Menstrual Migraine Research Articles

Knowledge, attitude, and practice on menstrual hygiene among adolescent girls in Coimbatore: A cross-sectional study

Background: Menstruation is a phenomenon specific to women. The World Health Organisation states that it is a normal biological occurrence that is defined by the uterine passage of mucus and blood periodically. Many girls have a range of symptoms during their menstrual cycle, including headaches, stomach cramps, tiredness, migraines, and acne. Girls continue to experience social and cultural shame in our society, which is exacerbated by common misconceptions and beliefs. India may be more susceptible to improper menstrual management practices due to a lack of adequate hygienic facilities and limited access to feminine hygiene products. Objectives: This study aimed to investigate teenage school girls'(10-19 years) KAP of menstruation, and to get their menstrual health-related health-seeking behavior. Methodology: Using a semi-structured, pretested questionnaire, 1137 teenage schoolgirls participated in a cross-sectional study conducted between March 2021 and July 2024 regarding their knowledge, practices, and hygienic methods for managing problems related to menstruation. Results: Most of them learned about menstruation and its issues from mothers (77.1%) and friends (15.9%). Nearly 4.5% were aware of menstrual problems, and 41.9% and 42.9% were aware of unexcepted menstruation, and the physiological changes respectively. According to the investigation of menstrual health management, 59.7% reported psychological symptoms and 59.2% of monthly absences from school. Approximately 34.8% exercised or performed yoga to reduce pain, and 47.4% sought medical assistance for menstrual health difficulties. Around 94.5% use disposable pads and, 58.9% use three to four napkins daily. Conclusion: This study emphasizes the importance of providing complete education on menstruation, reproductive health before puberty, appropriate menstrual hygiene management, and the negative consequences of a lack of information about hygiene practices among adolescent girls. Furthermore, through the provision of health cards to track and manage menstrual health and cleaning practices, it is advised that healthcare professionals hold regular workshops to raise awareness among parents, educators, and young girls. This will increase their attitudes and behaviors around menstrual hygiene.

Is ultrasound guided pulsed radiofrequency of proximal greater occipital nerve a game-changer for the treatment of pure menstrual migraine?

Is ultrasound guided pulsed radiofrequency of proximal greater occipital nerve a game-changer for the treatment of pure menstrual migraine?

Beyond the Pill: Exercise as a Potential Treatment for Menstrual Migraines

Menstrual migraine is a very common type of headache in women, caused by decreased estrogen levels during the menstruation cycle. It typically occurs two days before menstruation and lasts until the third day of menstrual bleeding. Treatment includes medications and preventive measures. Studies suggest that yoga and high-intensity interval training can be beneficial. Regular physical activity can help regulate hormone levels and reduce stress, potentially managing menstrual migraines.

Male-female comparison of vasomotor effects of circulating hormones in human intracranial arteries

BackgroundThe purpose of this study was to examine whether there are sex differences in vasomotor responses and receptor localization of hormones and neuropeptides with relevance to migraine (vasopressin, oxytocin, estrogen, progesterone, testosterone, amylin, adrenomedullin and calcitonin gene-related peptide (CGRP)) in human intracranial arteries.MethodsHuman cortical cerebral and middle meningeal arteries were used in this study. The tissues were removed in conjunction with neurosurgery and donated with consent. Vasomotor responses of arteries, after exposure to hormones or neuropeptides, were recorded using a wire myograph. Immunohistochemistry was performed to examine the expression and localization of their receptors within human intracranial arteries.ResultsVasopressin showed the strongest contractile responses, followed by oxytocin and progesterone. CGRP displayed the strongest vasodilatory response when compared to adrenomedullin, amylin, testosterone and estrogen. No significant differences were observed in vasomotor responses between male and female arteries. The vasomotor effects were supported by the presence of corresponding receptors in the vascular smooth muscle cells. Estrogen receptors (ERα and ERβ), progesterone receptor (PR), vasopressin 1a receptor (V1aR), and the oxytocin receptor (OTR) were expressed in the walls of both cerebral arteries overlying the cerebral cortex and intracranial arteries of the dura mater. ERα, V1aR, and PR were found to be localized in both smooth muscle cells and endothelium, whereas OTR was exclusively located within the smooth muscle cells.ConclusionsHypothalamic, sex hormones and the pancreas hormone (amylin) receptors are expressed in the human intracranial artery walls. The vasomotor responses revealed no sex differences, however contractile responses to vasopressin was higher and more potent in MMA compared to CCA when pooling data from both sexes. Overall, the hormones estrogen, progesterone and oxytocin, which drop in circulating levels at onset of menstruation, only showed modest vasomotor responses as compared to CGRP. This suggests that their role in inducing menstrual migraine attacks is not directly related to vasomotor responses.Graphical

