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Menstrual migraine is an important condition in which women experience regular migraine around the time of their period. This is defined as migraine attacks that occur within a 5-day window starting 2 days before the first day of menstruation through to the third day of bleeding.1 Recognizing menstrual migraine is important for management. Research has shown that migraine attacks that happen near the menstrual period are more severe, last longer, and are less responsive to treatment than attacks that happen at other times.2 Little is known about whether perimenstrual migraine attacks are more troublesome for women who have not received a specific diagnosis of menstrual migraine. The study by van Casteren et al.3 compared perimenstrual migraine attacks with migraine attacks occurring at other times of the cycle. This study examines whether differences between perimenstrual and nonperimenstrual attacks exist in women with and without a specific diagnosis of menstrual migraine.

Introduction. Menstrual migraine attacks are considered more intense, prolonged, and resistant to treatment than non-menstrual ones. Currently, effect of preventive therapy on the course of menstrual-associated migraine has not been well studied; there are isolated studies on the beneficial effect of hormonal therapy on these attacks.The aim of the study was to compare the treatment results in the groups of menstrual-associated and non-menstrual migraine.Materials and methods. This comparative study included 91 patients aged 18 to 48 years (mean age 33,82 ± 8.4) with migraine and menstrual cycle. Depending on the menstrual association of migraine attacks, the patients were divided into 2 groups: group 1 – 54 patients (mean age 36.07 ± 7.37 years) with menstrual-associated migraine (MAM); group 2 – 37 patients (mean age 30.46 ± 8.81 years) with non-menstrual migraine (NMM).Results. Patients with MAM had more migraine days per month, more often received therapy associated with medication-overuse headache (MOH), more often had experience with triptans in comparison with NMM patients. After the treatment, the number of days with migraine per month in the MAM group remained more than in the NMM group: 8 or more days per month were noted in 36.4%, while among NMM patients – 10.8%. The transition to the new therapy with monoclonal antibodies to the CGRP receptor / ligand was positively assessed by 42.9% of MAM patients and 8.1% of NMM patients. Increased duration of hormonal therapy was characterized by a decrease in the number of days with migraines per month (cor = -0,28).Conclusion. In the MAM group, more severe diseases and frequent formation of MOH are observed, as well as a higher resistance to therapy than in NMM. In general, the use of standard therapy regimens for MAM is less effective than for NMM.

Background Menstrual migraine is a special form of migraine with significant impact on quality of life for those women afflicted. Presently, there is no study reported on quality of life in menstrual migraine patients. The study reported here aimed to assess the health-related quality of life and identify its associated factors among Chinese menstrual migraine patients. Methods The cross-sectional study group consisted of 109 patients with menstrual migraine and the control group consisted of 397 female patients with non-menstrual migraine. In total, 506 patients completed questionnaires for demographic and clinical information, Self-rating Idea of Suicide Scale, Hamilton Depression Scale, Hamilton Anxiety Scale, Headache Impact Test-6, Perceived Social Support Scale, Pittsburgh Sleep Quality Index. Health-related quality of life was measured using the 36-Item Short Form Survey. Results Compared with non-menstrual migraine patients, five dimensions of health-related quality of life were all found to be significantly impaired in menstrual migraine patients. Headache frequency (ß=-0.218, P=0.014), the impact of headache on daily life (ß=-0.270, P=0.002), depression symptoms (ß=-0.345, P

The peak prevalence of migraine occurs in women of reproductive age, and women experience a higher burden of migraine symptoms and disability compared to men. This increased burden of migraine in women is related to both developmental and temporally variable activational effects of female sex hormones. Changing levels of female sex hormones affect the expression of migraine during pregnancy, and, to a lesser degree, lactation, and are the mechanism underlying menstrual migraine. This review describes the evidence for sex differences in the expression of migraine across the reproductive epoch; reviews the epidemiology of migraine during pregnancy, lactation, and menses; and summarizes the available evidence for safety and efficacy of acute treatments during pregnancy and lactation and for menstrual migraine. Areas of controversy in treatment of migraine during pregnancy, including the use of magnesium, triptans vs butalbital combination medications, and onabotulinum toxin, are also explored.

In this report, we present the successful treatment of five consecutive cases of premenopausal women suffering from severe menstrual migraine with tokishakuyakusan (TSS). Two patients were complicated by tension‐type headache (TTH), and another patient was by medication overuse headache (MOH). The effects of triptans were limited in all of them. After starting TSS, they showed dramatic improvement in the severity and frequency of their attacks. The patients with TTH and MOH also showed dramatic improvement in their symptoms. TSS could be a promising alternative choice for patients with intractable menstruation–related headaches that are refractory to conventional treatments, including triptans.

