Menstrual cycle is referred to the strongest migraine attack provokers. The interdependence between migraine and menstruation emerges in 60% of women during reproductive age. Typically, this interrelation is formed gradually in the second decade of life; in most women the presence of migraine during menstruation becomes apparent by 35 years.
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A migraine attack can occur before or during menstruation. These migraine attacks are typically characterized by increased severity, durability and resistance to analgesics. Besides, menstrual attacks often resistant to preventive treatment. Menstrual migraine is represented by two forms: true menstrual and menstrual-associated migraine.
True menstrual migraine is a relatively rare condition that occurs only in 10-14% of women. Menstrual-associated manifests in roughly 50% of females. In this case, in addition to the migraine attack in the perimenstrual period migraine attacks can be observed at other periods of the month. Menstrual attacks may be accompanied with nausea, vomiting, and significant impairment of ability to work. If a patient is suffering severe attacks that jeopardize an ability to work, triptans are typically prescribed.
The pathogenesis of menstrual migraine is increased sensitivity to normal fluctuations in estrogen levels during the menstrual cycle. An inverse correlation between the probability of the onset of a migraine attack and the concentration of degradation products of estrogen in the urine is largely observed.
Dealing with the problem
Treatment of menstrual migraine is characterized by significant complexity. In many patients, the attacks are not well relieved by analgesics, even triptans; pain intensity increases rapidly and the attack may last longer than usual (3-4 days). During this time, the patient receives a large amount of analgesics, which bring in the best short-term relief. That is why for a number of patients with menstrual migraine a need in preventive treatment exists, even if the amount and severity of migraine attacks is characterized by small quantity. In some situations, prophylactic treatment should be carried out even in patients with true menstrual migraines. This means that a patient is forced to take daily medication dosage to reduce the severity of the migraine attack, which occurs only once per month.
Keeping a diary of attacks for at least 3 months has a critical importance here. This will not only establish a relationship with menstruation, but also help to evaluate the effectiveness and the number of analgesics used, as well as the overall frequency of seizures.
In case of insufficient effectiveness of anesthesia, as well as high frequency of seizures (if necessary analgesics often 2 days per week) showed a prophylactic treatment for migraine using conventional pharmacological and non-pharmacological approaches. The goal of such therapy is to reduce the frequency of migraine attacks and their duration and intensity, which is especially important for migraine in a menstrual period.
Nevertheless, the effectiveness of preventive therapy may still not impact the severity of menstrual attack, which can be significant enough. If a menstrual migraine has an abrupt effect on the patient, a mini-prophylaxis may be a way to go. It makes sense to conduct it in patients with regular menstrual cycles and documented in a diary relationship with menstruation. This will allow predicting the day of the attack.
In mini-prevention currently hormonal and non-hormonal agents are mainly used. To prevent menstrual attacks some analgesic drugs are taken throughout the entire premenstrual period. For this purpose, can be used naproxen (550 mg 2 times a day), acetylsalicylic acid (500 mg 2 times a day) or mefenamic acid (500 mg 3 times a day). To begin receiving the drug should 2-4 days before menstrual migraine attack and until the third day of menstruation. Since the effectiveness of such prevention is pretty low, you a patient may test a number of drugs to select the most suitable. This method is primarily recommended to patients in whom menstruation is accompanied by abdominal pain.
Triptans have a considerably higher efficiency in the mini-prevention, but in order to prevent menstrual attacks they must be administered at a considerable amount of drug, e.g.: sumatriptan (25mg 3 times a day), naratriptan (1 mg 2 times a day) and zolmitriptan (2,5 mg times a day). The drug is taken for 5-6 days from the reception for 2 days before the expected attack of migraine.
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