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

Migraine commonly affects adolescents, and menstrual migraine often begins in young girls. If undiagnosed or ineffectively treated, migraine can lead to disability, school absenteeism, emotional or social difficulties, and chronification of headache. Thus, recognizing and accurately diagnosing migraine and menstrual migraine, developing effective treatment strategies (both pharmacologic and nonpharmacologic), and educating both the adolescent and her parents are important in order to minimize the potential early disability of this disorder and limit the otherwise likely progression of migraine to a disabling disorder of adulthood.
Curr Pain Headache Rep 2008 Oct
PMID:Adolescent issues in migraine: a focus on menstrual migraine. 1876 46

Hormonal and nonhormonal factors play a role in the pathophysiology of menstrual migraine, but estrogen withdrawal appears to be the most potent of these factors. It is postulated that estrogen withdrawal directly enhances excitability of trigeminal afferents, modulates the synthesis of neuropeptides, activates/deactivates specific neurotransmitter systems, and influences the function of microglia. These changes could activate and/or sensitize the trigeminal system and increase the likelihood of migraine headache during perimenstrual time periods. Three new theories are advanced in this article to explain the pathophysiology of menstrual migraine. Only through an understanding of the mechanisms involved in menstrual migraine can we gain insight into the management of this severe and debilitating form of migraine headache.
Curr Pain Headache Rep 2008 Dec
PMID:New theories in the pathogenesis of menstrual migraine. 1897 40

The risk of migraine is increased among women during a 5-day perimenstrual window that starts 2 days before the onset of menses and continues through the first 3 days of menstruation. For some women with menstrual migraine, headaches that occur at this time are more severe, of longer duration, and more disabling. Although it is recognized that menstrual migraine requires specific management, there remain a number of unmet needs. In particular, comorbidity can result in women with menstrual migraine presenting to obstetrician/gynecologists or psychiatrists rather than primary care physicians or neurologists. Failure to diagnose menstrual migraine will lead to suboptimal management. Accurate diagnosis is insufficient unless it results in effective treatment strategies. Although effective and specific treatments for menstrual migraine have been developed, there is a need to define individual timing and duration of perimenstrual prophylaxis.
Curr Pain Headache Rep 2008 Dec
PMID:Perimenstrual headaches: unmet needs. 1897 42

Migraine is frequently associated with menstruation in female migraineurs, and consequently it is commonly referred to as menstrually associated migraine. The trigger thought to be partially responsible for menstrually associated migraine is a significant drop in circulating estrogen that is noted during 2-3 days prior to onset of menses. It is estimated that approximately 50% of women have an increased risk of experiencing migraine during the premenstrual phase of decreasing estrogen levels. Understanding the biological basis of migraine associated with menses will facilitate an accurate diagnosis and help patients recognize time susceptible to migraine exacerbations. This paper will review the biological bases for the hormonal changes that occur during the menstrual cycle and review the prevalence and burden of menstrual migraine among female headache sufferers.
Headache
PMID:Epidemiology and biology of menstrual migraine. 1907 58

Women presenting with recurrent disabling headache frequently have migraine; but physicians need to rule out other headache disorders before they reach a diagnosis of migraine with or without aura. Many women who experience migraine in close association to their menstrual cycle may meet the diagnostic criteria for either menstrually related migraine (MRM), or pure menstrual migraine (PMM). Once an accurate diagnosis is made, treatment may be established to best suit the individual needs of that patient. Most women will find that migraine associated with hormone fluctuations respond well to standard treatment approaches including pharmacological and nonpharmacological treatments. Pharmacological approaches include acute, preventive, and short-term prophylaxis. Herein we review the difference between non-menstrual migraine, PMM, and MRM and identify effective treatment strategies for appropriate management of migraine associated with hormonal fluctuations.
Headache
PMID:Diagnosis and treatment of the menstrual migraine patient. 1907 57

This paper presents 2 case scenarios that illustrate the complexity of diagnosing and managing migraine associated with hormonal changes. Migraine is commonly associated with comorbidies such as depression, anxiety, obesity, cardiovascular disease, as well as other conditions, thereby making management more challenging for the physician and the patient. The first case is a 35-year-old woman who has migraine almost exclusively during menstruation. She is under a physician's care for long-term management of premenstrual dysphoric disorder (PMDD). Achieving a differential diagnosis of pure menstrual migraine is illustrated, and a detailed treatment plan including use of a migraine miniprophylaxis protocol, management of her PMDD, and prescription of acute treatment medications is reviewed. The second case scenario describes the diagnosis of menstrually associated migraine in a woman who suffers from a frequent disabling migraine along with work-related anxiety and depression. This paper reviews her differential diagnosis, laboratory testing, treatment plan, including management of her comorbid anxiety and depressive symptoms.
Headache
PMID:Menstrual migraine: case studies of women with estrogen-related headaches. 1907 59