We define a migraine trigger to be an endogenous agent or agency such as the menses or an exogenous agent or agency such as red wine or a drop in barometric pressure, and their ability to reduce the threshold of a migraine attack in those predisposed to migraine. This definition excludes agents with idiosyncratic mechanisms that may trigger a migrainous (migraine-like) headache in non-migraineurs such as benign cough headaches or headaches due to altitude-sickness. We also assume as axiomatic that migraine has as its basis the activation of the trigeminovascular pathway (TVP) and the key role of serotonin and the calcitonin gene-related peptide (CGRP). The network activation of the visual/auditory association cortices and the rostrodorsal pons (locus ceruleus and raphe nucleus) are also accepted as key features of activation of the TVP. In addition, we outline the role of the superior salivatory nucleus-sphenopalatine ganglion-greater superficial petrosal nerve (SSN-SPG-GSPN) arc in migraine activation. We also explore how olfactory afferents intermingle with trigeminal nerve collaterals in the glomeruli of the olfactory bulb thus allowing volatile molecules to activate the TVP and induce a migraine. The classification of migraine triggers is complex, as there is a wide panorama of inciting agents, including atmospheric conditions, a wide-ranging variety of foods and beverages, endogenous hormonal influences, synthetic alkaloids and dyes, and volatile molecules (odorants). We will explore the high-frequency migraine-provoking agents in each category. There are exciting and intriguing hypotheses regarding the role of atmospheric chemistry when the barometric pressure drops; the role of hot, dry desert winds and lightning discharges in the generation of cations and the turnover of serotonin in the nervous system. We will explore the effects of a drop in barometric pressure on the vestibular nuclei and the modulation of sympathetically mediated pain. The role of volatile odorants and their activation of the transient receptor potential ankyrin-1 (TRPA-1) receptor will be outlined. We will streamline the highly complex role of estrogen fluctuation in the precipitation of migraine headaches, its pharmacodynamic effects, and the role of the sexually dimorphic nucleus of the preoptic area (SDN-POA) of the hypothalamus. We will also adumbrate the protean effects of alcohol and its congeners and the role of stress and sleep disturbances in the allostatic load model of salience network-pain perception.

Menstrual migraine is a condition in females, where headaches are linked with menstruation and may be debilitating. Hormonal fluctuations could have a key role in migraine etiopathogenesis, as several women experience that their migraine attacks correlate with their menstrual cycle. Estrogen withdrawal appears to have a significant role in migraine associated with menstrual cycles, despite the fact that its pathophysiology is not well known. The treatment method can also vary from that used to treat nonmenstrual migraines. However, with proper identification and management of the condition, it can be bearable. This article highlights some portions of what is known about migraine, its triggers including the experience of a sufferer and aims to provide readers with a better understanding of migraine in women by understanding these aspects of the condition.

Purpose This study sought to determine the prevalence of menstrual migraine among female university students at the Nursing Faculty of Ciudad Real and to determine possible risk factors. Design and methods A cross-sectional observational study was performed using a self-report questionnaire. Two hundred and ninety-nine female university students participated in the study; all were enrolled in the 2017/2018 academic year at the Faculty of Nursing. Participants were over the age of 18 years and without any diagnosed gynecological pathology. The main measurement tools were menstrual migraine between days −2 and +3 of the menstrual cycle, over the previous six cycles. Results The prevalence of menstrual migraine was 45.15%, identifying the following possible risk factors: dysmenorrhea (OR 9.19; 1.62–6.28% CI), use of hormonal contraceptive methods (OR 2.60; 95% CI 1.30–5.20), menstrual irritability (OR 2.34; 95% CI 1.25–4.40), menstrual dizziness (OR 2.05; 95% CI % 1.12–3.75) and daily consumption of cola beverages (OR 1.85; 95% CI % 1.04–3.32). Conclusions The prevalence of this problem is high among our population and the approach is complex. Practice implications: It is necessary to continue to research the pharmacological measures and methods of pharmacological pain relief as well as interventions directed at lifestyle modifications considering the potential risk factors involved in menstrual migraine., Propósito Este estudio pretendía determinar la prevalencia de la migraña menstrual en mujeres universitarias de la Facultad de Enfermería de Ciudad Real y determinar posibles factores de riesgo. Diseño y métodos Se realizó un estudio observacional transversal mediante un cuestionario de autoinforme. Participaron en el estudio 299 mujeres universitarias; todos estaban matriculados en el curso 2017/2018 en la Facultad de Enfermería. Las participantes eran mayores de 18 años y sin ninguna patología ginecológica diagnosticada. Las principales herramientas de medición fueron la migraña menstrual entre los días −2 y +3 del ciclo menstrual, durante los seis ciclos anteriores. Resultados La prevalencia de migraña menstrual fue del 45,15%, identificándose los siguientes posibles factores de riesgo: dismenorrea (OR 9,19; IC 1,62-6,28%), uso de métodos anticonceptivos hormonales (OR 2,60; IC 95% 1,30-5,20), irritabilidad menstrual (OR 2,34 ; IC 95% 1,25-4,40), mareos menstruales (OR 2,05; IC 95% % 1,12-3,75) y consumo diario de refrescos de cola (OR 1,85; IC 95% % 1,04-3,32). Conclusiones La prevalencia de este problema es alta entre nuestra población y el abordaje es complejo. Implicaciones prácticas: es necesario continuar investigando las medidas farmacológicas y los métodos de alivio farmacológico del dolor, así como las intervenciones dirigidas a las modificaciones del estilo de vida considerando los factores de riesgo potenciales involucrados en la migraña menstrual.

