Data confirms difference of menstrual migraine attacks

A study in the July 27 issue of Neurology, using diary data from women attending a migraine clinic, has confirmed that migraine at menstruation is different from nonmenstrual attacks, even within individuals.Anne E. MacGregor and Allan Hackshaw from the City of London Migraine Clinic and the University College London Cancer Trials Center used diary cards from women who were not using hormonal contraception to characterise migraine types within each woman. "In clinical practice, 50% of women report an association between migraine and menstruation. Many women report that menstrual attacks are more severe, last longer, and respond less well to treatment compared with nonmenstrual attacks," they note.Their data covered a total of 693 cycles in 155 women. Compared with all other times of their cycle, 78% of women were more likely to have a migraine during the 2 days before menstruation (relative risk over 1), and 76% has a relative risk over 1 during the first three days of menstruation."Severe attacks were more likely to occur during the premenstruation (relative risk 1.43) and postmenstruation (relative risk 2.63) intervals," the authors write. "Women were more likely to have severe migraine on the first day of menstruation or dueing the following 2 days (relative risk 3.41)."The data shows that "migraine was more likely during a 5-day window from 2 days before to 2 days after the first day of menstruation (days -2 to +3). The within-woman analysis showed that menstrual attacks also tended to be more severe and associated with nausea and vomiting at this time compared with attacks at other times of the cycle. The greatest effect of menstruation on migraine was during the first 3 days of the cycle," they conclude.Reference...