Study Of Menstrual Migraine (MM) And Its Association with Iron Deficiency Anemia (IDA) Amongst Health Care Professionals & Students of A Tertiary Care Hospital in North Maharashtra.

Study Of Menstrual Migraine (MM) And Its Association with Iron Deficiency Anemia (IDA) Amongst Health Care Professionals & Students of A Tertiary Care Hospital in North Maharashtra.

Abortive and Prophylactic Therapies to Treat Migraine in Pregnancy: A Review.

Migraine is a common issue during pregnancy, often affected by hormonal changes. More than half of the womenaffected by migraine experience improvement in or remission of migraine symptoms, particularly during the second and third trimesters, with those having menstrual migraines or migraines without aura benefiting the most. However, a small percentage of women may see a worsening of their migraines, especially those with migraine with aura, and some may even develop migraines for the first time during pregnancy, often in the first trimester. Postpartum, many women experience a recurrence of migraines, likely due to the drop in estradiol and endorphin levels. A literature search was performed in PubMed for articles published from 2013 through 2023, and 80 out of 362 publications were included. When it comes to managing pregnant women with migraine, non-pharmacological treatments are preferred, including lifestyle modifications and avoiding known triggers. When medication is necessary, acetaminophen is the first-line treatment, with nonsteroidal anti-inflammatory drugsand triptans regarded as secondary options, though trimester-specific risks limit their use. Preventive treatments, if required, may include low doses of β-blockers or amitriptyline but should be used cautiously. This article aims to provide a concise overview of the existing research on the acute and prophylactic use of medications to treat migraines in pregnant and lactating women. Furthermore, it presents recommendations for healthcare professionals managing pregnant females presenting with migraine in clinical settings.

Intermittent spontaneous CSF rhinorrhea exacerbated by hormonal fluctuations associated with menstrual cycles.

This case underscores the importance of recognizing the potential link between hormonal fluctuations during the menstrual cycle and idiopathic intracranial hypertension (IIH), which could lead to spontaneous cerebrospinal fluid (CSF) rhinorrhea. Eliciting a history of intermittent clear rhinorrhea with the onset of menstrual cycle if presenting with menstrual migraines could allow for a more prompt diagnosis and treatment of IIH and CSF leak. Early diagnosis and intervention are crucial to prevent serious complications.

Acute and preventive treatment of menstrual migraine: a meta-analysis

Background and objectivesAbout a quarter of migraine cases among women have menstrual migraine (MM), which is usually more severe, longer lasting, and less responsive to treatment than typical migraine. Randomized controlled trials (RCTs) have evaluated the efficacy of several medication in the acute and preventive treatment of MM; this meta-analysis compared the effectiveness of these treatments.MethodsWe conducted systematic searches in the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase databases. The primary outcomes of acute treatment trials were pain relief at 2 and 24 h after treatment compared with placebo or another treatment. The three endpoints we checked for studying MM prevention were: no recurrence of headaches each month, a 50% reduction in monthly migraine days from baseline, and a decrease in the mean number of headache days per month.ResultsOut of 342 studies, 26 RCTs met the criteria. Triptans, combined with or without other analgesics, were superior to placebo in providing pain relief in the acute treatment and prevention of MM. Among the treatments, sumatriptan and lasmiditan demonstrated superior pain relief at 2 h (OR: 4.62) and 24 h (OR: 4.81). Frovatriptan exhibited effectiveness in preventing headache recurrence, whereas galcanezumab and erenumab displayed significant preventive benefits in reducing headache days per month.ConclusionSumatriptan and lasmiditan are effective first-line treatments for acute MM. For prevention, frovatriptan may be the more effective of triptans. Compared with triptans, CGRP monoclonal antibodies, here including erenumab and galcanezumab, are more effective in reducing headache days, and therefore, in preventing MM.