Migraine disease is a neurological brain disorder that has been associated with significant disability and socioeconomic burden affecting women three times more commonly than men. Menstrual migraine is a subclass of migraine disease affecting 42–61% of females living with migraine disease. Menstrual migraine is often far more disabling, of longer duration, and more resistant to treatment. It is crucial to gain a deeper understanding of the ongoing biological changes and have a current awareness of the management of this debilitating form of migraine disease to improve the quality of life of these females living with migraine disease. In new treatment options such as devices and with large-scale genome-wide association studies in migraine, genes related to migraine are being identified. This article will review the current literature regarding the pathophysiology, epidemiology, and treatment of menstrual migraine.

Background Many studies have described the features of menstrually-related migraines (MRM) in the natural cycle and the efficacy of prevention. MRM in combined hormonal contraceptive (CHC) users has scarcely been researched. Estrogen and progestin withdrawal in CHC users are both more abrupt and from higher hormone levels compared with the natural cycle. An advantage for prevention of MRM in CHC users is that the hormone withdrawal is predictable. It is unknown, whether the attacks during the hormone-free interval are associated with the hormone withdrawal or onset of bleeding. Improved understanding of this relation might contribute to better define and shorten the time interval for prevention. Methods For this prospective diary-based trial we collected migraine and bleeding data from CHC users with MRM in at least two of three cycles. We analyzed frequency of migraines over the whole CHC cycle. During the hormone-free phase the relation between onset of migraine and onset of bleeding was studied. We compared pain intensity and identified prolonged-migraine attacks during hormone use and the hormone-free phase. Results During the hormone-free interval the number of migraine days and the pain score/migraine day were significantly higher in comparison with the mean during hormone use. The prevalence of migraine attacks was fourfold on hormone-free days 3–6. Migraine typically started on days 1–4. Migraine in relation to bleeding mostly occurred on days − 1 to + 4. In 78% of the cycles the first migraine day occurred during bleeding days 1 ± 2 and 48% started on days − 1 and day 1. The predictability of the first bleeding day was very high. Conclusion The day of hormone-withdrawal migraine and the first bleeding day are highly predictable in CHC users. Migraine onset is mostly day − 1 and 1 of the bleeding and on days 1–4 of the hormone-free interval. Migraine attacks of CHC users in the hormone-free interval are severe and long lasting. Further trials are necessary to investigate if this knowledge can be used to optimise prevention.

Migraine is affected by the changing hormone environment, with perimenopause associated with increased migraine, particularly menstrual migraine. Menstrual attacks are recognised to be more disabling and less responsive to treatment compared with non-menstrual attacks. Perimenstrual estrogen 'withdrawal' is implicated in the pathophysiology of menstrual migraine, with increased prevalence of migraine in perimenopause associated with unpredictable estrogen fluctuations. Perimenopausal women often have contraceptive needs as well as menopause symptoms and it is important to understand the potential effects of exogenous hormones on migraine. Maintaining stable estrogen levels with exogenous hormones can benefit migraine but clinical trial data are limited. This short narrative review addresses the diagnosis and management of menstrual migraine in perimenopausal women, and discusses the management of menopause symptoms in peri- and postmenopausal women with migraine.

Objectives: To compare between acupuncture and acupressure for preventing menstrual migraine (MM). Methods: MM is one kind of migraine associated with menses in female. It is often associated with increased menstrual distress and disability, leading to decreased daily activity and quality of life. A randomized and controlled pilot study was conducted with three groups: verum acupuncture (VA) group, acupressure (AP) group, and control acupuncture (CA) group. The study lasted for 7 cycle-months, with a 1 cycle-month baseline observation (T1), a 3 cycle-month intervention (3 times per cycle-month) (T2–T4), and a 3 cycle-month follow-up (T5–T7). Outcome measures were number of migraine days, average and peak pain, total duration period of MM, and percentage of patients with ≥50% reduction in the number of MM days. Results: A total of 18 participants were included in the analysis (VA, n = 7; AP, n = 6; CA, n = 5). Both VA and AP were significantly more effective than CA for reducing MM days during the intervention period. Both VA and AP tended to be more effective than CA for reducing peak pain during the intervention period. No significant differences for the outcomes were observed among VA, AP, and CA during the follow-up period. No serious adverse events were reported. Discussion: Results of the pilot study suggest that both VA and AP could be considered as alternative and safe prophylactic interventions for MM. Register ClinicalTrials.gov Identifier: NCT02592681. Keywords: acupressure, acupuncture, menstrual migraine, prophylactic effect

