Women's Health - September 2004

Migraine Headache Link To Menstruation Studied

New Research Provides Therapy Hope

Migraines can attack with a vengeance during a woman's menstruation, but taking medication before it begins may help stave off excruciating headaches, according to new studies reported in the medical journal Neurology.

The first study sought to confirm the association between migraine and menstruation that many women already report to their physicians.  The researchers found that, indeed, such an association does exist: Women are 2.5 times more likely to have a migraine during the first three days of menstruation, and they are more than three times as likely to report the migraine as severe.

The second study looked for a way to relieve menstrual migraines. Researchers compared the preventative use of a migraine medication, frovatriptan, to a placebo (inactive substance).

They found that by starting medication therapy two days before menstruation begins and continuing treatment for six days, the occurrence of menstrual migraines could be reduced by as much as 26 percent.

Regarding the study linking menstruation with migraines, Dr. Anne MacGregor, director of clinical research at the City of London Migraine Clinic, says, "This is the first study to compare menstrual vs. non-menstrual attacks within individual women. It confirms what women themselves tell us, that it is the menstrual attacks that give them the most problems."

Migraines with Menstruation Not Uncommon

Dr. Raina Ernstoff, an attending neurologist at William Beaumont Hospital in Royal Oak, Mich., says that menstrual migraines are more common than many women realize.

Many women have menstrual migraines, but attribute them to other triggers, Dr. Ernstoff says. However, she notes that if women are exposed to these triggers when they are not in the premenstrual or menstrual period, they may not get migraines.

Dr. MacGregor's study included 155 women who had a history of migraines. None were taking birth control pills or using hormone therapy. All of the women kept diary cards that contained information on each headache and its severity, as well as any medications taken, and where in her menstrual cycle a woman was. Data were gathered for 693 menstrual cycles.

The researchers found that women were 2.1 times more likely to have a migraine in the two days before a period, and that number increased to 2.5 times more likely during the first three days of menstruation. Women were 3.4 times more likely to report that migraines that occurred during menstruation were severe.

In the treatment study, 443 women with migraines were recruited from 36 centers across the US. They were randomly assigned to one of three groups during each of three menstrual cycles. One group took a placebo; one group took 2.5 milligrams of frovatriptan once daily; and the other took 2.5 milligrams of frovatriptan twice a day. All took the treatments for six days, beginning two days before the expected start of menstruation.

Sixty-seven percent of the women taking the placebo reported having migraines, while only 52 percent of those taking frovatriptan reported migraines. The group taking frovatriptan twice a day had the best results, with only 41 percent experiencing a migraine.

"More than half of patients who used frovatriptan 2.5 milligrams twice daily had no menstruation-associated migraine," says study author Dr. Stephen Silberstein, from Thomas Jefferson University in Philadelphia.

Managing With and Without Medications

The researchers say the medication was well-tolerated in this study, but Dr. Ernstoff points out that frovatriptan, as with other triptan medications, cannot be used in women with cardiovascular disease or in those with uncontrolled hypertension.

Plus, she adds, if headaches do not interfere with daily living, it is a good idea to cut back on medications whenever possible.

"Women should talk to their neurologists about other ways of dealing with migraine symptoms, because there may be ways to reduce medications," she says.

Dr. MacGregor says knowing when menstruation will occur can help women prevent their migraines.

"We found that for many women in our study, being able to predict menstruation and hence migraine made them more able to prepare for menstrual attacks, avoiding other triggers and treating early," she says.

Always consult your physician for more information.