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Abstract Background and objectives About a quarter of migraine cases among women have menstrual migraine (MM), which is usually more severe, longer lasting, and less responsive to treatment than typical migraine. Randomized controlled trials (RCTs) have evaluated the efficacy of several medication in the acute and preventive treatment of MM; this meta-analysis compared the effectiveness of these treatments. Methods We conducted systematic searches in the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase databases. The primary outcomes of acute treatment trials were pain relief at 2 and 24 h after treatment compared with placebo or another treatment. The three endpoints we checked for studying MM prevention were: no recurrence of headaches each month, a 50% reduction in monthly migraine days from baseline, and a decrease in the mean number of headache days per month. Results Out of 342 studies, 26 RCTs met the criteria. Triptans, combined with or without other analgesics, were superior to placebo in providing pain relief in the acute treatment and prevention of MM. Among the treatments, sumatriptan and lasmiditan demonstrated superior pain relief at 2 h (OR: 4.62) and 24 h (OR: 4.81). Frovatriptan exhibited effectiveness in preventing headache recurrence, whereas galcanezumab and erenumab displayed significant preventive benefits in reducing headache days per month. Conclusion Sumatriptan and lasmiditan are effective first-line treatments for acute MM. For prevention, frovatriptan may be the more effective of triptans. Compared with triptans, CGRP monoclonal antibodies, here including erenumab and galcanezumab, are more effective in reducing headache days, and therefore, in preventing MM.

Introduction and purpose: Migraine is a prevalent neurological disorder, affecting significantly more women, especially during their childbearing years, due to its unique link to the menstrual cycle. Over 50% of women with migraines report a connection between their attacks and menstruation. This review aims to highlight the latest data on the pathophysiology, epidemiology, and treatment of menstrual migraines, emphasizing the need for increased attention to this condition. Materials and Methods: A literature review was conducted using PubMed and Google Scholar, with search phrases including menstrual migraine, migraine, menstruation, migraine diagnosis, migraine treatment, and non-pharmacological migraine treatments. Current Knowledge: Misinterpretation of diagnostic criteria results in conflicting information about the incidence, clinical characteristics, and treatment response of menstrual migraines. Furthermore, clinical studies often do not differentiate perimenstrual attacks. The role of ovarian hormones, particularly estrogen, in the pathogenesis of menstrual migraines complicates treatment efforts. Summary: Due to the common and debilitating nature of the menstrual migraine, more detailed research is essential to expand our understanding of its pathophysiology and to develop more effective treatments. Understanding the mechanisms behind menstrual migraines may lead to new treatment options targeting this specific condition.

Background: Menstrual migraine is a primary headache that often attacks women of reproductive age. This type of migraine has high severity and is resistant to treatment. Therefore, an effective treatment is needed to treat this menstrual migraine. Sumatriptan has been shown to have a better effect as an acute treatment for menstrual migraine patients. Purpose: This study aims to determine the prevalence and effectiveness of sumatriptan as a therapy for menstrual migraine. Methods: This research is based on a literature review following predetermined inclusion criteria. First, a literature search was carried out adhering to the PRISMA flow in 4 databases: Pubmed, Science Direct, ProQuest, and ClinicalTrial.co. Results: Based on keywords, 267 studies were found in the literature search. However, only three studies covering 845 participants met the predetermined inclusion criteria. The average age of menstrual migraine patients in the three studies was 37 years. These three studies of sumatriptan revealed a significant effect in providing a pain-free response in menstrual migraine patients. These three studies also showed that sumatriptan 100 mg has a higher level of effectiveness in providing a pain-free response in menstrual migraine sufferers and was preferably given during mild attacks. Conclusion: These three studies indicate that typically, women who suffer from menstrual migraines are of reproductive age. Additionally, this study shows that using sumatriptan as an acute therapy significantly helps provide a pain-free response in menstrual migraine patients.

