Menstrual migraine: clinical and therapeutical aspects.
Estrogens fluctuations, particularly their premenstrual fall, are currently regarded as the main triggers of menstrual migraine (MM). MM presents in two clinical forms: pure MM, where attacks are confined to the perimenstrual period (PMP), and menstrually related migraine, where attacks always occur during, but are not confined to, the PMP. MM episodes are usually longer, more intense, more disabling and more refractory than nonmenstrual attacks. Acute management of MM should initially be abortive and primarily sought with triptans. If this fails, short-term perimenstrual prophylaxis with NSAIDs, coxibs, triptans or ergotamine derivatives can be considered. Hormone manipulations, mainly application of percutaneous estradiol gel in PMP or administration of oral contraceptives in extended cycles, constitute an alternative approach for nonresponders.
Allais
Gianni
G
University of Turin, Women's Headache Center, Department of Gynecology & Obstetrics, Via Ventimiglia 3, I-10126 Turin, Italy. gb.allais@tiscali.it
Castagnoli Gabellari
Ilaria
I
De Lorenzo
Cristina
C
Mana
Ornella
O
Benedetto
Chiara
C
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use*; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D008598:Menstruation / Q000187:drug effects*; D008881:Migraine Disorders / Q000188:drug therapy* / Q000209:etiology; D011293:Premenstrual Syndrome / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D014363:Tryptamines / Q000627:therapeutic use*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D003278:Contraceptives, Oral, Hormonal; D014363:Tryptamines