period 1989 – 2012.Expert opinion: The excellent efficacy and superior tolerability profile of almotriptan administered early offer a potential improvement over existing triptans for the symptomatic treatment of migraine attacks. Compared with other triptans, the different pathways involved in the metabolism of almotriptan ensure a limited variability of clinical response to the drug, making it less susceptible to the individual genomic background.

Prophylactic treatment with repetitive cathodal transcranial direct current stimulation of the visual cortex decrease the number of attacks in patients with menstrual migraine

Background and Purpose: Differences between people with and without migraine on visual perception an cortical excitability have been attributed to abnormal cortical processing due to the disease between and during attacks. Preventive therapy is indicated in about third of patients, and although a broad range of pharmaceutical option exists, there is an increasing interest with regard to non-pharmaceutical alternatives. According to this, the application of repetitive cathodal transcranial direct current stimulation (rc-tDCS) of the visual cortex (V1) as a non-invasive brain stimulation method might be a therapeutic option by decreasing the excitability of the cortex. This study aimed to explore the efficacy of 5 days rc-tDCS as a prophylactic treatment in migraineurs.

A Cyclic Pain

Catamenial migraine is a headache disorder occurring in reproductive-aged women relevant to menstrual cycles. Catamenial migraine is defined as attacks of migraine that occurs regularly in at least 2 of 3 consecutive menstrual cycles and occurs exclusively on day 1 to 2 of menstruation, but may range from 2 days before (defined as -2) to 3 days after (defined as +3 with the first day of menstruation as day +1). There are 2 subtypes: the pure menstrual migraine and menstrually related migraine. In pure menstrual migraine, there are no aura and no migraine occurring during any other time of the menstrual cycle. In contrast, menstrually related migraine also occurs in 2 of 3 consecutive menstrual cycles, mostly on days 1 and 2 of menstruation, but it may occur outside the menstrual cycle. Catamenial migraine significantly interferes with the quality of life and causes functional disability in most sufferers. The fluctuation of estrogen levels is believed to play a role in the pathogenesis of catamenial migraine. In this review, we discuss estrogen and its direct and indirect pathophysiologic roles in menstrual-related migraine headaches and the available treatment for women. Obstetricians and gynecologists, family physicians. After completing this CME activity, physicians should be better able to discuss the pathophysiology of catamenial migraine, identify the risk factors for catamenial migraine among women, and list the prophylactic and abortive treatments for migraines.

Menstrual migraine, migraine and contraceptions, migraine and pregnancy and migraine triggers

More than 50% of women with migraine report an association with menstruation. Attacks are most likely to occur during the two days before menstruation and the first three days of bleeding and are typically without aura, even in women who have attacks with aura at other times of the cycle. The majority of menstrual attacks can be controlled with symptomatic treatment alone. If this is inadequate, pre-emptive treatment with perimenstrual estradiol, triptans or non-steroidal anti-inflammatory drugs (NSAIDs) may be effective. Suppression of the menstrual cycle with anovulatory contraceptive agents is an additional option for management, particularly for women who also require contraception. Using combined hormonal contraception continuously, without a break, can prevent estrogen “withdrawal” migraine during the hormone-free interval. Limited research suggests that high levels of estrogen, such as occur with use of combined hormonal contraceptives (CHCs), can trigger migraine with aura. Since aura and CHCs are independent risk factors for ischaemic stroke, the appropriateness of CHCs solely for contraception in women who have migraine with aura needs careful consideration. During pregnancy, migraine follows a benign course with improvement in migraine without aura likely by the second trimester. However, the high oestrogen state is associated with increased migraine aura in susceptible women. In these women, hypertensive disorders of pregnancy and stroke are more likely to occur although the absolute risk remains small. Women benefit from early advice on drugs that can be continued during pregnancy in order to optimize control and avoid unnecessary concern

Frovatriptan vs almotriptan for treatment of menstrual migraine: a double-blind, randomized, cross-over, multicenter Italian study

Results 67 of the 96 female patients of the intention-to-treat population of the main study had regular menstrual cycles and were thus included in this subgroup analysis. 77 migraine attacks classified as related to menses were treated with frovatriptan and 78 with almotriptan. Rate of pain relief at 2and 4-hrs was 36% and 53% for frovatriptan and 41% and 50% for almotriptan (p=NS between treatments). Rate of pain free at 2and 4-hrs was 19% and 47% with frovatriptan and 29% and 54% for almotriptan (p=NS). At 24-hrs, 62% of frovatriptanand 67% of almotriptan-treated patients had pain relief, while 60% vs. 67% were pain free (p=NS). Recurrence at 24-hrs was significantly (p<0.05) lower with frovatriptan (8% vs. 21% almotriptan). This was the case also at 48-hrs (9% vs. 24%, p<0.05).

Frovatriptan vs other triptans in the treatment of menstrual migraine: pooled analysis of three double-blind, randomized, cross-over studies

Methods Subjects with a history of migraine with or without aura were randomized to F 2.5 mg or R 10 mg (study 1), F or Z 2.5 mg (study 2), and F or A 12.5 mg (study 3). The studies had an identical multicenter, randomized, double blind, cross-over design. After treating 3 episodes of migraine in no more than 3 months with the first treatment, patients had to switch to the next treatment for other 3 months.

Triptans in prevention of menstrual migraine: a systematic review with meta-analysis

Randomized clinical trials (RCT) assessing the efficacy and tolerability of triptans compared with placebo as short-term prophylaxis of menstrual migraine (MM) were systematically reviewed in this study. Triptans, which interfere with the pathogenesis of migraine and are effective in relieving associated neurovegetative symptoms, have been extensively proposed for prevention of menstrual migraine attacks. We searched Cochrane CENTRAL, MEDLINE and EMBASE for randomized, double-blind, placebo-controlled trials on triptans for MM until 1 Oct, 2012. A total of six RCTs were identified. Two authors independently assessed trial’s quality and extracted data. Numbers of participants free from MM per perimenstrual period (PMP), requiring rescue medication, suffering from headache-associated symptoms and experiencing adverse events in treatment and control groups were used to calculate relative risk (RR) and number needed to treat (NNT) with their corresponding 95% confidence interval (CI). A total of 633 participants received frovatriptan 2.5 mg QD, 584 received frovatriptan 2.5 mg BID, 392 received naratriptan 1 mg BID, 70 received naratriptan 2.5 mg BID, 80 received zolmitriptan 2.5 mg BID, 83 received zolmitriptan 2.5 mg TID and 1104 received placebo. Overall, triptans is an effective, short-term, prophylactic treatment of choice for MM. Considering MM frequency, severity and adverse events, frovatriptan 2.5 mg BID and zolmitriptan 2.5 mg TID tend to be the preferred regimens.