Menstrual Migraine Treatments

Are Newly Announced Treatments for Menstrual Migraine Really New?

I have seen a number of blog posts and tweets lately announcing that this or that medication is effective for menstrual migraine. Generally, these are medications that have been around for many years. They are not new medications. So what's going on? Often, it's just that a particular pharmaceutical company has decided to test an existing drug to see how effective it is for menstrual migraine, either for "True menstrual migraine" or  for "menstrually-associated migraine." Some of these studies were looking at whether true menstrual migraine could be prevented; others were looking at whether menstrually-related migraine could be alleviated.

True menstrual migraine is defined as 'attacks of migraine without aura that occur regularly on day 1 of menstruation ± 2 days and at no other time.' This affects less than 10% of women. "True menstrual migraine where women do not get migraines the rest of the month is relatively unusual," says Lawrence Robbins, MD. Menstrually-associated migraine, however, occurs in about 50% of women who suffer from migraine. It isn't really another different type of migraine so much as it is a migraine triggered by the hormonal changes associated with the menstrual cycle.

This is underscored by the opinions of Dr. Anne Calhoun and Dr. Lisa Mannix, who state, "Initially, Menstrual Migraine should be treated as any other migraine." It's great that there is more attention on this topic. But really, the basics still apply. Prevent migraines. Treat acute attacks. You usually don't need anything special, novel, or unique.

Several studies were done that looked at using triptans for prevention of menstrual migraine. This has been done recently with sumatriptan, frovatriptan,  and eletriptan. However, older data also exist for rizatriptan, naratriptan, zolmitriptan, and almotriptan. So, basically, all triptans will work to prevent migraine. No one has compared all of them to each other, as that would be a very expensive trial to conduct.

But the other question to ask is, is using a triptan to prevent menstrual migraine the best strategy? If you have true menstrual migraine, it may be a good strategy. But if you have menstrually-associated migraine as well as other migraines, it may not be the most effective form of treatment.

The basics of migraine are still the basics: avoid triggers, prevent migraine with medication when appropriate, and treat with triptans. And at least one natural strategy for migraine prevention—magnesium—works a bit better in menstrually-associated migraine than in other forms of migraine. So, while menstrually-related migraines can be more difficult to treat than the nonmenstrual migraines a woman has, there are plenty of treatment strategies available. Click the link for more detailed information about menstrual migraine.