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A Cyclic Pain: The Pathophysiology and Treatment of Menstrual Migraine

Mathew, Paul G. MD, FAHS*†‡; Dun, Erica C. MD, MPH, FACOG§∥; Luo, Jin Jun MD, PhD, FAAN, FAANEM

Obstetrical & Gynecological Survey: February 2013 - Volume 68 - Issue 2 - p 130–140
doi: 10.1097/OGX.0b013e31827f2496

Catamenial migraine is a headache disorder occurring in reproductive-aged women relevant to menstrual cycles. Catamenial migraine is defined as attacks of migraine that occurs regularly in at least 2 of 3 consecutive menstrual cycles and occurs exclusively on day 1 to 2 of menstruation, but may range from 2 days before (defined as −2) to 3 days after (defined as +3 with the first day of menstruation as day +1). There are 2 subtypes: the pure menstrual migraine and menstrually related migraine. In pure menstrual migraine, there are no aura and no migraine occurring during any other time of the menstrual cycle. In contrast, menstrually related migraine also occurs in 2 of 3 consecutive menstrual cycles, mostly on days 1 and 2 of menstruation, but it may occur outside the menstrual cycle. Catamenial migraine significantly interferes with the quality of life and causes functional disability in most sufferers. The fluctuation of estrogen levels is believed to play a role in the pathogenesis of catamenial migraine. In this review, we discuss estrogen and its direct and indirect pathophysiologic roles in menstrual-related migraine headaches and the available treatment for women.

Target Audience: Obstetricians and gynecologists, family physicians

Learning Objectives: After completing this CME activity, physicians should be better able to discuss the pathophysiology of catamenial migraine, identify the risk factors for catamenial migraine among women, and list the prophylactic and abortive treatments for migraines.

*Instructor, Harvard Medical School, Boston; and †Department of Neurology, John R. Graham Headache Center, Brigham and Women’s/Faulkner Hospital; and ‡Division of Neurology, Cambridge Health Alliance, Cambridge, MA; and §Minimally Invasive Gynecology Fellow, Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA; ¶Associate Professor, Departments of Neurology and Pharmacology, Temple University School of Medicine, Philadelphia, PA; and Department of Obstetrics and Gynecology, Lankenau Hospital, Mainline Health System, Wynnewood

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Jin Jun Luo, MD, PhD, FAAN, FAANEM, Departments of Neurology and Pharmacology, Temple University School of Medicine, 3401 N Broad St, C525, Philadelphia, PA 19140. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.