Menstrual migraine - pathophysiology, clinical features and treatment options

Menstrual migraine - pathophysiology, clinical features and treatment options

(055) A RETROSPECTIVE ANALYSIS ON THE BENEFITS OF AN OVER-THE-COUNTER COMBINATION OF ASPIRIN, ACETAMINOPHEN, AND CAFFEINE (AAC) IN MENSTRUAL MIGRAINE

Abstract Introduction • Migraine affects approximately 15% of the general population globally. It is an episodic headache disorder that produces a wide spectrum of pain and associated disability. • Women are 3 times more likely than men to experience migraine headache. More than 60% of women with migraine experience attacks that occur in association with the menstrual periods. • Although some women experience migraine exclusively during the perimenstrual period others have attacks both during the perimenstrual period and at other times of the month. Menstrual migraine is thought to be more severe and disabling and less responsive to non-drug treatments than is non-menstrual migraine Objective Since menstrual migraine is an important health issue for women, we wanted to examine whether AAC is more effective than placebo in relieving menstruation associated migraine and improving the quality of life (QoL) of patients. Methods The study population selected for this analysis were adapted from a pooled analysis of women associated with menstrual migraine [Clin Therapeutics 21(3) 475, 1999]. A total of 185 women with menstrual associated migraine, of which 85 took one dose of AAC (aspirin/acetaminophen/caffeine – 250 mg/250 mg/65 mg) and 100 took placebo were included in this study. The data was analyzed using SAS Windows version 9.4. All post-rescue medication severity scores were assigned either the baseline value or the last recorded value whichever was most severe. Post-rescue medication pain relief scores were classified as “no relief”. Results It was observed that the intensity of the headache pain was reduced to mild or none (1) within 30 min in 20% (AAC treated) vs (10% in placebo). Within 1 hour in 40% (AAC treated) vs (14% placebo) (p<=0.001) treated patients and the pain relief lasted for at least six hours. The quality of life (able to perform all or usual activities with minimal or no additional effort) also improved within 1 hour in 48.2% (AAC treated patients) vs 28% (placebo) (p<=0.005) and within 3 hour in 68.2% AAC treated patients vs 40% (placebo) (p<=0.001). In addition, in terms of relative change (%) difference, there was a 19% improvement in QoL with a 24.6% reduction in pain intensity within 1 hour. At 3 hours the QoL scores improved to 38.1% with a reduction in pain intensity of 41.1% that lasted till 6 hours in AAC treated patients vs placebo. Conclusions This post- hoc pooled analysis provides evidence that a single dose of AAC provides significant benefits in relieving menstrual migraine associated pain relief and improves quality of life of patients in their ability to perform usual activities with minimal or no additional effort. Disclosure Yes, this is sponsored by industry/sponsor: Haleon Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Haleon.

Menstrual Migraine: A Review of Current Research and Clinical Challenges

The term “menstrual migraine” is commonly used to describe migraines that occur in association with menstruation, as distinct from other migraine types. A significant proportion of women of reproductive age experience migraine attacks related to their menstrual cycle. Menstrual migraine is characterized by migraine attacks occurring on day 1±2 (i.e., days −2 to +3) of menstruation in at least two out of three menstrual cycles. Although the reported prevalence of menstrual migraine varies considerably, population-based studies have found that menstrual migraine affects up to 60% of women with migraines. Several hypotheses have been proposed to explain the etiology of menstrual migraine, among which the estrogen withdrawal hypothesis is the most widely accepted. Women who experience menstrual migraines often face considerable disability due to perimenstrual attacks. Studies have reported that perimenstrual attacks are more severe and more difficult to manage. The principles of acute managing perimenstrual attacks are the same as those for managing nonmenstrual attacks. Short-term preventive therapy is needed to prevent menstrual migraines before they occur during the perimenstrual period. This review summarizes the prevalence, distinct clinical features, pathophysiological mechanisms, and management of menstrual migraine.

