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Migraines More Common During Menstrual Periods

WebMD Health News

Nov. 27, 2000 -- Researchers have now confirmed what doctors and migraine sufferers alike have long suspected: Women are twice as likely to have migraine headaches during the first two days of their menstrual period than at other times. Surprisingly, however, these migraines were no worse than those occurring later in the menstrual cycle. The study findings are published in the Nov. 28, 2000 issue of the journal Neurology.

"This kind of research is important in clarifying the exact relationship of headaches to the menstrual cycle, [which] may lead to specific [treatments for] menstrually associated headaches," says Carol A.J. Boyle, MD, FRCP(C). Boyle, a neurologist at the University of Saskatchewan in Saskatoon, Canada, reviewed the findings for WebMD.

Migraine headaches are three times more common in women than in men and are usually described as throbbing pain on one side of the head or behind the eye. Migraines are often associated with nausea and vomiting, and sensitivity to light or noise. Some patients experience an aura before the headache begins, with changes in vision or weakness or numbness on one side of the body.

Researchers did phone interviews on more than 4,000 women living in the community, then studied 81 menstruating women with clinically diagnosed migraine. For more than three months, these women completed detailed headache diaries, recording how long their headaches lasted, how severe the pain was, how well they were able to continue their usual activities during the headache, and any associated symptoms.

On the first two days of menstrual flow, the women were more than twice as likely to have both migraine without aura and tension-type headaches. Tension headaches usually involve both sides of the head and back of the neck with steady, burning, or pressure-type pain. In addition, migraine without aura occurred twice as often in the two days before menstrual flow began.

As study subjects were selected from the general population rather than from a headache clinic, the results are more likely to represent patients in general practice, says Boyle.

Still, Boyle says, "Not all menstrually associated headaches in [migraine patients] are migraines." In fact, tension headaches accounted for more than half of all headaches during the study.

"Women who have menstrually associated migraine can use their knowledge about the timing of their headaches to prevent or better treat attacks," says study co-author Richard B. Lipton, MD, a professor of neurology at Albert Einstein College of Medicine in New York and chief science officer of Innovative Medical Research in Stamford, Conn. Medications such as nonsteroidal anti-inflammatory drugs (such as Motrin or Advil) or 'triptan' drugs (such as Imitrex and Amerge) may be useful in preventing menstrual migraine, and many different treatments may be effective in acute attacks.

According to senior author Stephen D. Silberstein, MD, "the mechanism of menstrually associated headache appears to be related to declining estrogen levels."

"One treatment strategy is to give estrogen supplementation or nonsteroidal anti-inflammatory drugs at appropriate times during the [menstrual] cycle," Silberstein, a professor of neurology and director of the Headache Center at Thomas Jefferson University School of Medicine in Philadelphia, tells WebMD.

Because headaches during the early cycle were no worse than those occurring at other times, says lead author Walter F. Stewart, PhD, MPH, "This study dispels the belief that menstrual migraine is distinct from migraine." Stewart is an adjunct associate professor at the Johns Hopkins School of Hygiene and Public Health in Baltimore, and president of Innovative Medical Research.

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