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A novel specific prophylaxis for menstrual-associated migraine
1Department of Neurology, University Headache Clinic, University of North Carolina at Chapel Hill, 3114 Bioinformatics Bldg., Campus Box 7025, Chapel Hill, NC 27599-7025, USA.
Southern Medical Journal
|October 1, 2004
Summary
This study found an inexpensive oral contraceptive regimen effectively prevented menstrual migraines in 11 women. The treatment significantly reduced headache days and intensity, offering a novel prophylactic strategy for migraine sufferers.
Area of Science:
- Gynecology
- Neurology
- Pharmacology
Background:
- Few migraine prophylactic therapies achieve a 50% reduction in headaches.
- The economic burden of existing prophylactic treatments can limit accessibility.
- Menstrual-associated migraine is a common and debilitating condition.
Purpose of the Study:
- To pilot a novel, effective, specific, and inexpensive prophylactic strategy for menstrual-associated migraine.
- To evaluate the efficacy of a modified oral contraceptive regimen in reducing headache frequency and intensity.
- To assess the cost-effectiveness of the proposed treatment.
Main Methods:
- Eleven women with menstrual-associated migraine were enrolled.
- Patients received an open-label oral contraceptive (20 microg ethinyl estradiol days 1-21) supplemented with conjugated equine estrogens (0.9 mg days 22-28).
- Headache intensity and days were recorded in patient diaries.
Main Results:
- All patients achieved at least a 50% reduction in headache days per cycle (mean 77.9% reduction).
- Ten of 11 women achieved at least a 50% reduction in weighted headache score (mean 76.3% reduction).
- The intervention was associated with a low cost per headache-day prevented.
Conclusions:
- Supplementing estrogen during the placebo week of oral contraceptives can prevent menstrual-associated migraine.
- Limiting the ethinyl estradiol decline to the equivalent of 10 microg prevents menstrual migraine.
- This strategy offers an effective and inexpensive approach to managing a common migraine trigger.