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Menstrual Migraines: Diagnosis, Evidence, and Treatment.
S D Med. 2021 Dec; 74(12):570-575.SD

Abstract

"Menstrual" or "catamenial" migraine (MM) is separated into two categories in the International Classification of Headache Disorders pure menstrual migraine and menstrually-related migraine. Pure menstrual migraine is defined as a migraine occurring exclusively on day 1 ± 2 of menstruation in at least two out of three menstrual cycles and at no other time in the cycle. Menstrually-related migraine is defined as the same but may occur at other times in the menstrual cycle, not just around menstruation. The withdrawal of estrogen has been correlated with the onset of MM, providing an opportunity for specific treatment with hormone therapies. Traditionally, MM has been treated with nonspecific treatments such as abortive and prophylactic non-steroidal anti-inflammatory drugs and triptans. While this is first line, evidence suggests that nonspecific treatments can be used in combination with specific hormone treatments. The hormone treatment recommended is either continuous combined hormonal contraceptives (CHCs) with no placebo pills or using just two days of placebo pills to avoid the estrogen withdrawal trigger. Although MM with aura is uncommon, when referring to using CHCs for MM with aura, the U.S. Medical Eligibility Criteria for Contraceptive Use 2016 categorizes MM with aura as "A condition that represents an unacceptable health risk if the contraceptive method is used." Therefore, the current recommendation is not to use CHCs with a history of menstrual migraine with aura, especially when other risk factors such as smoking are present. Other treatments such as GnRH agonists, selective estrogen receptor modulators, and bilateral oophorectomy have limited evidence.

Authors+Show Affiliations

University of South Dakota Sanford School of Medicine.Sanford Fertility and Reproductive Medicine, Sioux Falls, South Dakota. Department of Obstetrics and Gynecology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

35015948

Citation

Olson, Avery K., and Keith A. Hansen. "Menstrual Migraines: Diagnosis, Evidence, and Treatment." South Dakota Medicine : the Journal of the South Dakota State Medical Association, vol. 74, no. 12, 2021, pp. 570-575.
Olson AK, Hansen KA. Menstrual Migraines: Diagnosis, Evidence, and Treatment. S D Med. 2021;74(12):570-575.
Olson, A. K., & Hansen, K. A. (2021). Menstrual Migraines: Diagnosis, Evidence, and Treatment. South Dakota Medicine : the Journal of the South Dakota State Medical Association, 74(12), 570-575.
Olson AK, Hansen KA. Menstrual Migraines: Diagnosis, Evidence, and Treatment. S D Med. 2021;74(12):570-575. PubMed PMID: 35015948.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Menstrual Migraines: Diagnosis, Evidence, and Treatment. AU - Olson,Avery K, AU - Hansen,Keith A, PY - 2022/1/11/entrez PY - 2022/1/12/pubmed PY - 2022/1/14/medline SP - 570 EP - 575 JF - South Dakota medicine : the journal of the South Dakota State Medical Association JO - S D Med VL - 74 IS - 12 N2 - "Menstrual" or "catamenial" migraine (MM) is separated into two categories in the International Classification of Headache Disorders pure menstrual migraine and menstrually-related migraine. Pure menstrual migraine is defined as a migraine occurring exclusively on day 1 ± 2 of menstruation in at least two out of three menstrual cycles and at no other time in the cycle. Menstrually-related migraine is defined as the same but may occur at other times in the menstrual cycle, not just around menstruation. The withdrawal of estrogen has been correlated with the onset of MM, providing an opportunity for specific treatment with hormone therapies. Traditionally, MM has been treated with nonspecific treatments such as abortive and prophylactic non-steroidal anti-inflammatory drugs and triptans. While this is first line, evidence suggests that nonspecific treatments can be used in combination with specific hormone treatments. The hormone treatment recommended is either continuous combined hormonal contraceptives (CHCs) with no placebo pills or using just two days of placebo pills to avoid the estrogen withdrawal trigger. Although MM with aura is uncommon, when referring to using CHCs for MM with aura, the U.S. Medical Eligibility Criteria for Contraceptive Use 2016 categorizes MM with aura as "A condition that represents an unacceptable health risk if the contraceptive method is used." Therefore, the current recommendation is not to use CHCs with a history of menstrual migraine with aura, especially when other risk factors such as smoking are present. Other treatments such as GnRH agonists, selective estrogen receptor modulators, and bilateral oophorectomy have limited evidence. SN - 0038-3317 UR - https://www.unboundmedicine.com/medline/citation/35015948/Menstrual_Migraines:_Diagnosis_Evidence_and_Treatment_ L2 - https://medlineplus.gov/migraine.html DB - PRIME DP - Unbound Medicine ER -
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