Migraines have been blessedly
rare for Mariel Comrie, 84, over the past 40 years. In
the past, however, they plagued her regularly. She received
scant sympathy from her physician husband, or the rest
of the medical establishment at the time who, noting the
migraines' monthly occurrence, dismissed them as the complaint
of a nervous woman. So, Mariel definitely felt vindicated
now that the current boom in migraine research has proven
that the link between menstruation and migraine is very
real indeed. "This news would have been welcome 60 years
ago. But it's better late than never!" she said with a
satisfied smile.
The fact that one in four adult
women suffers from migraine compared to one in 20 adult
men, as well as the often-reported association between
menstruation and migraine were the impetus behind a
British study published in the July 27 issue of Neurology.
This report goes further than any previous research
in establishing a link between migraine and menstruation.
Researchers from the City of London Migraine Clinic
asked 155 women migraine sufferers to keep a headache
diary, noting their menstrual status at the time of
attacks. Analysis of the diaries showed that the women
ran a 25% greater risk of a migraine in the five days
leading up to menstruation, and a 71% greater risk in
the last two days before menstruation. In the five days
following the onset of bleeding, patients had more than
twice their normal risk of developing a migraine. In
addition, attacks during or just before menstruation
tended to be more severe than attacks at other times
of the month, and were five times more likely to involve
vomiting.
"Our study supports new International
Headache Society (IHS) diagnostic criteria regarding
pure menstrual migraine and menstrually related migraine,"
concluded lead author Dr Anne MacGregor of St Bartholomew's
Hospital in London. However, despite this study the
IHS was still uncertain whether such migraines "should
be regarded as separate entities."
There is, for instance, the question
of whether menstrually related migraines are susceptible
to the same treatments as other migraines. Interestingly,
since the timing of these headaches can be predicted,
there would appear to be scope for preventing them from
ever occurring.
Dr Stephen Silberstein of Thomas
Jefferson University in Philadelphia addressed these
questions in a double-blind, placebo-controlled, three-way
crossover study involving 443 patients from 36 US centres.
The study looked at a drug called frovatriptan because,
despite labelling that specifically says it "will not
prevent or reduce the number of attacks you experience,"
it has a long duration of action that makes it a good
candidate for a migraine prophylactic. Patients were
randomly assigned to 2.5mg of frovatriptan once or twice
daily, or placebo for each of three menstrual cycles,
for a six-day treatment program that began two days
before the anticipated start of menstrually associated
migraine.
The researchers' reasoning proved
sound as taking the drug did reduce the number of menstrually
associated migraines the patients had to endure. For
instance, the placebo group experienced 67% as many
attacks as in a normal month, while those taking frovatriptan
had 52% as many attacks as usual. Moreover, those taking
the drug twice daily suffered only 42% as many attacks
as usual.
"Women have long reported menstrually
related migraines as prolonged and difficult to manage
with conventional therapies," noted Dr Silberstein.
"More than half of patients who used frovatriptan 2.5mg
twice daily had no menstruation-associated migraine.
The size of our study and the level of statistical significance
obtained make our results very robust."
This is good news for women who
suffer from more than just cramps at that time of the
month. Even better news is that frovatriptan is available
in Canada without prescription.
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