The term menstrual migraine refers to migraine that is associated with menstruation by more than chance, but it does not define pathophysiology. Menstrual migraine affects about 20-25% of female migraineurs in the general population, and 22-70% of patients presenting to headache clinics. In women diagnosed with menstrual migraine, perimenstrual migraine attacks are associated with substantially greater disability than their non-menstrual attacks. Loose interpretation of diagnostic criteria has led to conflicting results in studies on prevalence figures, clinical characteristics, and response to treatment. Importantly, clinical trials often do not distinguish between perimenstrual attacks in women diagnosed with menstrual migraine and attacks associated with menstruation by chance. Two pathophysiological mechanisms have been identified: oestrogen withdrawal and prostaglandin release. Although management strategies targeting these mechanisms might be effective, the evidence is not robust. Given how common and debilitating this distinct condition is, more research investment is needed to expand understanding of its pathophysiology and to develop more effective treatment strategies.

Background and objectiveIn clinical practice, the evidence of acupuncture used as a treatment for migraine without aura is employed interchangeably to guide treatment for menstrual migraine. However, its effect and safety are not substantiated. This study aimed to assess the efficacy of acupuncture on the frequency and pain intensity of menstrual migraine.MethodsWe searched PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI) and other two Chinese databases from their inception to 1 May 2019. This study included randomised controlled trials of women with menstrual migraine receiving acupuncture or a valid control. Two reviewers independently completed study selection, data extraction and risk of bias assessment. We combined data with a fixed-effect model in RevMan. Clinical outcomes included migraine frequency and duration, headache intensity, and adverse events.ResultsThirteen studies with 826 subjects were included, 9 of which had data suitable for meta-analyses. Current evidence showed that acupuncture was not superior to sham acupuncture in reducing monthly migraine frequency and duration, average headache intensity, and analgesic use at completion of treatment or follow-up. Pooled data demonstrated a significant improvement in mean headache intensity in the acupuncture group compared with drugs. However, all studies were underpowered and associated with moderate to high risk of bias. No serious adverse event was related to acupuncture treatment.ConclusionsThere is no convincing evidence to support the use of acupuncture in treating menstrual migraine. Acupuncture cannot yet be recommended to patients with menstrual migraine until more solid evidence is produced.Trial registration numberCRD42019119337.

Combined hormonal contraceptives are contraindicated in women who have migraine with aura, in whom these drugs can increase the risk of ischemic stroke. However, this contraindication is based on data from the 1960s and 1970s, when oral contraceptives contained much higher doses of estrogen. Stroke risk is not significantly increased with today's preparations, many of which contain less than 30 μg of ethinyl estradiol. Further, in continuous regimens, ultra-low-dose formulations--those that contain less than 20 μg of ethinyl estradiol--may help prevent menstrual migraine and reduce the frequency of aura.

Background: Menstrual Migraine (MM) is a subgroup of migraine headache that affect the quality of life of patients in menstrual age. Iron Deficiency Anemia (IDA) is the most common cause of anemia, especially in women of reproductive age. Objectives: To determine the association of iron deficiency anemia with menstrual migraine. Materials and Methods: This descriptive-analytic study was conducted on women with migraine visiting neurology clinics affiliated to Isfahan University of Medical Sciences in late 2015 and early 2016. The demographic data and characteristics of migraine headache were registered in a designed questionnaire. The patients underwent laboratory tests for iron deficiency and anemia. Data were analyzed in SPSS-20 using Chi-square test and independent t-test. Significance level was considered at p

Background Menstrual migraine is a highly prevalent disorder among adult women, resulting in disability and loss of quality of life. Some studies have reported menstrual cycle synchrony among women living together. No study has reported whether there may also be a higher prevalence of menstrual migraine among these women. Thus, they reported here the prevalence of menstrual migraine in a group of women living together compared with a control group of women living alone, and discussed the possible factors involved. Methods The study was conducted on female university students aged 18-30 years with a diagnosis of migraine according to the criteria of the International Classification of Headache Disorders III, beta appendix criteria. The subjects were divided into a group of women who lived together with two or more other students and a control group of age-matched students who lived alone, interviewed with a specific questionnaire and assessed for 3 months by means of a paper pain diary. The data evaluated included frequency of headache, presence of menstrual migraine, intensity of headache, medications used including contraceptives, and triggering factors such as diet, sleep deprivation, and stress. The menstrual data and data related to migraine were also investigated in the roommates. Results A higher occurrence of menstrual migraine among women living together (9, 50%) compared with women living alone (3, 16.7%) (P = .03) was detected. After binary logistic regression analysis, this finding was not related to the main influencing factors detected, that is, use of a contraceptive, test stress, or sleep deprivation (P = .03, adjusted odds ratio: 7.87; 1.23-50.36). These women also showed menstrual cycle synchrony with their roommates (8, 44.4%) and the presence of headache crises during the menstruation of their colleagues (11, 61.1%). Conclusion The present study detected a higher occurrence of menstrual migraine among women who lived together. Since there was no previous description of this topic in the literature, it was believed that the present study could represent a step toward more elaborate investigations of this complex topic.

