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[Menstrual migraine]
1Service endocrinologie et médecine de la reproduction, hôpital Necker, Paris.
The cyclic fall in oestrogen level associated with the beginning of menstruations produces common migraine in 10 to 20 p. 100 of women in the general population. In women who already have migraine, the menstruations coincide with triggering or worsening of the attacks in 60 p. 100 of the cases. About 1 out of 10 women who do not have spontaneous menstrual migraine begin to suffer regularly as soon as they take an oral combination contraceptive. High doses of antigonadrotropic progestogens make the attacks worse because they herald or enhance the hypoestrogenaemia. Insufficient doses of oestrogens administered orally induce brief daily episodes of increased, then decreased oestrogenic stimulation, and they also facilitate the occurrence of migrainous attacks. The best available preventive treatment consists of cyclic percutaneous administration of oestradiol in doses that are sufficient to stabilize blood oestradiol levels at 60-80 pg/ml during the critical week. This treatment is the only one that prevents migrainous attacks and preserves the menstrual cycle. Obviously, it only benefits women with menstrual migraine, and fluctuations in oestradiolaemia are only one of the multiple precipitating factors of migrainous attacks.
The cyclic fall in oestrogen level associated with the beginning of menstruations produces common migraine in 10 to 20 p. 100 of women in the general population. In women who already have migraine, the menstruations coincide with triggering or worsening of the attacks in 60 p. 100 of the cases. About 1 out of 10 women who do not have spontaneous menstrual migraine begin to suffer regularly as soon as they take an oral combination contraceptive. High doses of antigonadrotropic progestogens make the attacks worse because they herald or enhance the hypoestrogenaemia. Insufficient doses of oestrogens administered orally induce brief daily episodes of increased, then decreased oestrogenic stimulation, and they also facilitate the occurrence of migrainous attacks. The best available preventive treatment consists of cyclic percutaneous administration of oestradiol in doses that are sufficient to stabilize blood oestradiol levels at 60-80 pg/ml during the critical week. This treatment is the only one that prevents migrainous attacks and preserves the menstrual cycle. Obviously, it only benefits women with menstrual migraine, and fluctuations in oestradiolaemia are only one of the multiple precipitating factors of migrainous attacks.