Skip to main content

Advertisement

Log in

Opinion statement

  • •Slightly less than half of women with migraine report that menstruation is an important trigger of headache episodes. However, it is rare that menstruation is the only trigger for a patient and its importance as a trigger may be overemphasized. Accurate diagnosis requires a prospectively kept diary of information showing a consistent and mechanistically valid temporal correlation between migraine attacks and menstrual periods.

  • •Abnormal central nervous system response to normal fluctuations in hormones is the likely underlying cause of menstrual migraine. Patients with menstrual migraine do not generally have hormonal abnormalities.

  • •Currently available abortive therapy works well for menstrual-related migraine attacks. For the small subset of women for whom this is not the case, and whose menstrual periods and associated headaches are predictable, pre-emptive treatment of the expected headache with scheduled perimenstrual use of a number of agents can be helpful.

  • •A hormonal trigger for migraine headache does not mean that treatment must also be hormonal in nature. Choice of therapy depends on the frequency of menstrual migraine, predictability of menstrual periods, patient preference, and cost.

  • •For the small group of women with refractory menstrual migraine, hormonal therapy can be tried, with the understanding that the quality of evidence for these interventions is low and their risk to benefit ratios not established.

  • •The perimenstrual use of triptan medications is currently being investigated forthe treatment of menstrual migraine. Preliminary results are inconclusive, and until further evidence regarding the efficacy, safety, practicality, and cost effectiveness of this approach is available, their routine use in this manner for menstrual migraine is not recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Silberstein S: Menstrual migraine. J Womens Health Gend Based Med 1999, 8:919–931.

    PubMed  CAS  Google Scholar 

  2. Somerville, BW: The role of estradiol withdrawal in the etiology of menstrual migraine. Neurology 1972, 22:355–365.

    PubMed  CAS  Google Scholar 

  3. Waters WE, O’Connor PJ: Epidemiology of headache and migraine in women. J Neurol Neurosurg Psychiatry 1971, 34:148–153.

    PubMed  CAS  Google Scholar 

  4. Lipton RB, Stewart WF, Celentano DD, Reed ML: Undiagnosed migraine headaches: a comparison of symptom-based and reported physician diagnosis. Arch Intern Med 1992, 152:1273–1278.

    Article  PubMed  CAS  Google Scholar 

  5. McFarland C: Women’s theories of menstruation and biases in recall of menstrual symptoms. J Pers Soc Psychol 1989, 57:522–531.

    Article  PubMed  CAS  Google Scholar 

  6. MacGregor EA: "Menstrual" migraine: towards a definition. Cephalalgia 1996, 11–21. Good paper that reviews problems with the definition of menstrual migraine.

  7. Lipton RB, Stewart WF: Platform presentation at: American Headache Society Scientific Meeting; June 2000; Montreal, Canada.

  8. Smetana GW: The diagnostic value of historical features in primary headache syndromes: a comprehensive review. Arch Intern Med 2000, 160:2729–2737.

    Article  PubMed  CAS  Google Scholar 

  9. Olesen J: Understanding the biologic basis of migraine. N Engl J Med 1994, 331:1713–1714.

    Article  PubMed  CAS  Google Scholar 

  10. Davies PTG, Eccles NK, Steiner TJ, et al.: Plasma oestrogen, progesterone and sex-hormone binding globulin levels in the pathogenesis of migraine. Cephalalgia 1989, 9:143.

    Google Scholar 

  11. Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988, 1–96.

  12. Loder E, Tietjen GE, Marcus DA: Evaluation and management issues in migraine. J Clin Outcomes Manage 1999, 6:58–74.

    Google Scholar 

  13. Blau JN, Diamond S: Dietary factors in migraine precipitation: the physicians’ view. Headache 1985, 25:184–187.

    Article  PubMed  CAS  Google Scholar 

  14. Solbach P, Sargent J, Coyne L: Menstrual migraine headache: results of a controlled, experimental, outcome study of non-drug treatments. Headache 1984, 24:75–78.

    Article  PubMed  CAS  Google Scholar 

  15. MaasenVanDenBrink A, Reekers M, Bax WA, et al.: Coronary side-effect potential of current and prospective antimigraine drugs. Circulation 1998, 25–30.

  16. Silberstein SD, Armellino JJ, Hoffman HD, et al.: Treatment of menstruation-associated migraine with the nonprescription combination of acetaminophen, aspirin and caffeine: results from three randomized, placebo-controlled studies. Clin Ther 1999, 21:1–15.

    Article  Google Scholar 

  17. Welch KM: Drug therapy of migraine. N Engl J Med 1993, 329:1476–1483.

    Article  PubMed  CAS  Google Scholar 

  18. Salonen R, Saiers J: Sumatriptan is effective in the treatment of menstrual migraine: a review of prospective studies and retrospective analyses. Cephalalgia 1999, 19:16–19.

    Article  PubMed  CAS  Google Scholar 

  19. Loder E, Silberstein S: Clinical efficacy of 2.5 and 5 mg zolmitriptan in migraine associated with menses or in patients using non-progestogen oral contraceptives [abstract]. Neurology 1998, A341.

  20. Silberstein SD, Massiou H, LeJeunne C, et al.: Rizatriptan in the treatment of menstrual migraine. Obstet Gynecol 2000, 96:237–242.

