Neurology Book

Headache Disorders

  • Menstrual Migraine

Seizure Disorders

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Menstrual Migraine

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  1. See Also
    1. Migraine Headache
  2. Pathophysiology
    1. Estrogen withdrawal precipitates Headache
    2. Headaches often improve in pregnancy
    3. Associated conditions
      1. Premenstrual Syndrome
      2. Dysmenorrhea
  3. Symptoms
    1. Headache onset:2 days prior to Menses
    2. Headache lasts until final day of Menses
  4. Management: Acute
    1. See Migraine Headache Management
  5. Management: Prevention
    1. See Migraine Prophylaxis
    2. Protocol
      1. Start 3 days prior to expected first day Menses
      2. Continue until Menses is finished
      3. Medication Option 1: Abortive medications
        1. Ergotamine 1 tab bid and
        2. Naprosyn 500 mg bid
          1. or mefenamic acid if Dysmenorrhea coexists
        3. Consider Magnesium Supplementation
      4. Medication Option 2: Estrogen supplementation
        1. Estradiol patch started 2-3 days prior to Menses
          1. Climara 1-2 patches over 1 week
          2. Estraderm or Vivelle 2-4 patches over 1 week
        2. Consider adding Methyltestosterone 20 mg
    3. Other measures
      1. Consider continuous OCP cycling (no Placebo pills)
      2. CVA risk in women on OCP with Migraine and aura
        1. OCP alone: CVA in 5-10 per 100,000 women
        2. OCP and Migraine: CVA in 17-19 per 100,000 women
  6. References
    1. Fettes (1997) Postgrad Med 101(5):67
    2. Matharu (2002) Practitioner 246:272
    3. Silberstein (1995) Postgrad Med 97(4):147

Menstrual migraine (C0269226)

ConceptsDisease or Syndrome (T047)
ICD9625.4
EnglishMenstrual migraine, Migraine - menstrual
Spanishcefalea menstrual, jaqueca menstrual, migrana menstrual
Parent ConceptsBrain Diseases (C0006111), Migraine Disorders (C0149931), Disorder associated with menstruation AND/OR menopause (C1263764)
SourcesMTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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