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Half of Female Migraine Related
to Menstrual Cycle |
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BY MAURY BREECHER
Contributing Writer |
SCOTTSDALE, ARIZ. (ECCC)—
As many as 60% of all migraines experienced by women are related
to the menstrual cycle, reported Dr. Lisa K. Mannix on February
19 at the annual headache symposium sponsored by the Diamond
Headache Clinical Research and Education Foundation.
“For some women their menstrual periods work as a trigger for
those headaches,” said Dr. Mannix, the medical director of
Headache Associates in Westchester, Ohio. “Those women can
benefit from hormonal therapy such as estrogen supplements
during the week of their period, or even continuous oral
contraceptive therapy through an extended period of time.”
Menstrual migraine (MM) can be either pure menstrual migraine
(PMM)—a headache that occurs only during the time of the
period—or it can be menstrually-related migraine, a headache
that occurs at other times of the month as well as during the
period, explained Dr. Mannix. About 10% of women have PMM, 50%
have menstrually-related migraines, and migraine unrelated to
menses accounts for the remaining percentage of headache, she
said.
The clinical characteristics of MM in the general population may
not be much different from non-menstrual migraine attacks.
However, in clinic populations, doctors see MMs that are more
severe, that are less responsive to acute therapy, are more
likely to cause work-related disability, and more likely to
recur, she said (Obstet Gynecol. 2003;102:835-842; Headache.
2004;44:120-130).
In an interview following her presentation, Dr. Mannix explained
that treatments for MM are similar in many ways to treatment of
other types of migraines: starting with keeping a diary or a
calendar to track the occurrence of those headaches, and then
treating them quickly, especially those that are more severe and
disabling.
She added that triptans are a first-line choice for the acute
treatment of MM and that doctors should encourage their patients
to keep headache diaries to track the occurrence of headache.
“Headache diaries and calendars are one of the most useful tools
we have for both the diagnosis as well as the management of
migraine, particularly with menstrual migraine, as the calendar
can track when the headaches occur in relationship to their
menstrual cycle,” said Dr. Mannix.
To prevent MM, she recommended the use of conventional
prophylactic drugs but said a boosted dosage might be necessary
during the perimenstrual period. She also recommended 400 to 600
mg of magnesium daily, and hormonal interventions either
monophasic, low dose contraceptives, supplemental estrogen
(0.1-mg patch during menses), or continuous combination hormonal
contraceptive dosing.
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