Background This retrospective observational study describes what appears to be a not-uncommon yet not previously typified headache disorder, “end-menstrual migraine” (EMM) named for its proximate occurrence with the terminal days of menstrual bleeding each month. Methods Our menstrual migraine (MM) clinic's database was queried for patients with migraine, regular menses, and the locally used diagnostic code of EMM, signifying the patient's assertion that she had migraine at the end of menses as well as calendar data confirming that association. Serum ferritin levels were available for all subjects with EMM. Results Among the most recently seen 119 women in the clinic, 85 had both regular menses and a diagnosis of migraine, and were thus appropriate for evaluation. In this selected population, 30 women (35.3%) were confirmed to have EMM. Twenty-eight of those 30 patients (93.3%) had ferritin levels that fell below the generally accepted lower desirable limit of 50 ng/mL (mean = 21.9 ng/mL) – half of whom fell below 18 ng/mL, the established minimum levels for women. Conclusions EMM is a common complaint in women evaluated for menstrual-related migraine (MRM), yet these migraines occur many days after the estrogen withdrawal that precipitates MRM. The authors do not believe that EMM is hormonally mediated, but rather that it is causally related to menstrual blood loss, resulting in a brief relative anemia with consequent migraine. Further study is needed to substantiate this association, search for confounders, and evaluate response to iron therapy.

Migraine is a common disabling primary headache disorder. Epidemiological studies have documented its high prevalence and high socio-economic and personal impacts. It is now ranked by the World Health Organization as number 19 among all diseases worldwide causing disability. Headaches in women, particularly migraine, have been related to changes in the levels of the female hormone estrogen during a woman’s menstrual cycle. Estrogen levels drop immediately before the start of the menstrual flow. Premenstrual migraines regularly occur during or after the time when the female hormones, estrogen and progesterone, decrease to their lowest levels.1 Ayurveda advocates management of ardhavabedhaka is to treat it as vatavyadhi, and also due to apana vata vaigunya in the yoni during rajaswala there will be vataja shula in different parts of the body and specially burning type of pain in the shiras, thus the main line of management should aim at treating the vata vaigunya rather than symptomatic treatment.2,3 This article aims at putting forth a few herbs, which can probably help in managing the intensity of migraine attack.

Background: We aimed to assess the differences between menstrual and non-menstrual headache in women with chronic migraine treated with erenumab. Methods: We included fertile women from a single center. Patients were defined as responders to erenumab if reporting a ≥50% decrease in monthly headache days, as compared to pre-treatment for more than half of the treatment period. Premenstrual days were defined as the two days preceding menstruation, while menstrual days were defined as the first three days of menstruation. Results: We included 18 women (11 erenumab responders and 7 erenumab non-responders) contributing to a total of 103 menstrual cycles and 2926 days. The proportion of headache days was higher in menstrual than in premenstrual and non-menstrual days in erenumab responders (34.4% vs. 14.8% vs. 16.3%, respectively, p &lt, 0.001) and in erenumab non-responders (71.4% vs. 53.6% vs. 48.3%, respectively, 0.001). Headache days with ≥2 acute medications were higher in menstrual than in premenstrual or non-menstrual headache days in erenumab non-responders (p = 0.002) but not in erenumab responders (p = 0.620). Conclusions: Our data suggest that migraine is more frequent during than outside menstrual days even in women treated with erenumab.

N/a.

Objective To develop a robust statistical tool for the diagnosis of menstrually related migraine. Background The International Classification of Headache Disorders (ICHD) has diagnostic criteria for menstrual migraine within the appendix. These include the requirement for menstrual attacks to occur within a 5-day window in at least \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$\frac {2}{3}$\end{document}23 menstrual cycles (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$\frac {2}{3}$\end{document}23-criterion). While this criterion has been shown to be sensitive, it is not specific. Yet in some circumstances, for example to establish the underlying pathophysiology of menstrual attacks, specificity is also important, to ensure that only women in whom the relationship between migraine and menstruation is more than a chance occurrence are recruited. Methods Using a simple mathematical model, a Markov chain, to model migraine attacks we developed a statistical criterion to diagnose menstrual migraine (sMM). We then analysed a data set of migraine diaries using both the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$\frac {2}{3}$\end{document}23-criterion and the sMM. Results sMM was superior to the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$\frac {2}{3}$\end{document}23-criterion for varying numbers of menstrual cycles and increased in accuracy with more cycle data. In contrast, the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$\frac {2}{3}$\end{document}23-criterion showed maximum sensitivity only for three cycles, although specificity increased with more cycle data. Conclusions While the ICHD \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$\frac {2}{3}$\end{document}23-criterion is a simple screening tool for menstrual migraine, the sMM provides a more specific diagnosis and can be applied irrespective of the number of menstrual cycles recorded. It is particularly useful for clinical trials of menstrual migraine where a chance association between migraine and menstruation must be excluded.

