Menstrual Migraines: Diagnosis, Evidence, and Treatment

Area of Science:

• Neurology
• Gynecology
• Pharmacology

Background:

• Menstrual migraine (MM) is categorized into pure and menstrually-related types.
• Estrogen withdrawal is a key factor in MM onset.
• Traditional treatments include NSAIDs and triptans.

Purpose of the Study:

• To review the classification and treatment of menstrual migraine.
• To highlight the role of hormone therapies in managing MM.
• To address contraindications for hormonal contraceptives in MM with aura.

Main Methods:

• Literature review of MM classification and treatment options.
• Analysis of hormonal triggers and therapeutic interventions.
• Examination of U.S. Medical Eligibility Criteria for contraceptive use in MM with aura.

Main Results:

• Hormone therapies, such as continuous combined hormonal contraceptives (CHCs) without placebo pills, are recommended for MM.
• MM with aura is a contraindication for CHC use, especially with risk factors like smoking.
• Alternative treatments like GnRH agonists have limited supporting evidence.

Conclusions:

• Specific hormone treatments offer targeted therapy for menstrual migraine.
• Careful patient selection is crucial when considering CHCs for MM, particularly regarding aura.
• Further research is needed for alternative MM treatments.