Update on menstrual migraine: from clinical aspects to therapeutical strategies.
Migraine occurrence is strongly influenced by the hormonal fluctuations of the female reproductive cycle; at least 60% of women affected by migraine relate the periodicity of their attacks to the menstrual cycle. The so-called menstrual migraine, which occurs immediately before, during or at the end of the menstrual flow, has been a largely undefined condition, including some clinical subtypes which are not well defined. In the last edition of the International Classification of Headache Disorders (ICHD-II), menstrual migraine gained new attention in the Appendix, where three clinical patterns were pointed out: pure menstrual migraine without aura; menstrually related migraine without aura and non-menstrual migraine without aura. Menstrual migraine attacks show severe intensity, long duration (lasting even more than 72 h), marked unresponsiveness to pharmacological treatments, and present higher recurrence rate and work-related disability than non-menstrual attacks. The pharmacological treatment of menstrual migraine can require specific cyclic prophylactic approaches (non-steroidal anti-inflammatory drugs, coxibs, magnesium, long half-life triptans or oestrogen supplements in various formulations), but usually the low frequency of attacks suggests a first approach with specific symptomatic drugs. Preference should be given to triptans, due to their specificity in controlling migraine pain and its accompanying symptomatology; among them, in particular for sumatriptan, many specific studies proved a real effectiveness in the management of acute menstrual migraine attack.
Allais
G
G
Woman's Headache Center, Department of Gynecology and Obstetrics, University of Turin, Via Ventimiglia 3, I-10126 Turin, Italy. gb.allais@tiscali.it
Benedetto
C
C
D005260:Female; D006801:Humans; D008598:Menstruation / Q000502:physiology*; D008881:Migraine Disorders / Q000145:classification / Q000503:physiopathology / Q000628:therapy*; D020326:Migraine without Aura / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D018582:Sick Leave; D018170:Sumatriptan / Q000627:therapeutic use
D017366:Serotonin Receptor Agonists; D018170:Sumatriptan