Characteristics of menstrual
migraine, which include functional disability, increased
headache severity, and lack of
aura, are often overlooked, and therefore menstrual
migraine is often underdiagnosed. Use of a 3-month diary to record
migraine patterns can reveal the predictable patterns associated with menstrual
migraine, and a diary is demonstrated to be a useful tool in diagnosis. Optimal treatment of menstrual
migraine takes advantage of the predictability of the disorder. Treatment alternatives for menstrual
migraine include acute
therapy and short- or long-term preventive
therapies. Acute
therapy is given shortly after the
migraine begins. Short-term preventive
therapies are effective when administered during the time that menstrual
migraine is most likely to occur; the treatment window is typically 2 days prior up to 3 days after the onset of menstruation. Providing
triptans, nonsteroidal anti-inflammatory drugs, or
estrogen supplements (gel or patches) during this window has been demonstrated to provide effective protection during the days when patients are at greatest risk for menstrual
migraine. Alternatively, long-term preventive
therapy may be required for recurrent
headaches in patients with concomitant medical conditions for whom
migraine therapy could serve a dual purpose.
CONCLUSION: By recognizing the patterns associated with menstrual
migraine, prompt, acute, or preventive
therapy can be used to effectively manage the disorder and reduce its related disability.