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Objective Background Methods Results Conclusion To analyze cognitive performance and brain activation during a working memory task in patients with migraine during various phases of the migraine cycle and compare to healthy participants.Cognitive difficulties reported during migraine attacks remain poorly understood, despite evidence that the lateral frontoparietal network undergoes reversible disturbances and decreased activation during attacks. Recent findings in resting state functional magnetic resonance imaging suggest that brain areas involved in this network interact with subcortical regions during spontaneous migraine attacks.In this prospective, within‐subject study, 10 patients with diagnosed menstrual‐related episodic migraine without aura underwent 3T functional magnetic resonance imaging assessments while performing a working memory task across four phases of the natural migraine cycle: peri‐ictal (preictal, ictal, postictal) phases and interictally (between attacks). Migraine prophylaxis was an exclusion criterion. Fourteen healthy controls were assessed during the corresponding phases of their menstrual cycles.The protocol was completed by 24 female participants aged 21 to 47 years: 10 with migraine (four sessions each) and 14 healthy controls (two sessions each) yielding a total of 68 analyzed datasets. Patients and controls showed similar performance on the working memory task and displayed increased brain activity in regions linked to this function, namely the middle frontal gyrus, inferior parietal lobe, and anterior cingulate cortex, during all phases of the migraine/menstrual cycle. Patients with migraine (N = 10) exhibited a significant decrease in hypothalamic activity (p = 0.007) as measured by the percent signal change (PSC) during the postictal phase compared to perimenstrual controls (N = 14), with −2 (16) and 31 (35) PSC, respectively. Comparing across the migraine cycle, the change in hypothalamic activity relative to controls in the postictal phase −0.33 (0.2) ΔPSC was significantly different from the ones in the interictal (0.006 [0.5] ΔPSC; p = 0.002) and preictal (−0.08 [0.4] ΔPSC; p = 0.034) phases.During a working memory task, cognition‐related brain activation was present across all phases of the migraine cycle similarly to healthy control participants. Patients with migraine, however, displayed lower neural activity at the subcortical level in the postictal phase. Nonetheless, the sample size is a limitation for the generalization of our results. More research is needed to fully understand how the brain copes with cognitive demands during spontaneous migraine attacks. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

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Copyright of Gaceta Médica de Caracas is the property of Academia Nacional de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose of Review: Migraine is both an important and prevalent disease affecting the health of women. The purpose of the current review is to describe how migraine can change throughout a woman's life in conjunction with hormonal fluctuations and to detail what treatments can be used to combat these hormonal changes. Additionally, menstrual migraine, medications safe in pregnancy, and hormonal contraception are discussed. Recent Findings: Contrary to popular belief, hormonal contraception can be used in women who have migraine with aura, precluding other contraindications. Preliminary data is now available on the safety of the newest migraine drugs in pregnancy. Summary: Despite it being one of the largest sources of disability globally, especially among women, migraine remains a poorly understood disease by many medical professionals. The levels of the hormones estrogen and progesterone vary greatly throughout a woman's life, such as in menarche, menstrual cycling, pregnancy, perimenopause, and menopause which can all affect migraine patterns. Menstrual migraine may require special prophylactic therapy with NSAIDs, triptans, or estradiol. Migraine can pose increased challenges during pregnancy, especially with more limited treatment options approved. When prescribing hormonal contraception, migraine should be an important consideration. [ABSTRACT FROM AUTHOR]

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.

