Perimenstrual migraine attack duration affects recurrence risk, triptan use

Longer duration of perimenstrual migraine attacks among women with menstrual-related migraine appeared linked to increased recurrence risk and triptan use, according to results of a prospective study published in Neurology.

“Previous studies suggested an increased risk of migraine in women with PMS of approximately 60%,” Daphne S. van Casteren, MD, of the department of neurology at Leiden University Medical Center in the Netherlands, and colleagues wrote. “Due to the strictly defined temporal relationships between menstrual related migraine, [premenstrual syndrome (PMS)] and the menstruation, prospective diaries are needed to reliably confirm diagnoses. With this prospective electronic diary (E-diary) study, we aimed to study perimenstrual and non-perimenstrual migraine attack characteristics in a large group of female migraine patients.”

The researchers received E-diary responses from a representative group of 500 participants for at least 1 month and compared characteristics of 998 perimenstrual migraine attacks with 4,097 non-perimenstrual attacks. Attack duration served as the primary outcome and headache intensity, accompanying symptoms, acute medication intake and pain coping as the secondary outcomes. Investigators accounted for multiple attacks within patients using mixed effects models. They evaluated PMS among participants without hormonal contraceptives and conducted subgroup analyses for women with menstrual-related migraine and non-menstrual-related migraine, as well as for women with a natural menstrual cycle and women using hormonal contraceptives.

Results showed perimenstrual migraine attacks compared with non-perimenstrual attacks correlated with longer duration (20 vs. 16.1 hours; 95% CI, 0.2-0.4), higher recurrence risk (OR = 2.3; 95% CI, 2-2.9), increased triptan intake (OR = 1.2; 95% CI, 1.1-1.4), higher headache intensity (OR = 1.4; 95% CI, 1.2-1.7), less pain coping (mean difference = –0.2; 95% CI, –0.3 to –0.1), more pronounced photophobia (OR = 1.3; 95% CI, 1.2-1.4) and phonophobia (OR = 1.2; 95% CI, 1.1-1.4) and less aura (OR = 0.8; 95% CI, 0.6-1). Of the 396 women who completed the diary for three or more consecutive menstrual cycles, 56% met menstrual-related migraine criteria. Women with menstrual-related migraine and those using hormonal contraceptives had more pronounced differences in attack characteristics. PMS prevalence did not differ for women with menstrual-related migraine vs. non-menstrual-related migraine.

“This knowledge will contribute to the development of an urgently needed female-specific prophylactic treatment intervening with sex hormones,” van Casteren and colleagues wrote. “To begin with, the potential efficacy of existing hormonal treatments, such as combined oral contraceptives, in the prevention of migraine attacks should be clarified. In addition, future large scale daily E-diary studies are needed to assess symptoms belonging to the premonitory phase in women with migraine and to determine their contribution in the prediction of an upcoming migraine attack.”