    Article  PubMed  CAS  Google Scholar 

  21. Mathew NT, Asgharnejad M, Peykamian M, et al.: Naratriptan is effective and well tolerated in the acute traetment of migraine. Results of a double-blind, placebo-controlled, crossover study. The Naratriptan Study Group. Neurology 1997, 49:1485–1490.

    PubMed  CAS  Google Scholar 

  22. Massiou H, Pitei D, Poole PH, et al.: Efficacy of eletriptan for the treatment of migraine in women with menstrually associated migraine, and in women on contraceptives or hormone replacement therapy: meta-analyses of randomized clinical trials. Poster presentation at: Headache World 2000; September 3–7, 2000; London, UK.

  23. MacGregor EA, Keywood C: Frovatriptan is effective in mensturally associated migraine. Poster presentation at: Headache World 200; September 3–7, 2000; London, UK.

  24. Goadsby P: A triptan too far? J Neurol Neurosurg Psychiatry 1998, 64:143–147.

    PubMed  CAS  Google Scholar 

  25. Cady RC, Ryan R, Jhingran P, et al.: Sumatriptan injection reduces productivity loss during a migraine attack. Arch Intern Med 1998, 158:1013–1018.

    Article  PubMed  CAS  Google Scholar 

  26. SilbersteinSD, Merriam GR: Sex hormones and headache. J Pain Symptom Manage 1993, 8:98–114. Important paper discussing the effect of sex hormones on headache disorders.

    Article  PubMed  CAS  Google Scholar 

  27. Szekely B, Merryman S, Croft H, et al.: Prophylactic effects of naproxen sodium on perimenstrual headache: a double blind placebo controlled study. Cephalalgia 1989, 9(suppl 10):452–453.

    Google Scholar 

  28. Sances G, Martignoni E, Fioroni L, et al.: Naproxen sodium in menstrual migraine prophylaxis: a double-blind placebo controlled study. Headache 1990, 30:705–709.

    Article  PubMed  CAS  Google Scholar 

  29. Lichten EM, Bennett RS, Whitty AJ, Daoud Y: Efficacy of danazol in the control of hormonal migraine. J Reproduc Med 1991, 419–424.

  30. O’Dea PK, Davis EH: Tamoxifen in the treatment of menstrual migraine. Neurology 1990, 40:1470–1471.

    PubMed  CAS  Google Scholar 

  31. Herzog AG: Continuous bromocriptine therapy in menstrual migraine. Neurology 1997, 101–102.

  32. Somerville BW: Estrogen-withdrawal migraine II: attempted prophylaxis by continuous estradiol administration. Neurology 1975, 245–250.

  33. Fettes I: Menstrual migraine: methods of prevention and control. Postgrad Med 1997, 5:67–77.

    Google Scholar 

  34. Newman LC, Lipton RB, Lay CL, Solomon S: A pilot study of oral sumatriptan as intermittent prophylaxis of menstruation-related migraine. Neurology 1998, 51:307–309.

    PubMed  CAS  Google Scholar 

  35. ewman LC, Mannix LK, Landy SH, et al.: Naratriptan as prophylaxis for mensturally associated migraine: a randomized, double-blind, placebo-controlled study. Poster presentation at: Headache World 2000; September 3–7, 2000, London, UK.

  36. Stewart WF, Lipton RB, Celentano DD, Reed L: Prevalence of migraine headache in the United States: relation to age, income, race and other sociodemographic factors. J Am Med Assoc 1992, 267:64–69.

    Article  CAS  Google Scholar 

  37. Magos AL, Zilkha KJ, Studd JWW: Treatment of menstrual migraine by oestradiol implants. J Neurol Neurosurg Psychiatry 1983, 46:1044–1046.

    PubMed  CAS  Google Scholar 

  38. DeLignieres B, Vincens M, Mauvais-Jarvis P, et al.: Prevention of menstrual migraine by percutaneous oestradiol. BMJ 1986, 293:1540.

    Article  CAS  Google Scholar 

  39. Pfaffenrath V: Efficacy and safety of percutaneous estradiol vs. placebo in menstrual migraine [abstract]. Cephalalgia 1993, 13:168.

    Google Scholar 

  40. Pradalier A, Vincent D, Beaulieu PH, et al.: Correlation between oestradiol plasma level and therapeutic effect on menstrual migraine.In New Advances in Headache Research, edn 4. Edited by Rose FD. London: Smith-Gordon; 1994:129–132.

    Google Scholar 

  41. Boyle CAJ: Management of menstrual migraine. Neurology 1999, 53(suppl 1):S14-S18. Detailed, well-written report on treatments for menstrualrelated headaches.

    PubMed  CAS  Google Scholar 

  42. D’Alessandro R, Gamberinin G, Lozito A, Sacquegna T: Menstrual migraine: intermittent prophylaxis with a timed-release formulation of dihydroergotamine. Cephalalgia 1983, 15:158.

    Google Scholar 

  43. Gallagher RM: Menstrual migraine and intermittent ergonovine therapy. Headache 1989, 29:366–367.

    Article  PubMed  CAS  Google Scholar 

  44. Facchinetti F, Montorsi S, Borella P, et al.: Magnesium prevention of premenstrual migraine: a placebo controlled study. In New Advances in Headache Research, edn 2. Edited by Rose FC. London: Smith-Gordon; 1991.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Loder, E. Menstrual migraine. Curr Treat Options Neurol 3, 189–200 (2001). https://doi.org/10.1007/s11940-001-0054-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-001-0054-1

Keywords

Navigation