Treatment of menstrual migraine: utility of control of related mood disturbances

Abstract

Menstrual migraine (MM) has a prevalence in the general population of approximately 7%, although it seems to be much higher within the population of females with migraine. Episodes of MM have been reported to be longer, more intense, more disabling, less responsive to acute therapy and more prone to recurrence than those of other types of migraine. MM is demonstrated to have a bi-directional link to affective illnesses such as premenstrual dysphoric disorder and depression. There is clinical and pathophysiological evidence suggesting that the relationship between MM and affective disorders could be linked to ovarian hormones. The aim of this review is to analyze treatment strategies in patients with co-existent MM and affective disorders.

Keywords::

• affective disorders
• comorbidity
• estrogens
• menstrual migraine
• non-steroidal anti-inflammatory drugs
• premenstrual syndrome
• triptans

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Migraine is a chronic multifactorial neurovascular disorder characterized by moderate-to-severe unilateral and pulsating pain lasting for 4–72 h, and is aggravated by physical activity typically associated with photophobia, phonophobia and neurovegetative symptoms.

• Menstrual migraine (MM) is a particular type of migraine with an overall prevalence of about 7% in the general population and much more higher in females with migraine.

• The ICHD-3 β defines two different clinical entities belonging to MM: pure menstrual migraine and menstrually related migraine.

• Episodes of MM have been reported to be longer, more intense, more disabling, less responsive to acute therapy and more prone to recurrence than those of the other types of migraines occurring in different phases of the menstrual cycle.

• The relationship between MM and affective disorders has been repeatedly investigated and a bidirectional association between them has been suggested.

• Both clinical and pathophysiological evidence suggest that the comorbidity between migraine (and in particular MM) and affective disorders could be linked to ovarian hormones.

• Acute treatment of MM includes triptans, nonsteroidal anti-inflammatory drugs (NSAIDs) alone or in combination with other analgesic drugs, ergot derivatives and opiates.

• Patients with coexistent MM and affective conditions may be acutely treated with NSAIDs and prophylactically treated with antidepressant drugs or with antiepileptic therapy.