Abstract Objective To explore and critically appraise the evidence supporting the role of estrogen withdrawal in menstrual migraine. Main body Menstrual migraine, impacting about 6% of reproductive-age women, manifests as migraine attacks closely related to the menstrual cycle. The estrogen withdrawal hypothesis posits that the premenstrual drop in estrogen levels serves as a trigger of migraine attacks. Despite its wide acceptance, the current body of evidence supporting this hypothesis remains limited, warranting further validation. Estrogen is believed to exert a modulatory effect on pain, particularly within the trigeminovascular system – the anatomic and physiologic substrate of migraine pathogenesis. Nevertheless, existing studies are limited by methodologic inconsistencies, small sample sizes, and variable case definitions, precluding definitive conclusions. To improve our understanding of menstrual migraine, future research should concentrate on untangling the intricate interplay between estrogen, the trigeminovascular system, and migraine itself. This necessitates the use of robust methods, larger sample sizes, and standardized case definitions to surmount the limitations encountered in previous investigations. Conclusion Further research is thus needed to ascertain the involvement of estrogen withdrawal in menstrual migraine and advance the development of effective management strategies to address unmet treatment needs.

Abstract Background Menstrual migraine is a subtype of migraine disease that is typically more disabling, longer-lasting, and more challenging to treat. The purpose of this network meta-analysis (NMA) is to compare the relative efficacy of treatments for menstrual migraine. Methods We systematically searched databases, including PubMed, EMBASE, and Cochrane, and included all eligible randomized controlled trials in the study. We conducted the statistical analysis using Stata version 14.0, based on the frequentist framework. We used the Cochrane Risk of Bias tool for randomized trials version 2 (RoB2) to assess the risk of bias of the included studies. Results This network meta-analysis included 14 randomized controlled trials with 4601 patients. For short-term prophylaxis, frovatriptan 2.5 mg twice daily had the highest probability of effectiveness [OR = 1.87 (95% CI: 1.48 to 2.38)] compared to placebo. For acute treatment, the results showed that sumatriptan 100 mg [OR = 4.32 (95% CI: 2.95 to 6.34)] was the most effective treatment compared to placebo. Conclusions These findings suggest that frovatriptan 2.5 mg twice daily was best for short-term prevention, sumatriptan 100 mg were best for acute treatment. More high-quality randomized trials are required to determine the most effective treatment.

Qiqi Wu,1,* Jiawei Wang,2,* Xiaoqi Lin,2,* Dexiong Han,3 Hantong Hu,3 Hong Gao3 1Department of Acupuncture, Moxibustion and Massage, Wenzhou Central Hospital, Wenzhou City, People’s Republic of China; 2The Third School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou City, People’s Republic of China; 3Department of Acupuncture and Moxibustion, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, People’s Republic of China*These authors contributed equally to this workCorrespondence: Hantong Hu; Hong Gao, Department of Acupuncture and Moxibustion, the Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Xihu District, Hangzhou City, People’s Republic of China, Email 413351308@qq.com; qtgh@vip.qq.comBackground: Menstrual migraine (MM), as a common type of headache related to women’s menstrual cycle, currently available treatments do not produce sufficient effectiveness, making it remains difficult to manage. Although acupuncture may be an effective treatment for MM, there is a lack of convincing evidence to recommend acupuncture to patients with MM until more solid evidence is produced. Therefore, the purpose of our systematic review (SR) and meta-analysis protocol is to synthesize up-to-date evidence regarding the clinical efficacy and safety of acupuncture on MM.Methods: To find qualifying RCTs, nine databases will be searched. RevMan 5.3 will be used to combine the retrieved data for meta-analyses. The Cochrane risk of bias instrument will be used to assess the methodological quality of each included trial. The strength and certainty of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Additionally, we will undertake sensitivity analyses, publication bias, and subgroup analyses if available.Discussion: Our SR and meta-analysis protocol will contribute to determining acupuncture’s therapeutic effect and safety in the preventive treatment of MM. Based on the up-to-date evidence produced by the subsequent SR and meta-analysis, informed treatment decisions will be made by patients, physicians and policy makers.Keywords: menstrual migraine, acupuncture, systematic review, meta-analysis

