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

Because of its pathophysiological and clinical peculiarities, true menstrual migraine (MM) (i.e. migraine starting exclusively between the days immediately before and immediately after the first day of the menstrual cycle) requires an ad hoc management different from that of other migraines. The paucity of well-conducted, controlled clinical trials and the lack of a universally accepted definition of MM have meant that the treatment of MM is still largely empirical. In our clinical practice, we adopt a sequential therapeutic approach, including the following steps: (i) acute attack drugs (sumatriptan, ergot derivatives, NSAIDs); (ii) intermittent prophylaxis with ergot derivatives or NSAIDs; (iii) oestrogen supplementation with percutaneous or transdermal oestradiol (100 microg patches); (iv) antioestrogen agents (danazol, tamoxifen).
Cephalalgia 1997 Dec
PMID:Treatment of menstrual migraine. 949 77

We investigated the threshold of the platelet release reaction during the luteal phase of the cycle in 46 patients suffering from menstrual migraine (MM) and 27 healthy normal women. The distribution in both groups of the three types of aggregometric curves (types 1, 2 or 3) obtained in response to ADP 1 microM as aggregating agent was evaluated. Among MM sufferers, 19 (41%) showed a type 1 curve, while 14 (31%) had a type 2 curve and 13 (28%) showed an irreversible aggregation with a type 3 pattern. Curve distribution in controls was 18 (67%) for type 1, 8 (30%) for type 2 and 1 (3%) for type 3. A significantly (p < 0.05) different distribution of the three curve types between MM and controls was present, suggesting that a secondary wave of aggregation is more frequent in MM; the highest difference was due to the observed frequencies of type 3 curves.
Cephalalgia 1997 Dec
PMID:Patterns of platelet aggregation in menstrual migraine. 949 78

Headaches associated with menstruation are often resistant to abortive and preventative medications. We performed an open-label study in 20 female migraineurs, employing oral sumatriptan perimenstrually as short-term prophylaxis of menstrual migraine. In 126 sumatriptan-treated cycles, headache was absent in 52.4% and reduced in severity by 50% or greater in 42%. Breakthrough headaches were rare and significantly reduced in severity compared with baseline headaches.
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PMID:A pilot study of oral sumatriptan as intermittent prophylaxis of menstruation-related migraine. 1021 73

Menstrual migraine may be debilitating, long-lasting, and refractory to treatment. Because the efficacy and tolerability of abortive and prophylactic treatment options for menstrual migraine have generally not been evaluated in controlled clinical trials, treatment choices are often made on the basis of personal experience and anecdotal reports. This article reviews evidence from retrospective analyses and prospective studies showing that sumatriptan injection and tablets are effective and well tolerated in menstrual migraine. (1) Sumatriptan injection 6 mg was as effective in the treatment of menstrual migraine attacks as it was for nonmenstrual attacks in a retrospective analysis of data from two randomized, double-blind, placebo-controlled, parallel-group trials (n = 1104). In the menstrual migraine group, 80% of women treated with sumatriptan injection 6 mg compared with 19% of placebo-treated patients reported headache relief 1 h postdose (p < 0.001). (2) Sumatriptan injection 6 mg was effective in the acute treatment of menstrual migraine attacks in a prospective, double-blind, placebo-controlled, parallel-group, two-attack study (n = 226). Across the two attacks, 70-71% of patients treating menstrual migraine attacks with sumatriptan injection 6 mg compared with 22-24% of placebo-treated patients reported headache relief 1 h postdose (p < 0.001). (3) Sumatriptan tablets 100 mg were effective in the acute treatment of menstrual migraine attacks in a prospective, double-blind, placebo-controlled, crossover study in women diagnosed with menstrual migraine (n = 115). For menstrual migraine attacks, headache relief 4 h postdose was reported by 67% of sumatriptan-treated patients compared with 33% of placebo-treated patients. Sumatriptan injection and tablets were generally well tolerated in these studies, in which adverse events were characteristic of those typically observed in sumatriptan acute migraine clinical trials. These data demonstrate that sumatriptan injection and tablets are effective and well tolerated in the treatment of menstrual migraine.
Cephalalgia 1999 Jan
PMID:Sumatriptan is effective in the treatment of menstrual migraine: a review of prospective studies and retrospective analyses. 1009 54

