Hope for Preventing Menstrual Migraine
Research Identifies Vulnerable Days, Suggests Option to Prevent Attacks
Two Pills a Day Is Best continued...
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.
Benefit Beyond Menstrual Migraine
Two experts not involved with either study praised the research -- and not only because nearly half of all women who visit their doctors for migraine treatment report a greater vulnerability to attacks during menstruation.
Migraine expert Robert Nett, MD, medical director of Texas Headache Associates in San Antonio, tells WebMD that the study provides new insights into preventive therapy for migraine suffers.
"His research implies a new direction for physicians to look at for weather-induced migraine or when patients are traveling by airplane and have high-altitude-induced migraine," Nett tells WebMD.
"We can take this data and then project to other highly vulnerable time periods. For instance, if historically, you know that when you go skiing in Colorado or Utah, you get a blistering migraine on the first day because of the altitude change, you can take a long-acting triptan twice a day on the day before you arrive and continue it for week, you may be able to diminish that high vulnerability."
In his own research, Nett finds that another triptan, Imitrex, may stop menstrual migraine. In his study on 450 women with a history of regularly occurring menstrual migraines, he finds that taking a 100-milligram dose within an hour of headache onset stopped pain and other symptoms in one-third of those studied.
Therapy When It's Needed
Richard B. Lipton, MD, of Albert Einstein College of Medicine and the Montefiore Headache Unit in the Bronx, N.Y., says that Silberstein's research details a treatment option that offers advantages to other "prophylactic" medications taken to prevent migraine. These drugs, usually prescribed to those people who have frequent attacks, include certain antidepressants, beta blockers such as Inderal and Tenormin, and antiseizure medications such as Depakote and Topamax.
"With those prophylactics, you need to take them every day, whether or not you need them," he tells WebMD. "But with a short-term prophylactic treatment as described in Steve [Silberstein's] paper, you take the drug for a relatively brief window of time when you really need it."
He also praised the British study for confirming previous research -- including his own -- that pinpoints the most vulnerable days for menstrual migraine.
"This is important research because so many women with migraine experience headaches around the time of their period," he says. "Treating those headaches is a hugely important clinical problem."