Menstrual Migraines

Menstrual migraine is common. 2 out of 3 premenopausal female migraine sufferers report that migraine attacks consistently occur during peri-menstrual time periods. Attacks of menstrual migraine have been found to be more severe, disabling and less responsive to acute medications than those that are non menstrually related.

What causes Menstrual Migraines?

The most likely trigger for menstrual migraine is the decline of oestradiol levels that occur shortly before and during the peri-menstrual time period.

Diagnosis

A headache diary/app is a particularly useful tool for the patient and doctor, recording the occurrence of migraine and the onset of the menstrual periods, as well as information about other potential triggers.

Treatment of Menstrual Migraine

Acute and Preventative therapies may be utilized for the treatment of menstrual migraine. Acute therapies are used to abort the migraine attack once it has begun, while preventative therapies are used to try and prevent menstrual migraines from occurring.

Patients with regular menstrual periods may be suitable for short term prophylactic (‘miniprophylaxis’) therapies.

The options may include magnesium, NSAIDs, topical oestrogen therapy or triptan medications (for eg Naramig)

Patients with irregular menstrual periods may be more suitable for long term, continuous prophylactic therapies.

The treatment typically involves the use of non hormonal preventative therapies, or in certain cases, if deemed appropriate following a screening history to exclude prior clotting disorder, DVT/stroke risk factors or migraine with aura symptoms, combination hormonal therapies.

 References:

Menstrual Migraine: New Approaches to Diagnosis and Treatment. American Headache Society

Use of Oral Contraceptives in Women with Migraine. American Headache Society

Diagnosis and Treatment of the Menstrual Migraine Patient. Headache 2008; 48:S115-S123

 

Note: information on this site is not a substitute for professional medical advice