Via practica 3/2008
MENSTRUAL AND PREMENSTRAUL MIGRAINE
Prior to puberty, the occurence of migraine is equal in both sexes – 4%. In adulthood the migraine occurs in 17% of females and only in 5% of males. The attack of migraine is usually brought about by a combination of several triggering factors. Individual factors are, as a rule, well tolerated, however, in women at reproductive age has menstruation an important role in in the development of migraine attacks. According to migraine timing in relation to menstruation, there are 3 types of migraine in women: Nonmenstrual migraine, premenstrual migraine and menstrual migraine . migraine attacks develop from 1 day before to 4 days after the beginning of menstruation. Menstrual migraine is most likely due to estrogen withdrawal, which may trigger migraine attacks in susceptile women. Menstrual migraine occasionally develops attacks without time link to menstruation. In true menstrual migraine (TMM) attacks of migraine do not appear out of the menstruation period. TMM afflicts 14% of women suffering from migraine. The symptoms of TMM are identical with those of migraine without aura, but their intensity is very strong, disabling the afflicted women professionally as well as socially. Mild to moderate migraine attacks are treated with antiemetics (metoclopramide or domperidone) in combination with analgesics (aspirin, paracetamol, ibuprofen, naproxen, diclofenac). Moderate and severe attacks are treated with 5HT 1B/1D receptor agonist (triptans). Introduction of triptans represent a significant progress in acute treatment of migraine. Women with frequent and severe attacks need medical and nonpharmacological migraine prophylaxis. Drug of first choice for menstrual migraine are nonsteroidal antiinflammatory agents. Estrogen therapy and triptans have been proven effective for shortterm prevention of menstrual migraine. Oral contraceptives may be used for longterm preventive therapy.
Keywords: pathophysiology, premenstrual and menstrual migraine, estrogen, triptans, prophylactic therapies.