Background: Migraine is a common health condition in both men and women. Premenstrual syndrome (PMS) affects many women during their menstrual cycle, with around 50–60% of women with migraine attacks experiencing menstrual headaches. Most have mild symptoms, but 5–8% suffer from moderate to severe symptoms, causing distress and functional issues. Pure menstrual migraine (PMM) occurs in about 50% of women with migraine, and it can be debilitating in terms of frequency and severity. This information is crucial for Saudi Arabian medical professionals to provide better care and support, improving the quality of life for women with PMS and menstrual migraine (MM) attacks. Objectives: To estimate the prevalence of MM in women, to evaluate the severity and frequency of MM in women with PMS, and to identify potential risk factors aggravating MM in women with PMS in Saudi Arabia. Methodology: A cross-sectional community-based study was conducted on reproductive-aged (18–50 years) women who had regular menstrual cycles and were diagnosed with PMS, using a self-administered questionnaire between December 2022 to May 2023 in Saudi Arabia. Results: Out of the 2130 female participants, 397 (18.6%) had migraine. Among these 397 migraine sufferers, 230 (57.9%) experienced MM, while 167 (42.1%) had non-MM. In reproductive women in general, MM occurred in 10.7% of cases, while non-MM was observed in 7.8%. There is a correlation between increasing BMI and an increased incidence of MM. About one-third of the participants experienced moderate disability due to migraine attacks, with 134 (33.8%) individuals affected. Additionally, most MM sufferers missed at least 3 days of work in the last 3 months due to their condition. Conclusions: Migraine attacks occurring during the menstrual cycle impair the ability to engage in social, physical, household, and academic activities, often hindering the fulfillment of professional commitments. To gain a deeper understanding of menstrual and non-menstrual migraine attacks, it is essential to conduct extensive prospective studies aimed at developing effective management strategies.

Abstract Background Menstrual migraine is a particular form of migraine with a significant impact on the quality of life for women afflicted. Presently, no study has reported the quality of life in menstrual migraine patients. This work aims to assess the health-related quality of life and identify its associated factors among Chinese menstrual migraine patients. Methods The cross-sectional study group consisted of 109 patients with menstrual migraine, and the control group consisted of 397 female patients with non-menstrual migraine. In total, 506 patients completed questionnaires for demographic and clinical information, the Self-rating Idea of Suicide Scale, the Hamilton Depression Scale, the Hamilton Anxiety Scale, the Headache Impact Test-6, the Perceived Social Support Scale, the Pittsburgh Sleep Quality Index. Health-related quality of life was measured using the 36-Item Short Form Survey. Results Compared with non-menstrual migraine patients, five dimensions of health-related quality of life were all found to be significantly impaired in menstrual migraine patients. Headache frequency (ß = − 0.218, P = 0.014), the impact of headache on daily life (ß = − 0.270, P = 0.002), depression symptoms (ß = − 0.345, P

ObjectiveTo assess the anxiety and depression symptoms and sleep quality in patients with menstrual migraine， so as to provide references for the prevention and treatment of menstrual migraine and its comorbidity.MethodsAccording to the diagnostic criteria of the International Classification of Headache Disorder， third edition （ICHD-3）， 501 female migraine patients， including 112 patients with menstrual migraine and 389 patients with non-menstrual migraine， who attended the outpatient clinic of the Affiliated Hospital of North Sichuan Medical College from February 2019 to February 2020， were selected for the study. The general and clinical data of the patients were collected， meantime， patients were assessed using Hamilton Anxiety Scale （HAMA）， Hamilton Depression Scale-24 item （HAMD-24）， 6-item Headache Impact Test （HIT-6） and Pittsburgh Sleep Quality Index （PSQI）.ResultsThe detection rates of pure anxiety， pure depression， comorbid anxiety-depression and sleep disorders in patients with menstrual migraine were higher than those in patients with non-menstrual migraine （χ2=4.198， 4.355， 5.236， 8.624， P

About 60% of women report menstrual-associated migraine attacks, characterized by a higher intensity and duration and more pronounced treatment resistance. Often, preventive treatment with drugs aimed to relieve menstrual attacks – non-steroidal anti-inflammatory drugs and triptans – is difficult in these patients due to a high risk of medication-overuse headache. In addition, due to a hormonal trigger – a perimenstrual decrease in estrogen – the effect of hormonal contraceptives on migraine attacks has been studied for a long time. This article discusses the results of studies indicating the successful administration of specific hormone therapy regimens, especially in patients with concomitant gynecological pathology or in patients using these drugs for contraception.