Background: We evaluated galcanezumab for migraine prevention in patients who met International Classification of Headache Disorders, 3rd edition criteria for menstrually related migraine (MRM). Methods: Patients were identified post hoc from three double‐blind, randomized, phase 3 clinical trials in patients with episodic migraine. Patients completed a 1‐month prospective baseline period and up to 6 months (EVOLVE‐1 and ‐2, studies pooled) of double‐blind treatment with galcanezumab (120 mg/month) or placebo. Menses and headache information were recorded by electronic daily diary. Patients with a migraine attack starting during the 5‐day perimenstrual interval (first day of bleeding ± 2 days) for ≥2 of their first three diary‐recorded menstrual cycles were categorized as having MRM. The primary efficacy measure was mean change in monthly migraine headache days from baseline, averaged over Months 4 through 6. Response rates, change in monthly perimenstrual migraine headache days, monthly non‐perimenstrual migraine headache days, and quality of life were also assessed. Results: Post hoc MRM analysis criteria were met by 462/1133 women (41%). Mean (standard deviation) baseline monthly migraine headache days were 9.7 (±3.1; n = 146) for galcanezumab‐treated patients and 9.6 (±2.8; n = 316) for placebo‐treated patients. The mean change (standard error [SE]) in migraine headache days over Months 4 through 6 was −5.1 days (±0.39) for galcanezumab versus −3.2 (±0.35) for placebo (p < 0.001). The mean change (SE) in perimenstrual migraine headache days over Months 4 through 6 was −0.75 days (±0.08) for galcanezumab versus −0.49 (±0.07) for placebo (p = 0.004). For migraine headache days outside the perimenstrual period, the mean change in migraine headache days was −4.6 (±0.38) for galcanezumab and −2.8 (±0.33) for placebo (p < 0.001). Improvements in response rates and the Migraine‐Specific Quality of Life Questionnaire were also observed over Months 4 through 6. Conclusion: Galcanezumab was effective for migraine prevention in women with MRM. [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

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 FROM AUTHOR]

Identifying migraine comorbidities may guide prognosis and treatment options. This study aimed to assess the frequency of comorbid conditions among adults with migraine living in Greater Cairo. In this cross-sectional study, Egyptian migraine sufferers aged ≥ 18 years living in Greater Cairo were consecutively recruited (April 2019 – April 2021). Following The International Classification of Headache Disorders-third edition, diagnosis of migraine was confirmed, and the type of migraine was defined as whether episodic or chronic, with or without aura, with childhood/adolescence or adulthood onset. Specialist physicians from the research team assessed comorbid conditions among the respondents. The mean age of respondents (n = 1064) was 35 ± 7. Irritable bowel syndrome represented the most common comorbidity in our patients (45.5%), followed by vitamin D deficiency (41.8%). The frequency of epilepsy, stroke, multiple sclerosis, and systemic lupus erythematosus was significantly higher in patients with chronic than episodic type (χ2 = 4.514, P = 0.034), (χ2 = 12.302, P = 0.001), (χ2 = 12.302, P = 0.001), (χ2 = 4.806, P 0.028), respectively. Females with menstrual migraines had a significantly higher frequency of generalized anxiety disorder, panic attacks, and restless leg syndrome than those with non-menstrual migraines (χ2 = 7.636, P 0.006), (χ2 = 9.245, P = 0.002), and (χ2 = 11.997, P = 0.001), respectively. The frequency of diabetes was significantly higher in patients with migraine with aura than in those without aura (χ2 = 4.248, P value 0.039). This study provides a better understanding of the comorbidities in Egyptian patients with migraine and will provide new avenues for developing individualized therapy for migraine patients. [ABSTRACT FROM AUTHOR]

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.