Prevalence and Characteristics of Women with Menstrual Migraine in the 2021 United States National Health & Wellness Survey (S22.002)

Prevalence and Characteristics of Women with Menstrual Migraine in the 2021 United States National Health & Wellness Survey (S22.002)

Continuous combined oral contraceptive use versus vitamin E in the treatment of menstrual migraine: rationale and protocol of a randomized controlled trial (WHAT!)

BackgroundCurrently, there is no evidence-based hormonal treatment for migraine in women. Several small studies suggest a beneficial effect of combined oral contraceptives, but no large randomized controlled trial has been performed. As proof of efficacy is lacking and usage may be accompanied by potentially severe side effects, there is a great need for clarity on this topic.MethodsWomen with menstrual migraine (n = 180) are randomly assigned (1:1) to ethinylestradiol/levonorgestrel 30/150 μg or vitamin E 400 IU. Participants start with a baseline period of 4 weeks, which is followed by a 12-week treatment period. During the study period, a E-headache diary will be used, which is time-locked and includes an automated algorithm differentiating headache and migraine days.ResultsThe primary outcome will be change in monthly migraine days (MMD) from baseline (weeks − 4 to 0) to the last 4 weeks of treatment (weeks 9 to 12). Secondary outcomes will be change in monthly headache days (MHD) and 50% responder rates of MMD and MHD.ConclusionsThe WHAT! trial aims to investigate effectivity and safety of continuous combined oral contraceptive treatment for menstrual migraine. Immediate implementation of results in clinical practice is possible.Trial registrationClinical trials.gov NCT04007874. Registered 28 June 2019.

Indian Consensus on the Role of Amitriptyline in Migraine Prophylaxis.

Migraine is a globally prevalent neurological disorder. Amitriptyline, a tricyclic antidepressant, has shown potential as a prophylactic treatment for migraine; however, its role as a first-line medication has been debated. A modified Delphi method was used to develop consensus statements on migraine and its management. The literature review identified knowledge gaps, and two survey rounds were conducted among a panel of experts. Consensus was reached for 12 out of 23 initial survey questions, whereas no consensus was reached for four questions after the deliberation in the second round. The results showed that migraine is highly prevalent among women aged 15-35 years in India. Amitriptyline is an effective monotherapy for prophylactic migraine management, with a recommended initial dose of 5-10 mg. A gradual titration over six months achieves optimal results. Amitriptyline is also safe for managing catamenial migraine and can be used at lower doses during pregnancy to alleviate symptoms. The outcomes of this study emphasize that amitriptyline should be considered as a primary prophylactic treatment for migraine because of its efficacy and safety. The evidence-based consensus achieved is intended to serve as guidance for healthcare practitioners in India, and it is anticipated that such adoption will lead to improvement in patient outcomes and an enhancement in the quality of life for those affected by migraines.

Association between anemia severity and migraine in iron deficiency anemia.

Migraine is an episodic public health problem that usually occurs with a severe headache. Various mechanisms and outcomes have been reported between iron deficiency anemia (IDA) and migraine. We aimed to investigate the effect of the presence and severity of anemia and iron parameters on the frequency and severity of migraine attacks. The study included 104 patients with IDA and newly diagnosed migraine in the neurology outpatient clinic and 38 age and gender-matched controls with normal hemoglobin levels. Patients were divided into 3 subgroups (mild, moderate, and severe anemia) to determine a significant relationship between the severity of IDA and migraine attacks. All patients were asked validated questions with the Visual Analogue Scale (VAS), Headache Impact Test-6 (HIT-6), and the Hamilton Anxiety Rating Scale (HAM-A) face-to-face. In this study, 85.6% of the participants were female, and 22 (14.6%) of them were male. Thirty-two mild anemia patients' mean age was 36.6 ± 12.5, 41 with moderate anemia was 46 ± 14.2, and 31 with severe anemia patients' mean age was 48 ± 14.1. There was no significant difference between the subgroups in VAS, HIT-6 score, headache type, and headache frequency. Menstrual migraine is associated with low hemoglobin levels. A significant increase was found in VAS and HIT-6 scores with low ferritin levels. The presence and severity of anemia and iron deficiency do not affect the frequency and severity of migraine attacks in groups other than menstruation-related migraine. An inverse relationship was found between VAS, HIT-6, and ferritin levels. VAS was found to be more effective than HIT-6.

