About 60% of women with migraine note an increased number of attacks in association with their menstrual period. This is known as menstrually-related migraine.
Pure Menstrual Migraine is diagnosed when attacks occur exclusively around the time of menstruation in at least two out of three menstrual cycles and at no other times during the cycle. Using this definition, about 10% of female migraineurs have pure menstrual migraine. Menstrual attacks tend to be less severe but longer than non-menstrual attacks
The most likely mechanisms responsible for menstrual migraine are:
– Falling levels of oestrogen/ progestogen.
– Entry of prostaglandins (hormone-like, lipid compounds) into the systemic circulation. These levels are at their peak during the first 48 hours of menstruation.
Management of Menstrual Migraine
A Migraine Diary can be very effective in establishing the link between menses and migraine.
Acute treatment is the same as for other migraine and can include triptans and NSAIDs. Triptans are just as effective for menstrual migraine.
An anticipated menstrual migraine attack may sometimes be prevented by either taking a long acting triptan or some NSAIDs in the hours prior to the attack.