Migraine onset and activity in women are influenced by the fluctuations of sex hormone levels, particularly estrogen. According to the “estrogen withdrawal hypothesis,” migraine episodes are precipitated by a decline in estrogen, as may occur in the menstrual period [1]. Therefore, exogenous estrogens such as those contained in combined hormonal contraceptives (CHC) might interfere with the course of headache in women with migraine. In most cases, the use of CHC leads to an exacerbation or even a new onset of migraine, while in other cases, CHC can lead to an improvement or even be used as migraine prophylaxis (e.g., menstrual migraine [MM]). A complex and still unknown interaction between the vascular actions of estrogens and the vascular alterations of subjects with migraine may also explain the highly increased risk of cardiovascular events among women with migraine using CHC [2].

Migraine is a common ailment which disproportionately affects women. The purpose of this chapter is to provide an overview of migraine as it relates to hormones, particularly estrogen. In addition, this chapter will address a subtype of migraine, menstrual migraine, its distinct pathophysiology, phenotype and treatment strategies.

Background In 2016, a large meta-analysis brought the number of susceptibility loci for migraine to 38. While sub-type analysis for migraine without aura (MO) and migraine with aura (MA) found some loci showed specificity to MO, the study did not test the loci with respect to other subtypes of migraine. This study aimed to test the hypothesis that single nucleotide polymorphisms (SNPs) robustly associated with migraine are individually or collectively associated with menstrual migraine (MM). Methods Genotyping of migraine susceptibility SNPs was conducted using the Agena MassARRAY platform on DNA samples from 235 women diagnosed with menstrual migraine as per International Classification for Headache Disorders II (ICHD-II) criteria and 140 controls. Alternative genotyping methods including restriction fragment length polymorphism, pyrosequencing and Sanger sequencing were used for validation. Statistical analysis was performed using PLINK and SPSS. Results Genotypes of 34 SNPs were obtained and investigated for their potential association with menstrual migraine. Of these SNPs, rs2506142 located near the neuropilin 1 gene (NRP1), was found to be significantly associated with menstrual migraine (p = 0.003). Genomic risk scores were calculated for all 34 SNPs as well as a subset of 7 SNPs that were nearing individual significance. Overall, this analysis suggested these SNPs to be weakly predictive of MM, but of no prognostic or diagnostic value. Conclusions Our results suggest that NRP1 may be important in the etiology of MM. It also suggests some genetic commonality between common migraine subtypes (MA and MO) and MM. The identification of associated SNPs may be the starting point to a better understanding of how genetic factors may contribute to the menstrual migraine sub-type.

The present study aimed to investigate the efficacy of repetitive cathodal direct current stimulation (rctDCS) over the visual cortex as a prophylactic treatment in patients with menstrual migraine. 20 female patients were recruited in this double-blind, placebo-controlled study and were assigned to receive either cathodal or sham stimulation. Over 3 menstrual cycles, tDCS with 2mA intensity and 20 min duration was applied to the visual cortex of the patients, in 5 consecutive sessions 1-5 days prior to the first day of their menstruation. The primary endpoint of the study was the frequency of the migraine attacks at the end of the treatment period, however, additional parameters, such as the number of migraine related days and the intensity of pain were also recorded 3 months before, during and 3 months post-treatment. Visual cortex excitability was determined by measuring the phosphene thresholds (PTs) using single pulse transcranial magnetic stimulation (TMS) over the visual cortex. Sixteen patients completed the study. A significant decrease in the number of migraine attacks (p=0.04) was found in the cathodal group compared to baseline but not compared to sham (p=0.053). In parallel the PTs increased significantly in this group, compared to the sham group (p

Premise Menstrual-related migraine is very prevalent, very disabling, yet very easy to manage given a good understanding of its cause. Possible Solution This article is intended to help with that understanding and to enable headache specialists to prescribe or create effective hormonal preventives of menstrual-related migraine.

Headaches in women, particularly migraines, have been related to changes in the levels of the female hormone estrogen during a woman's menstrual cycle. Estrogen levels drop immediately before the start of the menstrual flow. Premenstrual migraines regularly occur during or after the time when the female hormones, estrogen and progesterone, decrease to their lowest levels. Epidemiological studies have documented its high prevalence and high socio-economic and personal impacts. It is now ranked by the World Health Organization as number 19 among all diseases world-wide causing disability. Posing a great challenge to medical field, its need of the hour to develop, a safe, quick acting and effective treatment modality to combat the condition and also uplift the health status of women.

