title: Effective treatment of severe menstrual migraine headaches with gonadotropin-releasing hormone agonist and "add-back" therapy.
abstract: OBJECTIVE
  To determine the efficacy of treating women with severe menstrual migraine headaches with GnRH agonist (GnRH-a) therapy, alone and combined with continuous estrogen-progestin "add-back."
  
  
  METHODS
  Nonrandomized, prospective treatment study.
  
  
  METHODS
  Outpatient clinic in a university medical center.
  
  
  METHODS
  Five women who had repetitive, severe, migraine headaches limited to the perimenstrual period were selected carefully.
  
  
  METHODS
  After 2 months of basal evaluation, all subjects received GnRH-a (leuprolide acetate depot formulation, 3.75 mg IM, monthly) for 10 months. Beginning with the 5th month, "add-back" therapy (the addition of transdermal E2, 0.1 mg daily, and oral medroxyprogesterone acetate, 2.5 mg daily) was initiated.
  
  
  METHODS
  Patients rated headache severity from 0 (absent) to 3 (severe) each day; these were combined each month to obtain a cumulative score for that month. In addition, patients were asked their overall assessment of the treatments.
  
  
  RESULTS
  The mean headache scores for the GnRH-a treatment months (4.0 +/- 1.5, mean +/- SEM) and for the GnRH-a and "add-back" treatment months (3.1 +/- 0.7) were each significantly lower than those of the control months (15.3 +/- 2.4). The patients uniformly found both treatments to be well tolerated and near-curative for their condition.
  
  
  CONCLUSIONS
  Gonadotropin-releasing hormone agonist administration, alone or with "add-back" therapy, is a very effective treatment for carefully selected patients with severe, perimenstrual migraine headaches.
authors.affiliation: Department of Obstetrics and Gynecology, University of Kentucky, Lexington 40536-0084, USA. murrays@pop.uky.edu
authors.forename: S C
authors.initials: SC
authors.lastname: Murray
authors.forename: K N
authors.initials: KN
authors.lastname: Muse
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D016729:Leuprolide / Q000008:administration & dosage* / Q000627:therapeutic use; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage* / Q000627:therapeutic use; D008599:Menstruation Disturbances / Q000188:drug therapy* / Q000503:physiopathology; D008881:Migraine Disorders / Q000188:drug therapy* / Q000503:physiopathology; D045167:Progesterone Congeners / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D045167:Progesterone Congeners; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D017258:Medroxyprogesterone Acetate; D016729:Leuprolide