PREVALENCE OF MENSTRUAL MIGRAINE AND THE EFFICACY OF SUMATRIPTAN ADMINISTRATION

Background: Menstrual migraine is a primary headache that often attacks women of reproductive age. This type of migraine has high severity and is resistant to treatment. Therefore, an effective treatment is needed to treat this menstrual migraine. Sumatriptan has been shown to have a better effect as an acute treatment for menstrual migraine patients. Purpose: This study aims to determine the prevalence and effectiveness of sumatriptan as a therapy for menstrual migraine. Methods: This research is based on a literature review following predetermined inclusion criteria. First, a literature search was carried out adhering to the PRISMA flow in 4 databases: Pubmed, Science Direct, ProQuest, and ClinicalTrial.co. Results: Based on keywords, 267 studies were found in the literature search. However, only three studies covering 845 participants met the predetermined inclusion criteria. The average age of menstrual migraine patients in the three studies was 37 years. These three studies of sumatriptan revealed a significant effect in providing a pain-free response in menstrual migraine patients. These three studies also showed that sumatriptan 100 mg has a higher level of effectiveness in providing a pain-free response in menstrual migraine sufferers and was preferably given during mild attacks. Conclusion: These three studies indicate that typically, women who suffer from menstrual migraines are of reproductive age. Additionally, this study shows that using sumatriptan as an acute therapy significantly helps provide a pain-free response in menstrual migraine patients.

Study to Determine the Prevalence of Menstrual Migraine in Reproductive-Age Women in Saudi Arabia

Background: Migraine is a common health condition in both men and women. Premenstrual syndrome (PMS) affects many women during their menstrual cycle, with around 50–60% of women with migraine attacks experiencing menstrual headaches. Most have mild symptoms, but 5–8% suffer from moderate to severe symptoms, causing distress and functional issues. Pure menstrual migraine (PMM) occurs in about 50% of women with migraine, and it can be debilitating in terms of frequency and severity. This information is crucial for Saudi Arabian medical professionals to provide better care and support, improving the quality of life for women with PMS and menstrual migraine (MM) attacks. Objectives: To estimate the prevalence of MM in women, to evaluate the severity and frequency of MM in women with PMS, and to identify potential risk factors aggravating MM in women with PMS in Saudi Arabia. Methodology: A cross-sectional community-based study was conducted on reproductive-aged (18–50 years) women who had regular menstrual cycles and were diagnosed with PMS, using a self-administered questionnaire between December 2022 to May 2023 in Saudi Arabia. Results: Out of the 2130 female participants, 397 (18.6%) had migraine. Among these 397 migraine sufferers, 230 (57.9%) experienced MM, while 167 (42.1%) had non-MM. In reproductive women in general, MM occurred in 10.7% of cases, while non-MM was observed in 7.8%. There is a correlation between increasing BMI and an increased incidence of MM. About one-third of the participants experienced moderate disability due to migraine attacks, with 134 (33.8%) individuals affected. Additionally, most MM sufferers missed at least 3 days of work in the last 3 months due to their condition. Conclusions: Migraine attacks occurring during the menstrual cycle impair the ability to engage in social, physical, household, and academic activities, often hindering the fulfillment of professional commitments. To gain a deeper understanding of menstrual and non-menstrual migraine attacks, it is essential to conduct extensive prospective studies aimed at developing effective management strategies.

Aberrant brain functional hubs and causal effective connectivity in menstrually-related and non-menstrually-related migraine without aura.

