Perimenstrual headache: treatment options.

At least half of women migraineurs experience menstrual migraine (MM), suggesting a hormonal explanation for the incidence of these headaches. Basic science efforts suggest a relationship between estrogen and the neurotransmitters and neuronal structures critical in the pathophysiology of migraine. The notion that MM is more severe, longer in duration, and more resistant to treatment than headaches occurring at other times during the menstrual cycle may apply more to women seeking treatment for their headaches than to migraineurs in the general population. Triptans have been shown to be effective as both an abortive and short-term preventive treatment, and estradiol has been shown to be an effective short-term preventive treatment. Ergotamines, combinations of drugs such as sumatriptan-naproxen sodium, and rizatriptan with dexamethasone show promise in the treatment of MM.