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Menstrual Migraines Hit Hard

By: Serena Gordon - HealthDay Reporter

Migraines can attack with a vengeance during menstruation, but taking medication before your period begins may help stave off these excruciating headaches.

That's the conclusion of two studies that appear in the July 27 issue of Neurology.

One study sought to confirm the association between migraine and menstruation that many women already report to their doctors. The British 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're more than three times as likely to report the migraine as severe.

The other study looked for a way to relieve menstrual migraines. Researchers compared the preventative use of the migraine medication frovatriptan to a placebo. They found that by starting frovatriptan 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.

Of her study, Dr. Anne MacGregor, director of clinical research at the City of London Migraine Clinic, said, "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."

Dr. Raina Ernstoff, an attending neurologist at William Beaumont Hospital in Royal Oak, Mich., said that menstrual migraines are more common than many women realize. She said many women have menstrual migraines, but attribute them to other triggers. However, she noted that if women are exposed to these triggers when they're not in the premenstrual or menstrual period, they may not get migraines.

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.

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In the treatment study, 443 women with migraines were recruited from 36 centers across the United States. 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 did. 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," study author Stephen Silberstein, from Thomas Jefferson University in Philadelphia, said in a statement.

The researchers said the drug was well-tolerated in this study, but Ernstoff pointed out that frovatriptan, as with other triptan medications, can't be used in women with cardiovascular disease or in those with uncontrolled hypertension.

Plus, she added, if your headaches don't interfere with your daily living, it's 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 said.

MacGregor said 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 said.

Copyright © 2004 ScoutNews LLC. All rights reserved.

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SOURCES: Anne MacGregor, M.D., director, clinical research, City of London Migraine Clinic, London, England; Raina Ernstoff, M.D., attending neurologist, William Beaumont Hospital, Royal Oak, Mich., and clinical associate professor, Wayne State University, Detroit; July 27, 2004, Neurology