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.