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Review
. 2021 May 24;10(11):2263.
doi: 10.3390/jcm10112263.

Acute and Preventive Management of Migraine during Menstruation and Menopause

Raffaele Ornello  1 , Eleonora De Matteis  1 , Chiara Di Felice  1 , Valeria Caponnetto  1 , Francesca Pistoia  1 , Simona Sacco  1
Affiliations
Review

Acute and Preventive Management of Migraine during Menstruation and Menopause

Raffaele Ornello et al. J Clin Med. .

Abstract

Migraine course is influenced by female reproductive milestones, including menstruation and perimenopause; menstrual migraine (MM) represents a distinct clinical entity. Increased susceptibility to migraine during menstruation and in perimenopause is probably due to fluctuations in estrogen levels. The present review provides suggestions for the treatment of MM and perimenopausal migraine. MM is characterized by long, severe, and poorly treatable headaches, for which the use of long-acting triptans and/or combined treatment with triptans and common analgesics is advisable. Short-term prophylaxis with triptans and/or estrogen treatment is another viable option in women with regular menstrual cycles or treated with combined hormonal contraceptives; conventional prevention may also be considered depending on the attack-related disability and the presence of attacks unrelated to menstruation. In women with perimenopausal migraine, hormonal treatments should aim at avoiding estrogen fluctuations. Future research on migraine treatments will benefit from the ascertainment of the interplay between female sex hormones and the mechanisms of migraine pathogenesis, including the calcitonin gene-related peptide pathway.

Keywords: hormonal treatments; menopause; menstruation; migraine; migraine treatment; triptans.

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Conflict of interest statement

S.S. reports personal fees from Allergan-Abbvie, AstraZeneca, Abbott, Eli Lilly Teva and Novo Nordisk, and grants from Novartis. R.O. reports personal fees from Novartis, Eli Lilly, Teva, and non-financial support from Allergan. No other disclosures were reported.

Figures

Figure 1
Figure 1
Female sex hormones and pathogenesis of menstrual migraine.
Figure 2
Figure 2
Example of headache diary of patient with pure menstrual and menstrual-related migraine. The Xs represent headache days; Ms represent reported menstruation days.
Figure 3
Figure 3
Graphical representation of the menstrual and perimenopausal periods of increased susceptibility to migraine and women’s quality of life impairment. The panels on the left indicate the levels of female sex hormones during the menstrual cycle (above) and the years of women’s life (below). The graph on the right shows the proportion of women reporting impairment of daily activities due to menstrual-related migraine (blue columns) compared with other headaches (orange columns; data from [19]).
Figure 4
Figure 4
Suggestions for the treatment of menstrual migraine in clinical practice.
Figure 5
Figure 5
Suggestions for the treatment of perimenopausal migraine in clinical practice.
See this image and copyright information in PMC

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