Background: Migraine is a disease that is considered among the top 10 diseases causing disability in humans with the highest involvement in middle-aged and young females. In females of menstrual age, a different variant of migraine is seen and is known as MM (menstrual migraine). Aim: The present study aimed to comparatively assess the menstrual-related and menstrual unrelated migraine in Indian females. Methods: The present study assessed females from the Department of Obstetrics and Gynecology having the primary headache of the migraine type. After screening, the subjects were divided into two groups where Group I had menstrual migraine subjects and Group II had MUM (menstrual unrelated migraine) subjects following the criteria by IHS (International Headache Society). The subjects were then compared for migraine attacks after questioning them for different symptoms. Results: Among these 90 subjects, 70% (n=63) subjects were found to fit the inclusion criteria and had the primary headache. The results showed that phonophobia was seen in 41.93% (n=13) subjects with menstrual migraine and 25% (n=8) subjects with menstrual unrelated migraine which was significantly higher in the menstrual migraine group with p=0.02. Photophobia has seen in 67.74% (n=21) subjects from the menstrual migraine group and in 34.37% (n=11) subjects with MUM which was also significantly higher in the MM group with p=0.00007. Vomiting as a symptom was higher in the MM group with 64.51% (n=20) subjects and was seen in 53.12% (n=17) subjects from the MUM group with p=0.24. The nausea was significantly higher in 87.09% (n=27) subjects compared to 62.5% (n=20) subjects in the MUM group with p=0.002. In the menstrual migraine group, the unilateral headache was seen in 77.41% (n=24) study subjects and bilateral in 22.58% (n=7) study subjects respectively. Conclusion: The present study, considering its limitations, concludes that more features of migraine headaches are observed in females with menstrual-related migraine including the longer attack duration and overall worse migraine experience. [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Women with endometriosis are frequently affected by headache. How many of these have a clear diagnosis of migraine? Are the different forms of migraine related to the phenotypes and/or characteristics of endometriosis? This was a prospective nested case-control study. A consecutive series of 131 women with endometriosis who attended the endometriosis clinic were enrolled and examined for the presence of headache. A headache questionnaire was used to determine the characteristics of the headaches, and the diagnosis of migraine was confirmed by a specialist. The case group included women with endometriosis and a diagnosis of migraine, while the control group included women with only endometriosis. History, symptoms and other comorbidities were collected. A pelvic pain score and associated symptoms were assessed using a visual analogue scale. A diagnosis of migraine was made in 53.4% (70/131) of participants. Pure menstrual migraine was reported by 18.6% (13/70), menstrually related migraine by 45.7% (32/70) and non-menstrual migraine by 35.7% (25/70). Dysmenorrhoea and dysuria were significantly more frequent in patients with endometriosis and migraine than in those without migraine (P = 0.03 and P = 0.01). No difference was found for other variables, including age at diagnosis and duration of endometriosis, endometriosis phenotype, the presence of other autoimmune comorbidities or heavy menstrual bleeding. In most patients with migraine (85.7%) the headache symptoms had started years before the diagnosis of endometriosis. The occurrence of headache in many patients with endometriosis is associated with the presence of different forms of migraine, is related to pain symptoms and often precedes the diagnosis of endometriosis. [ABSTRACT FROM AUTHOR]

Background and purpose: Anti‐calcitonin gene‐related peptide (CGRP) (receptor) antibodies effectively reduce overall migraine attack frequency, but whether there are differences in effect between perimenstrual and nonperimenstrual migraine days has not been investigated. Methods: We performed a single‐arm study among women with migraine. Participants were followed with electronic E‐diaries during one (pretreatment) baseline month and 6 months of treatment with either erenumab or fremanezumab. Differences in treatment effect on perimenstrual and nonperimenstrual migraine days were assessed using a mixed effects logistic regression model, with migraine day as dependent variable; treatment, menstrual window, and an interaction term (treatment × menstrual window) as fixed effects; and patient as a random effect. Results: There was no interaction between the menstrual window and treatment effect, indicating that the reduction in migraine days under treatment was similar during the menstrual window and the remainder of the menstrual cycle (odds ratio for treatment = 0.44, 95% confidence interval = 0.38–0.51). Conclusions: Our findings support prophylactic use of anti‐CGRP (receptor) antibodies for women with menstrual migraine, as this leads to consistent reductions in number of migraine days during the entire menstrual cycle. [ABSTRACT FROM AUTHOR]

Background: Previous studies showed that the perimenstrual window is associated with an increased susceptibility to migraine attacks without aura, but had conflicting results regarding attacks with aura. Methods: We performed a longitudinal E-diary study among 526 premenopausal women with migraine. Differences in occurrence of perimenstrual migraine attacks between women with migraine with aura and without aura were assessed using a mixed effects logistic regression model. Additionally, participants completed a questionnaire about the influence of hormonal milestones on migraine frequency. Results: Prevalence of menstrual migraine did not differ between women with migraine without aura and migraine with aura (59% versus 53%, p = 0.176). The increased risk of migraine attacks without aura during the perimenstrual window was similar for women with migraine without aura (OR[95%CI]:1.53 [1.44–1.62]) and those with migraine with aura (1.53 [1.44–1.62]). The perimenstrual window was not associated with increased risk of migraine aura attacks (1.08 [0.93–1.26], p = 0.314). Women with migraine with aura more often reported increased migraine frequency during pregnancy and breastfeeding compared to women with migraine without aura, but not during hormonal contraception use. Conclusion: Sex hormone levels seem to differently affect the trigeminovascular system (migraine headache) and the susceptibility to cortical spreading depolarization (aura). Exclusively migraine attacks without aura should be interpreted as perimenstrual attacks. [ABSTRACT FROM AUTHOR]

