Get access

Menstrual Migraine: Case Studies of Women with Estrogen-Related Headaches

Authors

  • Susan L. Hutchinson MD,

    1. From the Orange County Migraine and Headache Center, University of California, Irvine, CA, USA (S.L. Hutchinson); Thomas Jefferson University, Jefferson Headache Center, Philadelphia, PA, USA (S.D. Silberstein).
    Search for more papers by this author
  • Stephen D. Silberstein MD, FACP

    1. From the Orange County Migraine and Headache Center, University of California, Irvine, CA, USA (S.L. Hutchinson); Thomas Jefferson University, Jefferson Headache Center, Philadelphia, PA, USA (S.D. Silberstein).
    Search for more papers by this author

  • Conflict of Interest: Susan L. Hutchinson, MD has received honoraria from GlaxoSmithKline and Ortho-McNeil and is on the advisory board of GlaxoSmithKline. Stephen D. Silberstein, MD, has received research grant support from Abbott Laboratories, Advanced Bionics Corporation, Advanced Neuromodulation Systems, Inc., AGA, Allergan Inc., AstraZeneca, Endo Pharmaceuticals, GlaxoSmithKline, Eli Lilly and Company, Medtronic, Inc., Merck & Co., Inc., Ortho-McNeil, Inc., Pfizer Inc., Pozen Inc., ProEthic, Valeant Pharmaceuticals, and Vernalis plc; is on the Speaker's Bureau for AstraZeneca, GlaxoSmithKline, Merck & Co., Inc., Ortho-McNeil, Inc., and Pfizer Inc.; and is an Advisory Board Member for Allergan Inc., Endo Pharmaceuticals, GlaxoSmithKline, Medtronic, Inc, Merck & Co., Inc., Ortho-McNeil, Inc., Pfizer Inc., Pozen Inc.,and Valeant Pharmaceuticals.

Susan Hutchinson, Orange County Migraine & Headache Center, 15825 Laguna Canyon Road, Suite 103, Irvine, CA 92618, USA.

Abstract

This paper presents 2 case scenarios that illustrate the complexity of diagnosing and managing migraine associated with hormonal changes. Migraine is commonly associated with comorbidies such as depression, anxiety, obesity, cardiovascular disease, as well as other conditions, thereby making management more challenging for the physician and the patient. The first case is a 35-year-old woman who has migraine almost exclusively during menstruation. She is under a physician's care for long-term management of premenstrual dysphoric disorder (PMDD). Achieving a differential diagnosis of pure menstrual migraine is illustrated, and a detailed treatment plan including use of a migraine miniprophylaxis protocol, management of her PMDD, and prescription of acute treatment medications is reviewed. The second case scenario describes the diagnosis of menstrually associated migraine in a woman who suffers from a frequent disabling migraine along with work-related anxiety and depression. This paper reviews her differential diagnosis, laboratory testing, treatment plan, including management of her comorbid anxiety and depressive symptoms.

Ancillary