Introduction. Menstrual migraine attacks are considered more intense, prolonged, and resistant to treatment than non-menstrual ones. Currently, effect of preventive therapy on the course of menstrual-associated migraine has not been well studied; there are isolated studies on the beneficial effect of hormonal therapy on these attacks.The aim of the study was to compare the treatment results in the groups of menstrual-associated and non-menstrual migraine.Materials and methods. This comparative study included 91 patients aged 18 to 48 years (mean age 33,82 ± 8.4) with migraine and menstrual cycle. Depending on the menstrual association of migraine attacks, the patients were divided into 2 groups: group 1 – 54 patients (mean age 36.07 ± 7.37 years) with menstrual-associated migraine (MAM); group 2 – 37 patients (mean age 30.46 ± 8.81 years) with non-menstrual migraine (NMM).Results. Patients with MAM had more migraine days per month, more often received therapy associated with medication-overuse headache (MOH), more often had experience with triptans in comparison with NMM patients. After the treatment, the number of days with migraine per month in the MAM group remained more than in the NMM group: 8 or more days per month were noted in 36.4%, while among NMM patients – 10.8%. The transition to the new therapy with monoclonal antibodies to the CGRP receptor / ligand was positively assessed by 42.9% of MAM patients and 8.1% of NMM patients. Increased duration of hormonal therapy was characterized by a decrease in the number of days with migraines per month (cor = -0,28).Conclusion. In the MAM group, more severe diseases and frequent formation of MOH are observed, as well as a higher resistance to therapy than in NMM. In general, the use of standard therapy regimens for MAM is less effective than for NMM.

ObjectivesMenstrual migraine (MM) is a special type of migraine associated with the ovarian cycle, which imposes a marked burden on female patients. However, the pathogenesis of MM is not completely understood. We investigated gray matter volume (GMV) and functional connectivity (FC) alterations in patients with MM to explore whether there are changes in resting-state FC (rsFC) in brain regions with structural GMV abnormalities and investigated their relevance to pain and concomitant symptoms.MethodsSeventy-five patients with MM and 54 female healthy controls underwent functional magnetic resonance imaging and examination. The patients completed a patient’s headache diary, which included the frequency of migraine attacks, a visual analog scale for pain, a self-rating anxiety scale, and a self-rating depression scale. We used voxel-based morphometry (VBM) to examine the GMV differences between the MM and healthy control groups. The identified brain areas were selected as seeds to assess functional changes in the MM group. Correlation analysis between the altered VBM/rsFC and clinical outcomes was performed.ResultsCompared with healthy controls, patients with MM showed decreased GMV in the right anterior cingulum cortex (ACC) and increased GMV in the right superior parietal cortex. Pearson’s correlation analysis illustrated that only GMV in the right ACC was associated with visual analogue scale pain scores in the MM group. RsFC with the ACC as the seed showed that patients with MM exhibited increased FC between the ACC and the left inferior temporal gyrus, bilateral angular gyrus, and right precuneus. Correlation analysis showed that the change in FC between the right ACC and the right precuneus was positively correlated with headache frequency, and the change in FC between the right ACC and the right angular gyrus was positively correlated with the depression score.ConclusionOur results suggested that the ACC may be an important biomarker in MM, and its structural and functional impairments are significantly associated with the severity of pain and pain-related impairment of emotion in patients with MM. These findings demonstrated that headache-associated structural and functional abnormalities in the ACC may can provide integrative evidence on the physiological mechanisms of MM.

