Menstrual migraine: clinical considerations in light of revised diagnostic criteria

Menstrual migraine is not formally recognised by the International Headache Society Diagnostic Classification, but “candidate criteria” for its diagnosis have been published. Attacks of migraine occurring in a consistent relationship with menstruation can be classified as “pure” menstrual migraine if they occur at no other time of the month, and as “menstrually related” if other attacks occur throughout the month. It remains controversial whether such attacks are longer, more severe or more difficult to treat than other attacks, but this form of migraine does lend itself to pre-emptive treatment because its timing and trigger can be anticipated. This paper reviews evidence for specific acute and pre-emptive treatment strategies, including the use of hormonal supplementation, scheduled triptans and nonsteroidal anti-inflammatory drugs.