Migraine is a prevalent, inherited and disabling brain disease with multiple symptoms and a variety of treatment options. Nerivio, utilizing remote electrical neuromodulation (REN) a wearable device, offers users good efficacy, tolerability and safety. It is user-friendly, affordable, non-addictive and cleared by the FDA and the European Conformity. The device structure, mechanism of action, indications for use, application instructions, efficacy, adverse events, tolerability, safety, patient satisfaction, associated application and the research highlights are discussed herein. The device works well for most people living with migraine, often without concomitant medication, is tolerable, safe and causes minimal and mild adverse effects. It expands our migraine treatment options and improves patient adherence to treatment. Nerivio is easy-to-use and can be worn at any time of the day; it provides a non-pharmacologic option for the optimization of migraine treatment without significant adverse events. [ABSTRACT FROM AUTHOR]

Qiqi Wu,1,&ast; Jiawei Wang,2,&ast; Xiaoqi Lin,2,&ast; 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&ast;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

In this article, we discuss menstrual migraine (MM), which can be categorized as menstrually related migraine (MRM) or pure menstrual migraine (PMM). MM attacks are often longer, more severe, and harder to treat than other migraine attacks. Appropriate treatment strategies include acute treatment, short term preventive treatment, and daily preventive treatment, depending on the patient's pattern of migraine and occurrence of migraine outside the menstrual period. A PubMed, Cochrane Library, Medline, and Ovid search from inception to October 2022 provided articles relating to MM pathophysiology and treatment. In patients for whom standard acute therapy is inadequate, short term or daily preventive treatment should be considered. Patients with PMM may be adequately managed with short term preventive treatment started 2 days prior to the onset of migraine and continued for 5–6 days. Frovatriptan is the mainstay of short-term prevention. Patients who experience additional attacks outside the menstrual period may benefit from daily preventive treatment. Estrogen-containing contraceptive treatment may be effective in appropriately selected patients. Emerging research on the pathophysiology of MM indicates that oxytocin agonists and CGRP antagonists may prove to be effective treatment options. [ABSTRACT FROM AUTHOR]

Background and purpose: Approximately 60% of female migraineurs experience menstrual migraine (MM). Whether MM is a distinct clinical entity with more severe migraine attacks and a worse prognosis than nonmenstrual migraine (nMM) is still under debate. We conducted a systematic review and meta-analysis to investigate clinical differences between MM and nMM patients. Methods: A systematic literature search was performed to identify observational studies comparing MM and nMM patients' clinical characteristics. Quality of evidence grades of the synthesized effect estimates for each outcome were determined following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Results: Of 1837 identified studies, 16 were eligible for inclusion. MM patients had more migraine attacks per month (MD 0.65, 95% CI 0.05–1.24) than nMM patients; however, the quality of evidence was "low" according to the GRADE assessment. They also had more headache days (MD 0.86, 95% CI 0.12–1.60) per month, a higher rate of family history of migraine (OR 1.41 95% CI 1.12–1.78), migraine aggravation with physical activity (OR 1.60, 95% CI 1.35–1.89), a younger age at migraine onset (MD − 0.99, 95% CI − 1.78 to − 0.19), and a higher risk of accompanying symptoms (OR 2.31, 95% CI 1.72–3.10) than nMM patients; however, the quality of evidence was "very low". Conclusions: There were differences between MM and nMM, showing that MM patients have a worse profile than nMM patients, but the quality of evidence is too low to draw definite conclusions on the separation/unification of the two clinical entities. [ABSTRACT FROM AUTHOR]

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.

