Migraine risk highest during first two days of menstrual cycle

November 27, 2000

ST. PAUL, MN - Women are twice as likely to experience migraine without aura during the first two days of their menstrual cycle than during the rest of the month, according to a study in the November 28 issue of Neurology, the scientific journal of the American Academy of Neurology.

The study also found a higher risk of migraine in the two days before menstruation begins, as well as a lower risk around the time of ovulation. "If women have a better idea when they'll get a migraine during their cycle, they have a better chance to prevent or treat it," said Stephen Silberstein, MD, a neurologist and director of the Headache Center at Thomas Jefferson University Hospital in Philadelphia, Penn. "That's important news - especially when you consider that 70 percent of all migraine sufferers are women."

The study is one of the few to look at the relationship between migraine and menstruation in the general population. It is also one of the first studies to ask if migraines during menstruation are different in their length and pain than during other times. For approximately three months, 81 women with clinically diagnosed migraine were asked to keep detailed diaries of their headaches. Participants were also asked to record pain features, symptoms and their disability such as days missed at work or reduced productivity.

The results showed 28 percent of migraine without aura, the type of migraine most often associated with menstruation, took place in the four days surrounding the beginning of menstruation. There was also a greater chance of tension-type headache. However, there was no increase in migraine with aura or any evidence to support the idea that migraines during menstruation are more painful or more severe.

"Menstruation was a powerful trigger for migraine, but the headache wasn't any different than those triggered by alcohol or chocolate," said Silberstein. "This study doesn't support the idea that "menstrual migraine" is longer or more intense than other migraines."

Previous studies have looked at the relationship between migraine and menstruation in patients at headache clinics. Migraine develops most often around adolescence, and researchers have looked at its relationship with the cyclic changes in female sex hormones. Research has shown that the primary trigger for migraine during menstruation may be the withdrawal of estrogen.

Prevention and treatment guidelines were recently released by the U.S. Headache Consortium, a multidisciplinary coalition of primary care physician, specialty physician and patient advocacy groups. By using the guidelines to develop treatment programs, physicians can help reduce the frequency and intensity of the headaches, and improve the lives of their patients by providing treatment that matches the severity of the migraine. The guidelines are available at www.aan.com.
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The migraine and menstruation study was funded by Astra Zeneca Pharmaceuticals.

Migraine is a complex biological disease that affects 28 million Americans. Migraines account for more than 10 million visits to physicians each year. It is estimated that migraine sufferers lose more than 157 million workdays each year, as well as reduced productivity and quality of life. The length of the attack can last from several minutes to several days, and includes throbbing pain on one side of the head, accompanied by nausea and vomiting and/or sensitivity to light, sound and odors. Migraine is believed to be related to increased excitability of the brain.

A neurologist is a medical doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system.

The American Academy of Neurology, an association of more than 17,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research.

For more information about the American Academy of Neurology, visit its Web site at www.aan.com. For online neurological health and wellness information, visit NeuroVista at www.aan.com/neurovista.

For more information contact:
Sarah Parsons (651) 695-2732

American Academy of Neurology

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