Abstract Background Many studies have described the features of menstrually-related migraines (MRM) in the natural cycle and the efficacy of prevention. MRM in combined hormonal contraceptive (CHC) users has scarcely been researched. Estrogen and progestin withdrawal in CHC users are both more abrupt and from higher hormone levels compared with the natural cycle. An advantage for prevention of MRM in CHC users is that the hormone withdrawal is predictable. It is unknown, whether the attacks during the hormone-free interval are associated with the hormone withdrawal or onset of bleeding. Improved understanding of this relation might contribute to better define and shorten the time interval for prevention. Methods For this prospective diary-based trial we collected migraine and bleeding data from CHC users with MRM in at least two of three cycles. We analyzed frequency of migraines over the whole CHC cycle. During the hormone-free phase the relation between onset of migraine and onset of bleeding was studied. We compared pain intensity and identified prolonged-migraine attacks during hormone use and the hormone-free phase. Results During the hormone-free interval the number of migraine days and the pain score/migraine day were significantly higher in comparison with the mean during hormone use. The prevalence of migraine attacks was fourfold on hormone-free days 3–6. Migraine typically started on days 1–4. Migraine in relation to bleeding mostly occurred on days − 1 to + 4. In 78% of the cycles the first migraine day occurred during bleeding days 1 ± 2 and 48% started on days − 1 and day 1. The predictability of the first bleeding day was very high. Conclusion The day of hormone-withdrawal migraine and the first bleeding day are highly predictable in CHC users. Migraine onset is mostly day − 1 and 1 of the bleeding and on days 1–4 of the hormone-free interval. Migraine attacks of CHC users in the hormone-free interval are severe and long lasting. Further trials are necessary to investigate if this knowledge can be used to optimise prevention.

The key characteristics of migraine are its considerable predominance in reproductive-aged women. Studying the role of gender characteristics in the pathogenesis and clinical manifestations of migraine, as well as the patterns of changes in the level of female sex hormones depending on the menstrual cycle allow menstrual-related migraine to be considered as an independent subtype of the disease with the presence of characteristic clinical symptoms. The role of comorbidity in the development of menstrual-related migraine remains one of the little studied aspects of this problem.The review presents an update on the patterns of the course of migraine in repriductive-aged women, the effects of hormonal drugs on migraine, and gynecological comorbidity.

Aim:Menstrual migraine (MM) is a condition linked to sudden estrogen withdrawal, however, changes in vascular system and neurotransmitters and several hormones are thought to be the underlying causes. Thyroid function affects both menstrual cycle and headache, however, the relationship between thyroid hormones and MM is still not clear. The aim of the study was to evaluate the relationship of MM with thyroid stimulating hormone (TSH), T3, and T4.Methods:Fifty-six patients without MM (group 1), 34 patients with MM (group 2) and 74 controls who had no migraine (group 3) were included in the study. The mean TSH, T3 and T4 levels were compared between the groups. Age, attack frequency (AF), attack period (AP), visual analog scale (VAS) score, Migraine Disability Assessment (MIDAS) grade, and MIDAS score were compared between group 1 and group 2. Correlation analysis was done for TSH, T3, T4 and each of the variables for the groups.Results:The mean T4 level in group 1, group 2 and group 3 was 1.06±1.74, 0.91±0.22 and 1.35±1.19 (p=0.03), respectively. The mean AF was 5.66±6.37 in group 1 and 3.08±1.81 in group 2 (p=0.02).Conclusion:T4 was significantly lower in patients with MM compared to patients without MM, and this difference became more prominent as compared with controls. We would like to draw attention of our colleagues to the relationship between thyroid function (particularly T4 decline) and MM.

Introduction: Migraine is a common disorder which can be seen in approximately 18% of women. The highest prevalence of this disorder has been reported vastly in the women of age between 18 and 49, when they are in the menstrual period and this is supposed to be associated with the same. Aim: To study the menstrual disorders in women with and without migraine. Materials and Methods: A case-control study was conducted with total population of 175 women (Jan 2018-Feb 2019), diagnosed with migraine, using International Headache Society criteria. Age and sex-matched control group was included in the present study. A semi-structured questionnaire about migraine and migraine-related disabilities, menstrual and headache history was conducted. All results were evaluated by SPSS version 22.0 statistical software; Independent t-test and to investigate the relationship between quantitative variables, Spearman’s correlation coefficient was used. Results: In case group, 25.6% of women had menstrual cycle 38 days, which was significantly more than control group. The proportion of women with period lasting