Menstrual migraine (MM) is either pure, if attacks are limited solely during the perimenstrual window (PMW), or menstrually related (MRM), if two of three PMWs are associated with attacks with additional migraine events outside the PMW. Acute migraine specific therapy is equally effective in MM and non-MM. Although the International Classification of Headache Disorders-II classifies MM without aura, data suggest this needs revision. The studies on extended-cycle oral contraceptives suggest benefits for headache-prone individuals. Triptan mini-prophylaxis outcomes are positive, but a conclusion of "minimal net benefit compared to placebo" is not entirely unwarranted. In a 2008 evidence-based review, grade B recommendations exist for sumatriptan (50 and 100 mg), mefenamic acid (500 mg), and riza-triptan (10 mg) for the acute treatment of MRM. For the preventive mini-prophylactic treatment of MRM, grade B recommendations are provided for transcutaneous estrogen (1.5 mg), frovatriptan (2.5 mg twice daily), and naratriptan (1 mg twice daily).
Curr Pain Headache Rep 2009 Feb
PMID:Clinical aspects of perimenstrual headaches. 1912 76

At least half of women migraineurs experience menstrual migraine (MM), suggesting a hormonal explanation for the incidence of these headaches. Basic science efforts suggest a relationship between estrogen and the neurotransmitters and neuronal structures critical in the pathophysiology of migraine. The notion that MM is more severe, longer in duration, and more resistant to treatment than headaches occurring at other times during the menstrual cycle may apply more to women seeking treatment for their headaches than to migraineurs in the general population. Triptans have been shown to be effective as both an abortive and short-term preventive treatment, and estradiol has been shown to be an effective short-term preventive treatment. Ergotamines, combinations of drugs such as sumatriptan-naproxen sodium, and rizatriptan with dexamethasone show promise in the treatment of MM.
Curr Pain Headache Rep 2009 Feb
PMID:Perimenstrual headache: treatment options. 1912 77

Clinical, genetic and pharmacological evidences suggest an abnormality of the dopaminergic system in the pathogenesis of migraine. Direct evidence of an abnormal metabolism of dopamine in migraine, however, is lacking. Platelets are a useful model to understand brain dopaminergic mechanisms. The present study has been undertaken to study the status of platelet dopamine receptor binding by carrying out radioligand receptor binding assay. Binding of (3)H-spiperone to platelet membranes, known to label dopamine (DA)-D2 receptors, was conducted in 20 patients with migraine and an equal number of healthy controls. The equilibrium dissociation constant (Kd) in patients with migraine (1.71 +/- 0.19 nM) was found to be significantly lower (P < 0.001) as compared with controls (3.14 +/- 0.33 nM). However, no significant change was observed in the maximal number of binding sites (Bmax) in patients with migraine. No relationship of Kd with type of migraine, presence of vomiting, family history, frequency of attack, duration of illness and menstrual migraine was observed. The findings of the present study provide support for the involvement of the dopaminergic system in migraine.
Cephalalgia 2009 May
PMID:Platelet dopamine: D2 receptor binding in patients with migraine. 1917 Jun 95

To evaluate brainstem excitability in menstrual migraine (MM) patients and compare the electrophysiological parameters of the trigeminocervical reflex (TCR) during the perimenstrual (headache period) and follicular (headache-free) periods with those in healthy controls. Thirty-one patients with MM and 22 volunteer age- and sex-matched healthy women were included in the study. The TCR was studied bilaterally with stimulation of the supraorbital branch of the trigeminal nerve during the perimenstrual period and follicular phase. The electrophysiological parameters of the TCR were compared between MM patients and controls. In controls, there was no statistically significant difference in the mean reflex latencies recorded during the perimenstrual and follicular phases (P > 0.05). In MM patients, the mean reflex latencies recorded during the perimenstrual (headache period) and follicular phase (headache-free) periods were significantly different from each other and from those in controls. The latencies of MM patients during the follicular (headache-free) period were significantly longer than those of controls. Brainstem excitability differed significantly between the perimenstrual (headache period) and follicular phase (headache-free) periods in MM. Furthermore, trigeminal excitability in MM patients was significantly different from that in healthy controls in both phases of the menstrual period.
J Headache Pain 2009 Aug
PMID:Altered trigeminal system excitability in menstrual migraine patients. 1949 32


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