Background: Perimenstrual migraine attacks in women with menstrual migraine is difficult to treat. This post-hoc analysis evaluated the efficacy of lasmiditan, a high affinity and selective 5-HT1F receptor agonist, for perimenstrual attacks.Methods: Patients from two randomized, double-blind, placebo-controlled clinical trials (MONONOFU and CENTURION) were instructed to treat an attack with a single dose of study medication within four hours of pain onset. After dosing, the proportion of patients who achieved freedom from migraine-related head pain, most bothersome symptom, and disability was reported at baseline up to 48 hours after dose and pooled data were evaluated.Results: A total of 303 patients (MONONOFU N = 78; CENTURION N = 225) treated perimenstrual migraine attacks with lasmiditan 50 mg (N = 24), 100 mg (N = 90), 200 mg (N = 110), and placebo (N = 79). More patients achieved migraine-related head pain freedom with lasmiditan 200 mg versus placebo at all time points assessed. At 2 hours, 33.6% of patients in the 200-mg group (p < 0.001), and 16.7% of patients in the 100-mg (p = 0.11) and 50-mg (p = 0.19) groups were pain free, compared with 7.6% in the placebo group.Conclusions: Lasmiditan treatment of perimenstrual migraine attacks was associated with freedom from migraine-related head pain at two hours, early onset of efficacy, and sustained efficacy.Clinical Trial registration: NCT03962738 and NCT03670810. [ABSTRACT FROM AUTHOR]

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.

Objective: To assess validity of ICHD-3 diagnostic criteria for menstrual migraine. Methods: We performed a longitudinal E-diary study in premenopausal women with migraine. Menstrual migraine diagnosis was self-reported at baseline, and verified according to diary based ICHD-3 criteria and a previous proposed statistical model. Validity of self-reported menstrual migraine was compared to diary based diagnosis and statistical diagnosis. Test-retest reliability and concordance between both methods were determined. Clinical characteristics of perimenstrual and non-perimenstrual migraine attacks were compared in women with and without menstrual migraine. Results: We included 607 women. Both women who did and women who did not self-report to suffer from menstrual migraine fulfilled ICHD-3 criteria in the E-diary in two thirds of cases. Pure menstrual migraine was extremely rare (<1%). Concordance between statistical and diary based diagnosis was minimal (κ = 0.28, 95% CI:0.23–0.33). Women diagnosed with menstrual migraine showed 37–50% longer attack duration and increased triptan intake (OR 1.19–1.22, p < 0.001) during perimenstrual attacks. Conclusion: Self-reported menstrual migraine diagnosis has extremely poor accuracy. Two thirds of women suffer from menstrual migraine, independent of self-reports. Pure menstrual migraine is rare. Women with menstrual migraine have longer attack duration and increased triptan intake during perimenstrual attacks, in contrast to women without menstrual migraine. Prospective headache (E-)diaries are required for a menstrual migraine diagnosis, also in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: Menstrual 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. Methods: Seventy-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. Results: Compared 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. Conclusion: Our 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 headacheassociated structural and functional abnormalities in the ACC may can provide integrative evidence on the physiological mechanisms of MM. [ABSTRACT FROM AUTHOR]

This literature review explores the association between iron deficiency anemia and migraines, examining their prevalence, underlying pathophysiology, and therapeutic potential of iron supplementation in managing migraine symptoms. A systematic search across major academic databases, including PubMed, Google Scholar, ScienceDirect, and Science.gov, identified relevant peer-reviewed studies that focus on the link between iron deficiency anemia and migraines. The review highlights a higher prevalence of iron deficiency anemia among migraine sufferers, particularly women, with several studies indicating a significant inverse relationship between serum ferritin levels and migraine severity. The findings suggest that low iron levels may exacerbate migraine symptoms, and iron supplementation has been shown to reduce the frequency and intensity of migraines, especially in patients with confirmed iron deficiency anemia. The review also discusses the unique susceptibility of women, particularly those of reproductive age, to both iron deficiency anemia and migraines, emphasizing the importance of gender-specific approaches in treatment. Moreover, the potential impact of iron deficiency on neurovascular function and its contribution to migraine pathogenesis is explored, reinforcing the need for comprehensive management strategies that include nutritional interventions. While iron supplementation appears to be a promising therapeutic option, further research is required to fully understand its long-term effects and to refine treatment protocols to avoid the risks associated with iron overload. This review underscores the significance of addressing nutritional deficiencies as part of a holistic approach to migraine management, offering insights into potential avenues for improving patient outcomes., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Al-Qassab et al.)

