Menstrual Migraine: Literature Review Indicates Most Effective Treatment

Many women suffer from menstrual migraine attacks, which are often more debilitating, longer, more likely to recur, and less responsive to treatment than migraines not related to the menstrual cycle.

Information on how best to prevent menstrual migraine is scant, and until recently no evidence-based review of acute and preventive treatment had been done in more than a decade. To address that, Hida del C. Nierenburg, MD, of the Medstar Georgetown University Hospital in Washington, D.C., and colleagues evaluated treatments and found that triptans, the most commonly prescribed migraine medication, are the most effective treatment for menstrual migraine as well.

In their literature review, the authors included 11 articles regarding acute treatment and 25 for preventive treatment of menstrual migraine. The articles covered a range of treatment options, including triptans, combination therapy, prostaglandin synthesis inhibitor, and ergot alkaloids for acute treatment. Preventive treatment medications included triptans, combined therapy, oral contraceptives, estrogen, nonsteroidal anti-inflammatories, phytoestrogen, gonadotropin-releasing hormone agonist, dopamine agonist, vitamin, mineral, and non-pharmacological therapies. Triptans proved to be the best choice.

“Overall, triptans had strong evidence for treatment in both acute and short term prevention of menstrual migraine,” the authors wrote in the article, which appeared in the journal Headache.

The authors also compared the results of several different triptans, indicating which medications provided the best results. Frovatriptan was found to be more effective than almotriptan and placebo for acute treatment of menstrual migraine; frovatriptan was also superior to placebo in preventing menstrual migraine. Other triptans, including naratriptan, sumatriptan, and zolmitriptan, were all superior to placebo as acute menstrual migraine treatment.

Limited evidence exists for other preventative therapies, and most studies that involved them were open label with a small sample size. Exceptions that had been evaluated in placebo-controlled trials were naproxen, nimesulide, estradiol gel, magnesium, vitamin E, and acupuncture. The authors found that all showed improvement of symptoms, except for acupuncture, where no difference was found between it and the placebo group.

To improve treatment for patients with menstrual migraine, the authors call for stronger studies and randomized controls, in particular for oral contraceptives, which are commonly used to prevent migraine.

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