Migraine is one of the most common neurological disorders in the general population. It affects 18% of women and 6% of men. In more than 50% of women migraineurs the occurrence of migraine attacks correlates strongly with the perimenstrual period. Menstrual migraine is highly debilitating, less responsive to therapy, and attacks are longer than those not correlated with menses. Menstrual migraine requires accurate evaluation and targeted therapy, that we aim to recommend in this review.This review of the literature provides an overview of currently available pharmacological therapies (especially with triptans, anti-inflammatory drugs, hormonal strategies) and drugs in development (in particular those acting on calcitonin gene-related peptide) for the treatment of acute migraine attacks and the prophylaxis of menstrual migraine. The studies reviewed here were retrieved from the Medline database as of June 2017.The treatment of menstrual migraine is highly complex. Accurate evaluation of its characteristics is prerequisite to selecting appropriate therapy. An integrated approach involving neurologists and gynecologists is essential for patient management and for continuous updating on new therapies under development.

A growing amount of evidence suggests that magnesium deficiency may play an important role in several clinical conditions concerning women health such as premenstrual syndrome, dysmenorrhea, and postmenopausal symptoms. A number of studies highlighted a positive correlation between magnesium administration and relief or prevention of these symptoms, thus suggesting that magnesium supplementation may represent a viable treatment for these conditions. Despite this amount of evidence describing the efficacy of magnesium, few and un-systematize data are available about the pharmacological mechanism of this ion for these conditions. Herein, we review and systematize the available evidence about the use of oral magnesium supplementation in several gynecological conditions and discuss the pharmacological mechanisms that characterize these interventions. The picture that emerges indicates that magnesium supplementation is effective in the prevention of dysmenorrhea, premenstrual syndrome, and menstrual migraine and in the prevention of climacteric symptoms.

Introduction: Migraine is a common headache disorder that causes significant disability. COX inhibitors (also referred to as NSAIDs) are a frequently used treatment option.Areas covered: A PubMed search provided articles relating to migraine and COX inhibitors. This article reviews the mechanism of action of NSAIDs in migraine, specifically the inhibition of COX isoenzymes and prostaglandin synthesis. Their central and peripheral effects are reviewed. The evidence for the use of NSAIDs in acute, preventive and rescue therapy, as well as other special circumstances, is discussed.Expert opinion: We use NSAIDs as first-line acute treatment for migraine in both out-patient and in-patient settings, as well as for preventive treatment in menstrual migraine. We also employ NSAIDS as a bridge therapy. We feel more research is needed to develop a greater variation of dosage forms for current NSAIDs as well as more combination therapies.

Background The aim of this study was to compare a multidisciplinary approach of menstrual (related) migraine, combining the neurological and gynaecological consultation, to a mono-disciplinary approach involving neurological treatment. There is a clear relationship between the menstruation cycle and the occurrence of migraine (menstrual migraine). Nowadays the treatment of menstrual (related) migraine is performed by a neurologist. A treatment with attention to hormonal treatment seems more convenient. Methods This retrospective study was performed in a cohort using data of 88 women with menstrual (related) migraine who visited the menstrual migraine clinic between 2012 and 2014 (intervention group). The results were compared to a historical control group, which consisted of women with menstrual (related) migraine who were treated before 2012 and received a mono-disciplinary approach. Results In the intervention group the Headache Impact (HIT) score significantly improved (65 to 59 points). The mean headache days per month declined significantly (from 6 to 3.83 days) and these women needed less use of pain medication. In the control group the decline in HIT score was less striking (65 to 63.5 points) and the mean headache days per month increased (6 to 6,5 days). It appeared that 20 out of 27 patients in the control group required a gynaecological consultation in course of time. Conclusion A multidisicplinary treatment of women with menstrual (related) migraine gives better results compared to a mono-disciplinary approach. These results should be interpreted with caution as we performed a retrospective study with a relative small control group.

Background Menstrual migraine and menstrually related migraine attacks are typically longer, more disabling, and less responsive to medications than non-menstrual attacks. The aim of this study was to evaluate the efficacy, safety, and tolerability of non-invasive vagus nerve stimulation for the prophylactic treatment of menstrual migraine/menstrually related migraine. Methods Fifty-six enrolled subjects (menstrual migraine, 9 %; menstrually related migraine, 91 %), 33 (59 %) of whom were receiving other prophylactic therapies, entered a 12-week baseline period. Fifty-one subjects subsequently entered a 12-week treatment period to receive open-label prophylactic non-invasive vagus nerve stimulation adjunctively (31/51; 61 %) or as monotherapy (20/51; 39 %) on day −3 before estimated onset of menses through day +3 after the end of menses. Results The number of menstrual migraine/menstrually related migraine days per month was significantly reduced from baseline (mean ± standard error, 7.2 ± 0.7 days) to the end of treatment (mean ± standard error, 4.7 ± 0.5 days; P

Pure menstrual migraine (PMM) and menstrually related migraine (MRM) are difficult challenges in migraine management. Triptans are a class of highly selective serotonin receptor agonists, which interfere with the pathogenesis of migraine and are effective in relieving the associated neurovegetative symptoms. In recent years triptans have been extensively proposed for the treatment of severe, disabling, and recurrent perimenstrual migraine attacks. This review summarizes the different levels of recommendations for the use of triptans in the treatment of perimenstrual migraine. This review is also intended to offer an updated reasonable guide to physicians treating perimenstrual migraine in daily practice.