Abstract Background Menstrual migraine (MM) and premenstrual syndrome (PMS) are two conditions linked to specific phases of the menstrual cycle. The exact pathophysiological mechanisms are not fully understood, but both conditions are hypothesized to be triggered by female sex hormones. Co-occurrence of MM and PMS is controversial. The objective of this population-based study was to compare self-assessed symptoms of PMS in female migraineurs with and without MM. A total of 237 women from the general population who self-reported migraine in at least50% of their menstruations in a screening questionnaire were invited to a clinical interview and diagnosed by a neurologist according to the International Classification of Headache Disorders II (ICHD II), including the appendix criteria for MM. All women were asked to complete a self-administered form containing 11 questions about PMS-symptoms adapted from the Diagnostic and Statistical Manual of Mental Disorders. The number of PMS symptoms was compared among migraineurs with and without MM. In addition, each participant completed the Headache Impact test (HIT-6) and Migraine Disability Assessment Score (MIDAS). Findings A total of 193 women returned a complete PMS questionnaire, of which 67 women were excluded from the analyses due to current use of hormonal contraception (n = 61) or because they did not fulfil the ICHD-criteria for migraine (n = 6). Among the remaining 126 migraineurs, 78 had MM and 48 non-menstrually related migraine. PMS symptoms were equally frequent in migraineurs with and without MM (5.4 vs. 5.9, p = 0.84). Women with MM reported more migraine days/month, longer lasting migraine attacks and higher HIT-6 scores than those without MM, but MIDAS scores were similar. Conclusion We did not find any difference in number of self-reported PMS-symptoms between migraineurs with and without MM.

The article is interdisciplinary in its nature: it involves the areas of neurology, endocrinology and gynecology, and specifically embraces the important problem of using combined oral contraceptives. Thus, the types and side effects of commonly used contraceptive agents are described and discussed. The authors also focus on migraines in women during their periods; to that end, pathogeneses of different types of migraine are analyzed. The relationship between various types of migraines and the use of hormonal contraceptives is discussed. This discussion is supplemented with alternative ways of the women migraine treatment.

Abstract Background In 2016, a large meta-analysis brought the number of susceptibility loci for migraine to 38. While sub-type analysis for migraine without aura (MO) and migraine with aura (MA) found some loci showed specificity to MO, the study did not test the loci with respect to other subtypes of migraine. This study aimed to test the hypothesis that single nucleotide polymorphisms (SNPs) robustly associated with migraine are individually or collectively associated with menstrual migraine (MM). Methods Genotyping of migraine susceptibility SNPs was conducted using the Agena MassARRAY platform on DNA samples from 235 women diagnosed with menstrual migraine as per International Classification for Headache Disorders II (ICHD-II) criteria and 140 controls. Alternative genotyping methods including restriction fragment length polymorphism, pyrosequencing and Sanger sequencing were used for validation. Statistical analysis was performed using PLINK and SPSS. Results Genotypes of 34 SNPs were obtained and investigated for their potential association with menstrual migraine. Of these SNPs, rs2506142 located near the neuropilin 1 gene (NRP1), was found to be significantly associated with menstrual migraine (p = 0.003). Genomic risk scores were calculated for all 34 SNPs as well as a subset of 7 SNPs that were nearing individual significance. Overall, this analysis suggested these SNPs to be weakly predictive of MM, but of no prognostic or diagnostic value. Conclusions Our results suggest that NRP1 may be important in the etiology of MM. It also suggests some genetic commonality between common migraine subtypes (MA and MO) and MM. The identification of associated SNPs may be the starting point to a better understanding of how genetic factors may contribute to the menstrual migraine sub-type.

Abstract Background The aim of this study was to compare a multidisciplinary approach of menstrual (related) migraine, combining the neurological and gynaecological consultation, to a mono-disciplinary approach involving neurological treatment. There is a clear relationship between the menstruation cycle and the occurrence of migraine (menstrual migraine). Nowadays the treatment of menstrual (related) migraine is performed by a neurologist. A treatment with attention to hormonal treatment seems more convenient. Methods This retrospective study was performed in a cohort using data of 88 women with menstrual (related) migraine who visited the menstrual migraine clinic between 2012 and 2014 (intervention group). The results were compared to a historical control group, which consisted of women with menstrual (related) migraine who were treated before 2012 and received a mono-disciplinary approach. Results In the intervention group the Headache Impact (HIT) score significantly improved (65 to 59 points). The mean headache days per month declined significantly (from 6 to 3.83 days) and these women needed less use of pain medication. In the control group the decline in HIT score was less striking (65 to 63.5 points) and the mean headache days per month increased (6 to 6,5 days). It appeared that 20 out of 27 patients in the control group required a gynaecological consultation in course of time. Conclusion A multidisicplinary treatment of women with menstrual (related) migraine gives better results compared to a mono-disciplinary approach. These results should be interpreted with caution as we performed a retrospective study with a relative small control group.