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.

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 < 0.001) were significantly associated with physical component summary, depression symptoms (ß = - 0.379, P < 0.001), social support (ß = 0.270, P < 0.001), suicidal ideation (ß = - 0.344, P < 0.001) were closely related to mental component summary.Conclusion: Menstrual migraine patients had a significantly poorer health-related quality of life in many domains than non-menstrual migraine patients. Headache frequency, the impact of headache on daily life, depression symptoms, social support, and suicidal ideation were significantly associated with health-related quality of life in menstrual migraine patients.Trial Registration: ChiCTR1800014343. This study was registered prospectively on 7 January 2018 at Chinese Clinical Trial registry. http://www.chictr.org.cn/showproj.aspx?proj=24526. [ABSTRACT FROM AUTHOR]

Perimenopause is linked to increased migraine (Mg), especially menstrual Mg (MMg), influenced by hormonal changes. Compared to nonmenstrual attacks, menstrual attacks are more disabling and less responsive to treatment. Women with perimenstrual estrogen withdrawal have been linked to Mg during menstruation, whereas Mg during perimenopause has been linked to unpredictable fluctuations in estrogen levels. It has been widely established that female sex hormones play a role in Mg, but how it occurs remains unclear. This narrative review was identified using Medline and PubMed searches between 1946 and 2021. Search terms included "headache," "migraine," "menstrual migraine," "menstruation," "menopause," "perimenopause," "estrogen," and "progesterone." This article focuses on the candidate genes and female hormones that play a role in MMg. More study is necessary to understand better the environmental components that play a critical role in disease development. Currently, there is insufficient clinical evidence to support the function of menstrual Mg. The specific research facts examined MMg unique candidate genes and female hormonal factors that support their association and found MMg etiologic processes for generating an early diagnostic marker. [ABSTRACT FROM AUTHOR]

Introduction: The interaction between breast cancer and migraine is complex and not fully elucidated. Large epidemiological studies point towards a beneficial effect of migraines on breast cancer (BC). We aimed to investigate the BC–migraine relationship, with strict data checks and clinical evaluations of both BC and common headache forms. Methods: Consecutive BC patients were evaluated with the International Classification of Headache Disorders. Clinical data on the BC subtypes and treatments were collected. Parametric and nonparametric statistics were used according to data distributions. Results: Fifty patients were recruited. The mean age was 53.5 ± 12.5 years; 42% were postmenopausal, 52% were premenopausal, and 6% were peri-menopausal. Eleven patients were diagnosed as luminal A, nine as luminal B, 24 as HER2-positive (HER2 +), six as triple-negative BC. Thirty-eight (76%) patients had hormone receptor-positive disease. Ninety-two percent received chemotherapy, 66% received endocrine therapy, and 52% received radiotherapy. Nine out of 50 reported a worsening of headache after systemic treatment. Migraine was diagnosed in 29 patients (18 with menstrual migraine), tension-type headache (TTH) in nine, and no headache in 12. Patients with migraine were younger (48.4 ± 10.7 vs. 60.5 ± 12; p < 0.01). Patients with migraine and TTH had a higher chance of having a HER2 + BC (p < 0.05). Active migraine was associated with a higher expression of estrogen receptors (p = 0.04). Conclusions: Patients with active migraine had higher estrogen receptor expression, while migraine and TTH patients mainly had HER2 + BC. This association was not known earlier and could be helpful to understand deeper the relationship between BC and headache. [ABSTRACT FROM AUTHOR]

