Menstrual Migraine: Current Strategies for Diagnosis and Management

Migraine is a common health problem among women and can cause significant disability. Approximately 60% of women with migraine report a correlation between migraine and their menstrual cycle. Because of this prevalence, the International Headache Society outlined criteria for the diagnosis of pure menstrual migraine and menstrually related migraine. After practitioners accurately diagnose menstrual migraine based upon these criteria, they can then work with individual clients to determine the best treatment plan. This article focuses on the accurate diagnosis of menstrual migraine and several evidence-based treatment options available to women who suffer from this debilitating condition.

Treatment 

Pharmacological treatment methods available for MM include acute therapy, short- and long-term prophylaxis, and hormonal therapy. Though MM tends to be severe and pharmacological management is usually necessary, nonpharmacologic treatments, such as ice, heat, and peppermint oil, can be
 beneficial as adjunct therapy or to treat nonpain symptoms, such as nausea and vomiting.
Before initiating pharmacologic therapy, the practitioner should review with the patient possible lifestyle changes for alleviating or avoiding migraine. Sufficient sleep, exercise, and water, as well as avoiding certain substances like caffeine, chocolate, and alcohol, can lessen migraine attacks or diminish severity.Clients, especially those with MRM, should be encouraged to record information on these possible triggers in their headache diaries, especially for those migraines not occurring on days −2 to +3.

When considering treatment for MM, assessing headache frequency and predictability is key. For clients with infrequent attacks, acute therapy is usually sufficient. If attacks are frequent or respond poorly to acute therapy, the provider should consider the predictability of the headaches. Predictable headaches can be treated with short-term prevention methods. If headaches are unpredictable, the provider could consider long-term continuous therapy....read more