Acute Treatment of Menstrually Related Migraine*

Acute treatment of menstrually related migraine (MRM) focuses not only on prescribing a drug to abort an individual attack, but also on the patient’s treatment needs and the link between menstruation and migraine, other menstrually related symptoms and events, and the phases of a migraine attack. Because of its unique clinical characteristics, and because it is historically underdiagnosed and undertreated, MRM requires a unique treatment approach. This article reviews the components of such an approach, which include recognition of the contributions of the menstrual cycle and the migraine headache process, treatment dynamics, clinical aspects of acute treatment, and phase-based therapy. Central to the treatment approach is the premise that the clinical characteristics of MRM represent opportunities to integrate the predictability of the migraine attack into acute treatment, to explore new and potentially more effective treatment paradigms, and to help women with MRM achieve better control of their headaches. The importance of calendars and diaries in diagnosis and monitoring therapy and the special considerations involved in treating migraine during pregnancy and lactation also are addressed. (Adv Stud Med. 2005;5(9A):S783-S789) A cute management of menstrually related migraine (MRM) goes beyond simply prescribing a drug to treat individual attacks. It also requires a philosophy that involves treating the patient and recognizing the connection between menstruation and migraine, other symptoms and events that occur during the menstrual cycle, the phases of a migraine attack, and the need to define treatment goals with each patient and construct an appropriate treatment paradigm.