We conducted an investigation of migraine headache in a general population of Mexican-Americans living in San Diego county. Specific headache triggers were reported and analyzed, the most frequently reported for females with migraine being missing meals (58.9%), weather changes (54.4%), menstruation (53.6%), post-crisis letdown (52.7%), and fatigue (51.8%). The most frequently reported trigger factors for migraines reported by males were fatigue (58.8%), sleep (as a precipitating factor) (56.3%), post-crisis letdown (41.2%), and weather changes (37.5%). Trigger factors were further evaluated using stratification by presence or absence of Raynaud's phenomenon (RP), menstrual migraine, family history of migraine, and by migraine type. Odds ratios and 95% confidence intervals were calculated. These results suggest that subjects with migraine and RP (perhaps indicative of a systematic vascular tone disorder) and those with menstrual migraine (indicative of sensitivity to hormonal changes) may overall be more sensitive to certain environmental stimuli, particularly those involving change in the internal environment.
Cephalalgia 1995 Dec
PMID:Migraine trigger factors in non-clinical Mexican-American population in San Diego county: implications for etiology. 1035 2

This document presents the primary care diagnosis and management of headache in women. The varying patterns of chronic headache among females during their reproductive years are related to the changing hormonal levels. Migraine occurs in 25% and tension-type of headache occurs in 88% of women. These changes occur during menarche, menstrual cycling, oral contraceptive use, pregnancy and menopause as a result of the changes in sex steroid levels. The physiological relationship between estradiol and other neurotransmitters that causes headache is described. Diagnosis of headache includes physical and neurologic examinations. Treatment of headache depends on the woman's reproductive stage. Acute-care headache treatments include analgesics, opioids, ergotamines, and the triptans for 2-3 days a week. Chronic or tension-type headaches require preventive therapy, which includes the daily use of antidepressants, beta-blockers, calcium channel blockers, and antiepilepsy medications. Menstrual migraine medication includes serotonin and prostaglandin active agents during chronic headaches and beta-blockers, antidepressants, calcium channel blockers or valproic acid. Nonpharmacologic treatment of headache is preferred for pregnant women.
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PMID:Focus on primary care diagnosis and management of headache in women. 1035 52

The normal female life cycle is associated with a number of hormonal milestones: menarche, pregnancy, contraceptive use, menopause, and the use of replacement sex hormones. All these events and interventions alter the levels and cycling of sex hormones and may cause a change in the prevalence or intensity of headache. The menstrual cycle is the result of a carefully orchestrated sequence of interactions among the hypothalamus, pituitary, ovary, and endometrium, with the sex hormones acting as modulators and effectors at each level. Estrogen and progestins have potent effects on central serotonergic and opioid neurons, modulating both neuronal activity and receptor density. The primary trigger of menstrual migraine appears to be the withdrawal of estrogen rather than the maintenance of sustained high or low estrogen levels. However, changes in the sustained estrogen levels with pregnancy (increased) and menopause (decreased) appear to affect headaches. Headaches that occur with premenstrual syndrome appear to be centrally generated, involving the inherent rhythm of CNS neurons, including perhaps the serotonergic pain-modulating systems.
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PMID:Sex hormones and headache 1999 (menstrual migraine). 1048 7

