Hope for Preventing Menstrual Migraine
Research Identifies Vulnerable Days, Suggests Option to Prevent Attacks
July 27, 2004 -- For women who get migraines, these disabling headaches are especially common and intense around the time of menstruation.
But two new studies in this week's Neurology offer new insights that may help ease their suffering -- one that better identifies what days menstrual-induced migraines are most likely to occur, and the other indicating an option to prevent these attacks during this vulnerable time.
In one study, British researchers find that women who suffer from migraines are more likely to have an attack during the premenstrual period and during the first days of menstruation. They also find that these attacks are more likely to be severe compared with migraines that occur during other times of the month.
After having 155 women keep "headache diaries," researchers report that women with a history of migraines are more than twice as likely to have a migraine during the first three days of menstruation than during any other time of the month. Premenstrual (two days before menstrual bleeding) migraines occurred almost twice as often during that point in their menstrual cycle.
In the other study, neurologist Stephen Silberstein, MD, FACP, of the Headache Clinic at Thomas Jefferson University Medical College in Philadelphia, finds that menstrual migraines can be prevented in many women who start migraine-preventive drug therapy two days before menstruation begins, and continuing it for the next four days.
The medication is called Frova, one of the so-called "triptan" medications typically used to relieve migraine pain and symptoms once a migraine attack has begun.
Two Pills a Day Is Best
"There could be benefit from taking the other triptans, but we don't know because Frova has been the only one studied so far," Silberstein tells WebMD. "But I'm impressed with our results. More than half of the women studied had no headaches during their period."
However, he and other experts tell WebMD that Frova may have an advantage over other triptans, at least in theory, because it is among the longer-lasting drugs in this class.
In Silberstein's study, 443 women with migraine were recruited from 36 headache centers across the country and randomly assigned to receive either a daily dose of Frova, a twice-daily dose, or a placebo. All took the treatments for six days, beginning two days before their expected periods. The study was sponsored by Elan Pharmaceuticals, the manufacturer of the drug.
Those getting the twice-daily 2.5-milligram dose fared best, with only 41% experiencing menstrual migraines. That compares with 52% getting migraines despite taking a single daily dose of the triptan, and 67% getting migraines after taking a placebo.
Because triptan drugs can constrict blood vessels in the heart, they are not usually advised for those with heart disease or uncontrolled high blood pressure. "However, women who are menstruating in general do not have these conditions," adds Silberstein.