Objective: According to the ICHD-3 criteria, menstrual migraine (MM) is divided into two groups: pure menstrual migraine (PMM) and menstrually-related migraine (MRM). The present study aimed to evaluate and compare the severity of headache using a visual analog scale (VAS) and the effect on quality of life using the Headache Impact Test (HIT) and Migraine Disability Assessment (MIDAS) tests before and after 3 months of treatment in using short-term prophylaxis with acetazolamide. Methods: Patients who presented to the headache outpatient clinic of the neurology department with a diagnosis of MM were retrospectively reviewed. Acetazolamide was given at a dosage of 500 mg daily for 5 days starting two days before the predicted onset of the menstrual cycle as a short-term prophylactic treatment. VAS, MIDAS, and HIT assessments were performed before and after treatment. Results: A total of 26 patients with PMM and 26 patients with MRM were identified. After acetazolamide treatment, statistically significant improvement was found in MIDAS, VAS and HIT scores in both groups of patients. The post-treatment MIDAS score was significantly lower in the MRM group, but there was no significant difference in post-treatment VAS and HIT scores between the groups. Conclusion: Using acetazolamide for short-term prophylaxis in patients with MM leads to decreased severity and frequency of headache and improvement in quality of life. The study is the first in the literature to use acetazolamide for short-term prophylaxis in patients diagnosed with MM. [ABSTRACT FROM AUTHOR]

Introduction: Migraine shows a significantly higher prevalence in women, especially during reproductive age when menstrual-related hormonal fluctuations represent the most common migraine trigger. Indeed, over 50% of patients report a higher occurrence of migraine attacks during the perimenstrual window. Menstrual migraine attacks are consistently referred to as more disabling, less responsive to symptomatic treatments, longer in duration, and more prone to relapse than non-menstrual migraine attacks. Evidence strongly suggests that estrogen fluctuations are involved in migraine attacks worsening during the perimenstrual window through several mechanisms directly or indirectly involving the CGRP pathway. We aimed to evaluate whether mAbs blocking CGRP-ligand or receptor (CGRP-mAbs) could represent an effective and safe preventive treatment for menstrual migraine attacks in patients with menstrual-related migraine (MRM) with previous treatment failures. Methods: Forty patients with MRM with at least three previous treatment failures received monthly CGRP-mAbs. At the baseline and after six CGRP-mAbs administrations, patients underwent to extensive interviews to assess frequency, duration, intensity, and responsiveness to painkiller intake of migraine attacks occurring during the perimenstrual window. Results: After six administrations of CGRP-mAbs we observed a reduction of median menstrual migraine frequency (from 5 to 2 days per month), pain intensity (from 8/10 to 6/10), and attacks duration (from 24 to 8 h) (p < 0.001). Nevertheless, a significant increase in the percentage of responding to migraine painkillers was observed from 42.5% at baseline to 95% at T1 (p < 0.001). Conclusions: CGRP-mAbs could represent a safe and effective preventive therapeutic strategy able to reduce the disabling burden of menstrual migraine attack frequency, duration, intensity, and significantly improve the response to painkillers. These findings could be related to and further indirectly prove the greater influence of CGRP-mediated mechanisms in the pathophysiology of menstrual migraine attacks. [ABSTRACT FROM AUTHOR]

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.

Objectives: Transcranial direct current stimulation (tDCS) has been suggested as an alternative treatment option for migraine. The present study aimed to evaluate the efficacy of tDCS on clinical outcomes in addition to calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating peptide 38 (PACAP-38) levels in individuals with menstrual-related migraine (MRM) for the first time., Materials and Methods: In this parallel study, 58 female patients between the ages of 18 and 45 years, including 36 with MRM and 22 with nonmenstrual migraines (nMM), were recruited. Sessions of 2-mA 20-minute anodal tDCS were administered over the left dorsolateral prefrontal cortex within three consecutive days (1:1 active and sham stimulation). Migraine attack frequency, severity, analgesic usage, CGRP, and PACAP-38 levels of the patients were evaluated before and one month after tDCS., Results: After tDCS, in the active group compared with the sham group, the frequency (p = 0.031), the severity of attacks (p = 0.003), the number of days with headache (p = 0.004), and the analgesic usage (p = 0.024) were all decreased. In both MRM and nMM groups, the frequency and severity of attacks and analgesic usage were decreased in those receiving active stimulation (p < 0.001 for each). CGRP and PACAP-38 levels were no different in the active group and the sham group after tDCS., Conclusions: tDCS was shown to be efficacious in migraine prophylaxis and a valuable option for migraine and MRM treatment. The absence of changes in serum CGRP and PACAP-38 levels suggests that tDCS efficacy may stem from distinct cerebral electrophysiological mechanisms., Competing Interests: Conflict of Interest The authors report no conflict of interest., (Copyright © 2024 International Neuromodulation Society. All rights reserved.)