Migraines may occur at any time during the menstrual cycle but are commonly associated with the menses. Migraine-specific medications, such as the triptans, may be effective for acute management of menstrual migraine. However, it is important to recognize the relationship between migraines and the menstrual cycle because these headaches may not respond to the usual antimigraine medications. In that case, management may involve perimenstrual migraine prophylaxis, with migraine-specific medications used in addition for severe breakthrough migraines. Prostaglandin inhibitors started just before the time of headache vulnerability may prevent menstrual migraine attacks or reduce the severity of the headaches. Estrogen withdrawal has been shown to precipitate migraine headaches, and a sustained elevated level of estrogen will postpone the migraine. Transdermal estrogen started just before menstruation can provide a sustained low level of estrogen, decreasing the degree of estrogen decline, and thus may prevent induction of migraines. Ergotamine tartrate is usually taken only for acute migraine, but may also be effective for prevention of menstrual migraine when used regularly once or twice per day during the time of risk. By understanding the underlying pathophysiology of the relationship between migraines and the menstrual cycle, the physician can successfully treat migraines associated with menses.
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PMID:Management of menstrual migraine. 1048 8

Migraine in women is influenced by hormonal changes throughout the life cycle: menarche, menstruation, oral contraceptive use, pregnancy, menopause, and hormonal replacement therapy (HRT). Based on clinical experience, the frequency of menstrual migraine has been reported to be as high as 60%-70%. Most women have increased headache and migraine attacks (usually without aura) at the time of menses. Attacks occurring only with menstruation, even if infrequent, are called true menstrual migraine. Attacks occurring both at menstruation and at other times of the month could be called "menstrually triggered migraine." Menstrual migraine occurs at the time of the greatest fluctuation in estrogen levels. Estrogen withdrawal is probably the trigger for migraine attacks in susceptible women. Drugs that are proven effective or commonly used for the acute treatment of menstrual migraine include nonsteroidal anti-inflammatory drugs (NSAIDs), dihydroergotamine, the triptans, and the combination of aspirin, acetaminophen, and caffeine. The goal of standard continuous preventive therapy is to reduce the frequency, duration, and intensity of attacks. Preventive therapy may eliminate all headaches except those associated with menses. Women already using prophylactic medication who continue to have menstrual migraine can increase the dose of their medication prior to their menses. Women who do not use preventive medicine or have migraine exclusively with their menses can be treated perimenstrually with short-term prophylaxis. If severe menstrual migraine cannot be controlled by acute and preventive treatment, hormonal therapy may be indicated.
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PMID:Menstrual migraine. 1053 94

The therapeutic effect of mefenamic acid, prostaglandin synthesis inhibitor, on pain of acute menstrual migraine and at the following days during menstrual bleeding period was studied and compared with placebo. 24 patients, 18 to 35 years old, with menstrual migraine were entered for study. They had regular menstrual cycles and they had been diagnosed as experiencing menstrual migraine without aura for more than one year. The patients were treated for 2 consecutive menstrual cycles, one cycle with 500 mg mefenamic acid and one cycle with placebo. Each drug was given at beginning of complaint and similar dose was repeated 8 hourly at following days during the menstrual bleeding period (Total dosage used 1500 mg per day). The use of medication was double blind. Pain intensity was rated by means of a 4 points scale and functional disability was rated from 0 to 3. Results showed that 79.16% of the patients showed significant pain relief with mefenamic acid as compared to 16.6% with placebo. The mean pain score of the mefenamic acid treated attacks decreased significantly from 2.46 +/- 0.5 to 0.62 +/- 1.0 at 2hr postdose. 83.3% of patients treated with mefenamic acid was able to function with or without little effort whereas 12.4% restored their activities with placebo. All the patients (100%) who showed significant initial responses to placebo experienced headache recurrence as compared to 26.3% with mefenamic acid. When considering mean pain scores, percentage of patients with pain free at 2h postdose, percentage of patients required rescue treatment, percentage of patients with headache recurrence and percentages of patients restored full activities, mefenamic acid is significantly superior to placebo in treatment of acute menstrual migraine. It might be concluded that mefenamic acid is safe and effective for treatment of acute menstrual migraine.
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PMID:Treatment of menstrual migraine with prostaglandin synthesis inhibitor mefenamic acid: double-blind study with placebo. 1079 53


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