Comorbidity may be defined as the association of two or more diseases in individuals at a frequency greater than that expected statistically by chance. Studying the co-occurrence of two disorders requires a careful statistical analysis before any clear conclusion on causality is reached. Many studies have looked for an association between migraine and many diseases, reporting several sometimes controversial comorbidities in migraine subjects. Although migraine is more common in women than in men, very few studies have analyzed the comorbidity of perimenstrual migraine, a migraine sub-type characterized by attacks of migraine without aura related to menstruation. We review the studies on migraine comorbidities, particularly migraine without aura in women.

As menstrual-related migraine (MRM) has been reported to be longer, more disabling, less responsive to acute therapy, and more prone to recurrence than nonmenstrual migraine attacks, effective preventive strategies are key to their management. Some combined hormonal contraceptives have been suggested as specific preventives for MRM. This article takes a closer look at some of these products, including concerns surrounding them, non-contraceptive benefits, and their potential role as preventive agents for MRM.

Migraine is a common health problem among women and can cause significant disability. Approximately 60% of women with migraine report a correlation between migraine and their menstrual cycle. Because of this prevalence, the International Headache Society outlined criteria for the diagnosis of pure menstrual migraine and menstrually related migraine. After practitioners accurately diagnose menstrual migraine based upon these criteria, they can then work with individual clients to determine the best treatment plan. This article focuses on the accurate diagnosis of menstrual migraine and several evidence-based treatment options available to women who suffer from this debilitating condition.

The prevalence of migraine is highest during the peak reproductive years and many women report its association with their menstrual periods. In this review, Professor MacGregor discusses the diagnosis, pathophysiology and management of menstrual migraine. Copyright © 2011 Wiley Interface Ltd

Migraine is a very disabling condition that can severely impair quality of life. Eighteen percent of women suffer from migraine headaches, and of those, approximately 60% have migraines near the time of their menstrual period. Migraine is generally undertreated, not only because some sufferers do not have access to proper care, but also because many fail to seek treatment because of misperceptions that nothing can be done for a condition from which generations of women have suffered. Research has shown that migraine is not a disorder of blood vessels, but rather a brain disorder characterized by inflammation. The goal of this paper is to explain practical approaches to managing menstrual migraine.

Approximately one of every three to five women with migraine without aura experience migraine attacks in relation to menstruation. The International Classification of Headache Disorders, 2nd Edition provides appendix diagnoses for pure and menstrually related migraine without aura that need further validation. Probands with menstrual migraine might have more affected relatives than probands with nonmenstrual migraine. However, precise epidemiological, family, and twin data still are lacking.

Migraine is considered to be a multifactorial disorder in which genetic, environmental, and, in the case of menstrual and menstrually related migraine, hormonal events influence the phenotype. Certainly, the role of female sex hormones in migraine has been well established, yet the mechanism behind this well-known relationship remains unclear. This review focuses on the potential role of hormonally related genes in migraine, summarizes results of candidate gene studies to date, and discusses challenges and issues involved in interpreting hormone-related gene results. In light of the molecular evidence presented, we discuss future approaches for analysis with the view to elucidate the complex genetic architecture that underlies the disorder.

Migraine attacks are common in the perimenstrual period (menstrually-related migraine, MRM) and can be particularly exacerbated by the cyclic suspension of oral contraceptives (oral contraceptive-induced menstrual migraine, OCMM). This cross-over, randomised study evaluated the efficacy and tolerability of rectal (25 mg) and oral (50 mg) sumatriptan in the treatment of 232 menstrual migraine attacks (135 MRM and 97 OCMM). Two hours after suppository administration, 72% of patients in the MRM group achieved pain relief and 24% were pain free; after tablet administration, the percentages were 66% and 27%, respectively. In the OCMM group 55% of patients improved at 2 h with suppositories and 46% with tablets, 27% of patients were pain-free after suppositories and 18% after tablets. Fifty percent of patients given suppositories were pain-free at 4 h post-treatment and 47% of those given tablets. Sumatriptan also effectively alleviated symptoms associated with migraine, such as nausea, vomiting and photo/phonophobia. A single dose of medication sufficed for pain relief without relapse in 47.4% of the attacks (MRM: 66%; OCMM: 33%). Both formulations were well tolerated.

Menstrual-related migraine (MRM) affects the majority of female migraineurs, with menstrual-associated attacks reported to be more disabling, longer lasting, and less responsive to traditional treatments than nonmenstrual attacks. Emerging evidence suggests that minimizing or eliminating monthly declines in estrogen concentration may be effective in preventing MRM. This article gives a practical overview of current hormonal options, both contraceptive and noncontraceptive. Our intent is to help the reader better understand the differences in currently available formulations and how some of these agents may be utilized as hormonal preventives of MRM.