Objective: To highlight the emerging understanding of oxytocin (OT) and oxytocin receptors (OTRs) in modulating menstrual‐related migraine (MRM). Background: MRM is highly debilitating and less responsive to therapy, and attacks are of longer duration than nonmenstrually related migraine. A clear understanding of the mechanisms underlying MRM is lacking. Methods: We present a narrative literature review on the developing understanding of the role of OT and the OTR in MRM. Literature on MRM on PubMed/MEDLINE database including clinical trials and basic science publications was reviewed using specific keywords. Results: OT is a cyclically released hypothalamic hormone/neurotransmitter that binds to the OTR resulting in inhibition of trigeminal neuronal excitability that can promote migraine pain including that of MRM. Estrogen regulates OT release as well as expression of the OTR. Coincident with menstruation, levels of both estrogen and OT decrease. Additionally, other serum biochemical factors, including magnesium and cholesterol, which positively modulate the affinity of OT for OTRs, both decrease during menstruation. Thus, during menstruation, multiple menstrually associated factors may lead to decreased circulating OT levels, decreased OT affinity for OTR, and decreased expression of the trigeminal OTR. Consistent with the view of migraine as a threshold disorder, these events may collectively result in decreased inhibition promoting lower thresholds for activation of meningeal trigeminal nociceptors and increasing the likelihood of an MRM attack. Conclusion: Trigeminal OTR may thus be a novel target for the development of MRM therapeutics. [ABSTRACT FROM AUTHOR]

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This study sought to determine the prevalence of menstrual migraine among female university students at the Nursing Faculty of Ciudad Real and to determine possible risk factors. A cross-sectional observational study was performed using a self-report questionnaire. Two hundred and ninety-nine female university students participated in the study; all were enrolled in the 2017/2018 academic year at the Faculty of Nursing. Participants were over the age of 18 years and without any diagnosed gynecological pathology. The main measurement tools were menstrual migraine between days −2 and +3 of the menstrual cycle, over the previous six cycles. The prevalence of menstrual migraine was 45.15%, identifying the following possible risk factors: dysmenorrhea (OR 9.19; 1.62–6.28% CI), use of hormonal contraceptive methods (OR 2.60; 95% CI 1.30–5.20), menstrual irritability (OR 2.34; 95% CI 1.25–4.40), menstrual dizziness (OR 2.05; 95% CI % 1.12–3.75) and daily consumption of cola beverages (OR 1.85; 95% CI % 1.04–3.32). The prevalence of this problem is high among our population and the approach is complex. Practice implications: It is necessary to continue to research the pharmacological measures and methods of pharmacological pain relief as well as interventions directed at lifestyle modifications considering the potential risk factors involved in menstrual migraine. • The prevalence of menstrual migraine was 45.15% in young Spanish woman. • Dysmenorrhea, menstrual irritability and menstrual dizziness are identified as possible risk factors for migraine. • The use of hormonal contraceptive methods and daily consumption of cola beverages are identified as possible risk factors for menstrual migraine. • Nurses should be the key to providing community interventions based on lifestyle modification. [ABSTRACT FROM AUTHOR]

Migraine is affected by the changing hormone environment, with perimenopause associated with increased migraine, particularly menstrual migraine. Menstrual attacks are recognised to be more disabling and less responsive to treatment compared with non-menstrual attacks. Perimenstrual estrogen 'withdrawal' is implicated in the pathophysiology of menstrual migraine, with increased prevalence of migraine in perimenopause associated with unpredictable estrogen fluctuations. Perimenopausal women often have contraceptive needs as well as menopause symptoms and it is important to understand the potential effects of exogenous hormones on migraine. Maintaining stable estrogen levels with exogenous hormones can benefit migraine but clinical trial data are limited. This short narrative review addresses the diagnosis and management of menstrual migraine in perimenopausal women, and discusses the management of menopause symptoms in peri- and postmenopausal women with migraine. [ABSTRACT FROM AUTHOR]

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