Menstrual migraine: a review of current and developing pharmacotherapies for women

Expert Opin Pharmacother. 2018 Feb;19(2):123-136. doi: 10.1080/14656566.2017.1414182. Epub 2017 Dec 12.

Abstract

Introduction: Migraine is one of the most common neurological disorders in the general population. It affects 18% of women and 6% of men. In more than 50% of women migraineurs the occurrence of migraine attacks correlates strongly with the perimenstrual period. Menstrual migraine is highly debilitating, less responsive to therapy, and attacks are longer than those not correlated with menses. Menstrual migraine requires accurate evaluation and targeted therapy, that we aim to recommend in this review.

Areas covered: This review of the literature provides an overview of currently available pharmacological therapies (especially with triptans, anti-inflammatory drugs, hormonal strategies) and drugs in development (in particular those acting on calcitonin gene-related peptide) for the treatment of acute migraine attacks and the prophylaxis of menstrual migraine. The studies reviewed here were retrieved from the Medline database as of June 2017.

Expert opinion: The treatment of menstrual migraine is highly complex. Accurate evaluation of its characteristics is prerequisite to selecting appropriate therapy. An integrated approach involving neurologists and gynecologists is essential for patient management and for continuous updating on new therapies under development.

Keywords: Menstrually-related migraine; calcitonin gene-related peptide; contraceptives; estrogen; gepants; menstrual migraine; perimenstrual window; pure menstrual migraine; short-term prophylaxis; triptans.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Calcitonin Gene-Related Peptide / therapeutic use*
  • Female
  • Fructose / analogs & derivatives
  • Fructose / therapeutic use
  • Humans
  • Menstruation*
  • Migraine Disorders / drug therapy*
  • Migraine Disorders / etiology
  • Serotonin Receptor Agonists / therapeutic use
  • Sumatriptan / therapeutic use
  • Topiramate
  • Tryptamines / therapeutic use
  • Vasodilator Agents / therapeutic use*

Substances

  • Serotonin Receptor Agonists
  • Tryptamines
  • Vasodilator Agents
  • Topiramate
  • Fructose
  • Sumatriptan
  • Calcitonin Gene-Related Peptide