Background: Menstrual Migraine (MM) is a subgroup of migraine headache that affect the quality of life of patients in menstrual age. Iron Deficiency Anemia (IDA) is the most common cause of anemia, especially in women of reproductive age. Objectives: To determine the association of iron deficiency anemia with menstrual migraine. Materials and Methods: This descriptive-analytic study was conducted on women with migraine visiting neurology clinics affiliated to Isfahan University of Medical Sciences in late 2015 and early 2016. The demographic data and characteristics of migraine headache were registered in a designed questionnaire. The patients underwent laboratory tests for iron deficiency and anemia. Data were analyzed in SPSS-20 using Chi-square test and independent t-test. Significance level was considered at p

Background: We aimed to assess the differences between menstrual and non-menstrual headache in women with chronic migraine treated with erenumab. Methods: We included fertile women from a single center. Patients were defined as responders to erenumab if reporting a ≥50% decrease in monthly headache days, as compared to pre-treatment for more than half of the treatment period. Premenstrual days were defined as the two days preceding menstruation, while menstrual days were defined as the first three days of menstruation. Results: We included 18 women (11 erenumab responders and 7 erenumab non-responders) contributing to a total of 103 menstrual cycles and 2926 days. The proportion of headache days was higher in menstrual than in premenstrual and non-menstrual days in erenumab responders (34.4% vs. 14.8% vs. 16.3%, respectively; p < 0.001) and in erenumab non-responders (71.4% vs. 53.6% vs. 48.3%, respectively; p < 0.001). Headache days with ≥2 acute medications were higher in menstrual than in premenstrual or non-menstrual headache days in erenumab non-responders (p = 0.002) but not in erenumab responders (p = 0.620). Conclusions: Our data suggest that migraine is more frequent during than outside menstrual days even in women treated with erenumab.

Menstrual migraine represent a big challenge for practitioners. Various therapy try to alleviate these attacks, usually long half-life triptans and-or anti-inflammatory drugs, combined with caffeine, magnesium etc, but sometimes without efficacy. To support this limited class of patients, we considered to use the Oxycodone/Naloxone Extended Release (O/N-ER) for its favourable mechanism of action on neuropathic pain, long half life and well documented gastrointestinal safety. Recruitment is only for patients non-responders to classical preventive therapy. We have collected 33 patients, 25 with pure menstrual migraine, 8 with menstrual correlated migraine, reduction of days with migraine was significant passing from 3,5 to 2 day per attack,with also a significant reduction in pain at NRS scale from 7,7 with classical preventive therapy to 4,1 with O/N-ER, with also high level of tollerability.

Migraine often begins during menarche and generally improves during the second and third trimesters of pregnancy. According to epidemiologic studies, up to 60% of migraines are menstrual migraine. A new subclassification for menstrual migraine was proposed in the 2004 International Classification of Headache Disorders that differentiated between pure menstrual migraine without aura and menstrually-related migraine without aura. The decline in the estrogen level occurring before menstruation has been implicated as the precipitating biologic event for menstrual migraine. Menstrual migraine are of longer duration and are more likely to be severe than headaches occurring at the other times in the menstrual cycle. The options available for the treatment of menstrual migraine include nonpharmacologic approaches, acute therapy, short-term preventive therapy and long-term preventive therapy. The purpose of the present study is to assess the diagnosis, pathogenesis and treatment of menstrual migraine

The relationship between migraines and the menstrual cycle in prepubertal and pubertal girls was analyzed retrospectively in 896 girls, aged 9 to 18 years (mean age 14.3 years), attending a pediatric Headache Center at the Cincinnati Children’s Hospital, OH.