6. International Classification of Headache Disorders II criteria for menstrual migraine
(Headache Classification Subcommittee of the International Headache Society, 2004)
7. Epidemiology
60 % migraineurs reported increased frequency related to menstruation
7-14 % migraneurs have menstruation as the only trigger of their migraines
Migraines is more severe in menstrual period
Kornstein SG, Parker AJ. Menstrual migraines:Etiology, treatment, and relationship to premenstrual syndrome. Curr Opin Obstet Gynecol. 1997;9:154-159.
9. Pathophysiology
estrogen serotonin production, serotonin reuptake and elimination
estrogen greater pain tolerance, acts as endogenous opioid, regulate galanine and
neuropeptide Y involved in nociception
estrogen during pregnancy pregnant women have better pain tolerance
1. Martin VT, Behbehani M. Ovarian hormones and migraine headache: Understanding mechanisms and pathogenesis—part I. Headache. 2006;46:3-23.
2. Silberstein SD, Elkind AH, Schreiber C, Keywood C. A randomized trial of frovatriptan for the intermittent prevention of menstrual migraine. Neurology. 2004;63:261-269.
3. Dawson-Basoa MB, Gintzler AR. 17-β-estradiol and progesterone modulate an intrinsic opioid analgesic system. Brain Res. 1993;601:241-245.
4. Puri V, Cui L, Liverman CS, Roby KF, Klein RM, Welch KM, Berman NE. Ovarian steroids regulate neuropeptides in the trigeminal ganglion. Neuropeptides. 2005;39:409-417.
5. Cahill CA. Beta-endorphin levels during pregnancy and labor: A role in pain modulation? Nurs Res. 1989;38:200-203.
11. Other Theories
1. Opioid System
2. Hypothalamic–Pituitary–Adrenal (HPA) System
3. Adrenergic System
4. Serotonergic System
5. Prolactin
6. Melatonin
7. Nitric Oxides
8. Prostaglandins
(Fioroni et al., 1995; R.E. Nappi et al., 1999)
13. Summary
Migraines that happen during menstruation or related to menstrual cycle
Frequent among migraneurs and usually more severe headache
Fall of estrogen level related
Treatment strategies including:
enhanced acute treatments, mini-prevention, and continuous prevention