Perimenstrual migraines: are they different from migraines in general?
Differences between menstrually related migraine (MRM) and non-MRM are subtle. Preconception that population-based trials do not show differences, but that clinic-based trials showed severe, longer, and clinically refractory menstrual migraines, turns out to be simplistic. This review examines studies comparing and contrasting MRM and non-MRM. All of the pertinent studies show increase of migraine around menses. A judicious reading of the studies suggests that MRM is probably more severe in pain intensity than non-MRM. MRM is more disabling than non-MRM. MRM in clinics is more likely to have both worse prodrome and nausea. A significant subset of MRM patients has poorer response to acute medication. Overall, it appears that MRM is more severe than non-MRM when considering population- and clinic-based studies, with slightly but clinically meaningfully worse intensity, duration, disability, prodrome, nausea, and response to acute medications. Clinicians must have compassion and skill to manage patients with MRM.
Tepper
Stewart J
SJ
Center for Headache and Pain, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. sjtepper@aol.com
D002986:Clinical Trials as Topic / Q000379:methods; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000502:physiology*; D008881:Migraine Disorders / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology*; D011293:Premenstrual Syndrome / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology*