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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Headaches appear to be a reaction to changes in either exogenous or endogenous levels. We are now investigating serum immunoglobulins in women with menstrual migraine and have found that in 22 women, 6 have low immunoglobulin A levels, all below the normal range, and 5 have high immunoglobulin M levels, above the normal range. The hereditary aspect of migraine may depend on inheriting a particular immune pattern which might cause a special sensitivity to hormone effects on blood vessels. This might account for the suppression of menstrual migraine by cortisone or large doses of progesterone. Deficiency of progesterone is unlikely to be responsible for the premenstrual syndrome as the week following menstruation is usually the time which is most often free from symptoms and at this part of the cycle there are very low levels of progesterone. The most reactive women are also the most sensitive to the side effects of drugs or hormones given to treat migraine, which makes the treatment of migraine difficult.
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PMID:[The influence of hormones on headaches in women and the associated endometrial patterns (author's transl)]. 81 Jun 82

Headaches appear to be a reaction to changes in either exogenous levels. We are now investigating serum immunoglobulins in women with menstrual migraine and have found that in 22 women, 6 have low immunoglobulin A levels, all below the normal range, and 5 have high immunoglobulin M levels, above the normal range. The hereditary aspect of migraine may depend on inheriting a particular immune pattern which might cause a special sensitivity to hormone effects on blood vessels. This might account for the suppression of menstrual migraine by cortisone or large doses of progesterone. Deficiency of progesterone is unlikely to be responsible for the premenstrual syndrome as the week following menstruation is usually the time which is most often free from symptoms and at this part of the cycle there are very low levels of progesterone. The most reactive women are also the most sensitive to the side effects of drugs or hormones given to treat migraine, which makes the treatment of migraine difficult.
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PMID:[Effect of hormones on headaches in women and the associated endometrial patterns]. 94 20

Prophylaxis of menstrual migraine was attempted in five women, using estradiol implants. The treatment was successful in suppressing ovulation and in producing high, although fluctuating, levels of estradiol in the plasma. Clinically this was associated with severe menstrual disturbance. The regular periodicity of the headaches was lost, but clinical benefit was unpredictable, with some patients actually experiencing more headaches than before the treatment. The administration of progesterone against a background of prolonged exposure to high estrogen levels did not provoke migraine, nor in any case did its subsequent withdrawal result in migraine. These findings cast further doubt on the importance of progesterone withdrawal in the etiology of menstrual migraine.
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PMID:Estrogen-withdrawal migraine. II. Attempted prophylaxis by continuous estradiol administration. 116 31

Sumatriptan is a highly selective 5 HT1 receptor subtype agonist. The efficacy and safety profiles of sumatriptan given by tablet or subcutaneous injection have been extensively investigated in the acute treatment of migraine attacks, where it has proved effective and well tolerated. A substantial proportion of patients with an acute attack of migraine suffer from once or more gastrointestinal symptom, including nausea, vomiting and occasionally diarrhoea. The presence of these symptoms may make the oral administration of acute treatments unsatisfactory. Subcutaneous administration is an alternative, but fear or dislike of injections or an inability to self inject makes subcutaneous treatment unacceptable to some patients. Alternative routes of administration are being investigated to overcome these difficulties including intranasal sprays and rectal suppositories. For those patients who experience difficulties swallowing whole tablets, an effervescent tablet is under development. Recent data have demonstrated that sumatriptan offers effective relief of cluster headache attacks, a condition where suffers experience repeated severe headache attacks, of short duration, during a cluster period. Further new indications are being investigated including the treatment of menstrual migraine, paediatric migraine and other headaches.
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PMID:[Sumatriptan--future development, alternative features and potential new indications]. 133 67

Fourteen female volunteers who met diagnostic criteria for migraine headache monitored their headache activity and menstrual distress symptoms for one menstrual cycle. Serum estradiol and progesterone levels, and menstrual distress measures were collected at four points of the menstrual cycle: menstrual, ovulatory, luteal and premenstrual. Results indicated that one patient (7.1%) had menstrual migraine, 10 patients (71.4%) had menstrually-related headache and 3 (21.4%) had migraine headache unrelated to their menstrual cycle: subsequent analyses were conducted with the first two groups. Headache activity for the sample was highest during the premenstrual phase. Headache activity during the luteal and premenstrual phases was related to luteal phase progesterone levels. Menstrual distress was highest during the menstrual and premenstrual phases of the cycle, and these symptoms were related to higher estradiol levels, higher estradiol/progesterone ratios, and increased headache activity. These results indicated that for women with menstrual migraine or menstrually-related migraine, luteal progesterone and estradiol and the estradiol/progesterone ratio may be significantly related to menstrual distress during the premenstrual phase of the cycle. The estradiol/progesterone ratio was not more related to headache or menstrual distress than either of these ovarian hormones alone. Suggestions for future research in this area are offered.
Headache 1992 Jun
PMID:The relationship of ovarian steroids, headache activity and menstrual distress: a pilot study with female migraineurs. 139 54

The purpose of the present study was the evaluation of the excitability threshold and the central motor conduction time (CCT) studied by means of electromagnetic cortical stimulation in ten subjects affected by menstrual migraine without aura, both in the ictal and the interictal period. The patients were chosen from among a group of 254 outpatients affected by migraine, diagnosed according to the International Headache Society criteria. The control group consisted of ten healthy female subjects. As far as CCTs were concerned no differences emerged between patients and controls. However in the patient group we found a significant increase in the excitability threshold values, both in the ictal and the interictal period, and in both hemispheres. If confirmed, the increased excitability threshold may be a useful neurophysiological correlate of migraine without aura.
Headache 1992 Jul
PMID:Menstrual migraine without aura: cortical excitability to magnetic stimulation. 152 65

Pharmacotherapy is the mainstay for patients with persistent headaches. When simple analgesics can no longer be used, combination analgesics are prescribed. Symptomatic medications also include antiemetics, ergot derivatives, corticosteroids, neuroleptics, and narcotics. Nonsteroidal anti-inflammatory drugs are commonly used both symptomatically and prophylactically, and are the treatment of choice for menstrual migraine. Exertional migraine, benign orgasmic cephalalgia, chronic paroxysmal hemicrania, cough headache, and "ice-pick" headache are treated with indomethacin. Ergotamine tartrate is often recommended when simple or combination analgesics do not relieve headaches. Dihydroergotamine (DHE) is effective for treating intractable headache; because it has fewer side effects than ergotamine, it is tolerated by patients unable to tolerate other ergotamine preparations. DHE is administered IM and, for occasional use, patients can be taught self-injection. Repetitive IV DHE therapy for chronic severe headaches requires hospitalization; most patients become headache-free within 3 days. Patients who refuse hospitalization, do not respond to the drug, or are not suitable candidates for DHE therapy may receive a short course of a corticosteroid, a neuroleptic or, rarely, a narcotic. For frequent headaches, prophylactic treatment usually begins with a tricyclic antidepressant or a beta blocker.
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PMID:Symptomatic and prophylactic treatment of migraine and tension-type headache. 155 87

Women tend to suffer more often from migraine than men (19% vs. 9%). Further menstruation is associated with attacks in 60% of women who have migraine. Moreover 14% of women with migraine suffer from attacks only with menses. Migraine may be linked to late luteal phase dysphoric disorder and dysmenorrhea. these conditions occur when the greatest fluctuation of estrogen levels occur. These fluctuations indeed cause prostaglandin levels to rise, prolactin release to intensify, and central nervous system opioid dysregulation to occur. In fact, several studies show that decreasing levels of estrogen activate menstrual migraine. Further estrogens and progesterone trigger synthesis of endometrial prostaglandins. In fact, prostaglandins regulate descending norepinephrine pain control systems in the brain, thus increased levels of prostaglandins decreases the pain threshold. In addition, falling levels of estrogens produce dopamine receptor hypersensitivity. Dopamine antagonists cause increased prolactin release throughout the luteal phase in all women and during the entire menstrual cycle in women with menstrual migraine. Physicians can treat menstrual migraine with various nonsteroidal antiinflammatory drugs, simple or combination analgesics, ergotamine, or hormonal therapy when other treatments fail. They should be aware that diuretics and pyridoxine are ineffective in treating menstrual migraine. Several replacement therapies to treat menopausal women with migraine exist. these include adding androgens, reducing estrogen dosage, converting to continuous dosing, and converting to parenteral dosing. Some data show an increase in or severity of migraine among oral contraceptive (OC) users, but other studies find no difference in headache among OC and placebo users. In fact, OCs may exacerbate, improve, or not change the frequency or severity of headaches.
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PMID:The role of sex hormones in headache. 155 90

In order to evaluate the effect of non-pharmacological treatment on menstrual and non-menstrual migraine headache (HA), 2 studies have been conducted. In Study 1 which was a retrospective examination of between group reactions to non-drug treatments, 37 self-defined menstrual migraineurs and 62 non-menstrual migraineurs showed comparable overall improvement (reduction in HA activity) after treatment, but menstrual migraineurs maintained larger usage of medication across time than non-menstrual migraineurs. In Study 2 which was a prospective examination of within subject reactions to non-drug treatments, 15 carefully documented menstrual migraineurs again showed comparable levels of overall improvement but also showed that level of menstrual headache activity remained higher across time than non-menstrual migraine HA. Because there were no interactions of time and type of migraine in either study, these results raise some questions about the existence of differential effectiveness of non-pharmacological treatment of menstrual vs non-menstrual migraine.
Headache 1992 Apr
PMID:Two studies of the non-pharmacological treatment of menstrually-related migraine headaches. 158 40

Migraine occurring at menstruation is frequently difficult to treat. A 38-year-old woman with exceptionally severe menstrual migraine was treated by temporary ovarian suppression using Zoladex, a long acting luteinizing hormone-releasing hormone agonist. There was prompt relief of headache, and after several months of treatment the patient elected to undergo surgical oophorectomy with subsequent resolution of her migraine. A trial of reversible hypogonadism using an LHRH agonist may thus be helpful in predicting the result of surgical castration in this situation.
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PMID:Treatment of a patient with severe menstrual migraine using the depot LHRH analogue Zoladex. 183 50


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