Menstrual migraine: a clinical review

Migraine attacks are often associated with menstruation in many, but not all, women with migraine. To date, no hormonal abnormalities have been identified in these women and it appears that normal hormonal fluctuations are associated with an abnormal central nervous system response. Diagnosis of migraine and confirmation of menstrual association is clinical, based on headache history and review of diary cards. Tests of hormone levels are rarely useful. Standard drugs to treat the acute symptoms suffice for the majority of women with monthly attacks. If acute therapy alone is inadequate, pre-emptive treatment of the expected menstrual headache with perimenstrual estradiol, triptans or non-steroidal anti-inflammatory drugs (NSAIDs) may be effective. Suppression of the menstrual cycle with anovulatory contraceptive agents is an additional option, particularly for women who also require contraception. A variety of other treatments have been studied, but the quality of evidence for their use is generally poor.