Clinical Aspects of Perimenstrual Headaches

Curr Pain Headache Rep. 2009 Feb;13(1):75-81. doi: 10.1007/s11916-009-0015-z.


Menstrual migraine (MM) is either pure, if attacks are limited solely during the perimenstrual window (PMW), or menstrually related (MRM), if two of three PMWs are associated with attacks with additional migraine events outside the PMW. Acute migraine specific therapy is equally effective in MM and non-MM. Although the International Classification of Headache Disorders-II classifies MM without aura, data suggest this needs revision. The studies on extended-cycle oral contraceptives suggest benefits for headache-prone individuals. Triptan mini-prophylaxis outcomes are positive, but a conclusion of "minimal net benefit compared to placebo" is not entirely unwarranted. In a 2008 evidence-based review, grade B recommendations exist for sumatriptan (50 and 100 mg), mefenamic acid (500 mg), and riza-triptan (10 mg) for the acute treatment of MRM. For the preventive mini-prophylactic treatment of MRM, grade B recommendations are provided for transcutaneous estrogen (1.5 mg), frovatriptan (2.5 mg twice daily), and naratriptan (1 mg twice daily).

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Female
  • Headache / diagnosis
  • Headache / etiology*
  • Headache / therapy*
  • Humans
  • Migraine without Aura / diagnosis
  • Migraine without Aura / etiology
  • Migraine without Aura / therapy
  • Premenstrual Syndrome / complications*
  • Premenstrual Syndrome / diagnosis
  • Premenstrual Syndrome / therapy*
  • Randomized Controlled Trials as Topic / methods