Menstrual migraine without aura (MRM) is common in female migraineurs and is closely related to cerebral functional abnormalities. However, whether the whole brain networks and directional functional connectivity of MRM patients are altered remains unclear. The purpose of this study was to detect the alterations of resting-state functional networks and directional functional connectivity between MRM and non-menstrual migraine without aura (NMM) patients using functional magnetic resonance imaging (fMRI) with degree centrality (DC) and Granger causality analysis (GCA) methods. In this retrospective and cross-sectional study, 45 MRM and 40 NMM patients (matched in age, gender, and years of education) were recruited in the study between May 2018 and June 2022. All participants had undergone resting-state fMRI scanning at the Neurology and Pain Outpatient Department of Nanjing First Hospital. Their brain functions were analyzed in terms of DC and GCA, with the significant threshold at voxel level P<0.01 and cluster level P<0.05, Gaussian random field corrected. Correlation analysis was adopted to assess the relationships between the fMRI results and clinical features (P<0.05, Bonferroni corrected). Compared with those in the NMM group, MRM patients showed decreased DC in the right insula (T=-4.253). Using the right insula as the seed region, patients with MRM demonstrated enhanced effective connectivity from the right insula to the ipsilateral middle temporal gyrus (T=4.138) and contralateral superior temporal gyrus (T=3.523). Furthermore, the MRM group also showed decreased effective connectivity from several brain regions to the right insula, which included the right inferior occipital gyrus (T=-4.498), left middle frontal gyrus (T=-4.879), right precuneus (T=-4.644), and left inferior parietal gyrus (T=-4.113). The average Self-rating Anxiety Scale score of the MRM group was significantly higher than that of the NMM group [P=0.032, 95% confidence interval (CI): 0.363-7.761]. In the MRM group, disease duration was negatively correlated with the mean value of DC in right insula (r=-0.428, P=0.01). The present research demonstrated that patients with MRM have disruption in insula resting-state functional networks. Disrupted networks contained regions associated with cognitive processes, emotional perception, and migraine attack in MRM patients. These results may improve our comprehension of the neuromechanism of menstrually-related migraine.

Применение анти-CGRP-моноклональных антител у женщин: влияние на менструально-ассоциированную мигрень и альгодисменорею

Background. Menstrual related migraine (MRM) occurs in 60% of women with migraine. These attacks are characterized by high intensity and poor response to abortive and prophylactic treatment. Hormonal therapy is one of the main treatment methods, but it has a large number of limitations. Increase in the CGRP level triggered by a decrease of estrogen levels is one of the basic mechanisms of MRM. It is of interest therefore to study the impact of anti-CGRP monoclonal antibodies (mAbs) in MRM. In addition, many patients have severe pelvic pain in the perimenstrual period (algodysmenorrhea). Algodysmenorrhea is associated with other chronic pain syndromes including migraine. Therefore, it is interesting to study the impact of anti-CGRP monoclonal antibodies on algodysmenorrhea. Material and methods. We recruited 64 women with migraine (episodic and chronic) over 18 years of age with regular menstrual cycle. 21 patients were diagnosed with MRM according to the International Classification of Headache Disorders, 3rd edition. Demographic data, migraine history, menstrual cycle characteristics and algodysmenorrhea symptoms were collected. Patients were treated with erenumab or fremanezumab for 3 months and followed up monthly with headache diaries. Results. After 3 months of treatment, the intensity of menstrual migraine attacks and algodysmenorrhea decreased by 50% or more (p=0,03* and p=0,045*, accordingly). There was a significant decrease in the total amount of headache days in MRM patients.

Pure menstrual tension-type headache: demonstration of its existence.

Menstrual migraine (MM) is widely recognized among the scientific community, with diagnostic criteria included in the appendix of the third edition of the International Headache Classification. However, this classification does not include other primary headaches that may occur during menstruation. Previous retrospective studies suggest the existence of menstrual tension-type headache. Our objective is to prospectively determine the existence of this type of headache and to determine its frequency relative to that of MM. This is a descriptive, cross-sectional (case series), prospective, observational study, conducted in a hospital neurology department, using a previously validated ad hoc questionnaire. Participants were recruited by consecutive sampling, applying inclusion and exclusion criteria among women accompanying neurology outpatients, and classified into five groups: pure menstrual tension-type headache, menstrual-related tension-type headache, pure menstrual migraine, menstrual-related migraine and unclassifiable. Ninety-five women (median age of 38.50years, IQR: 13) were included, with the following group distribution: 13 (13.6%) pure menstrual tension-type headache, 14 (14.7%) menstruation-related tension-type headache, 23 (24.2%) pure menstrual migraine, 44 (46.3%) menstrual-related migraine and 1 unclassifiable. Of these patients, 23% did not treat menstrual headache, but this figure rose to 30.8% in the case of pure menstrual tension-type headache. The results confirm the existence of pure menstrual tension-type headache among women who do not seek medical care for this condition. The frequency of this headache is lower than that of MM. This reduced incidence, together with its generally mild nature, may explain the lack of prior recognition.