From Harvard Medical School and Pain and Headache Management Programs, Spaulding Rehabilitation Hospital, Boston, MA.
Address correspondence and reprint requests to Dr. Elizabeth Loder, Pain and Headache Management Programs, Spaulding Rehabilitation Hospital, Boston, MA 02114; e-mail: eloder{at}partners.org
Menstruation is a prominent, predictable attack trigger formany women with migraine. If abortive therapy of menstrual attacksis ineffective, prophylactic therapy is used to prevent attacksor render them shorter and less resistant to acute therapy.Interest is increasing in the use of triptan medications forthe prophylaxis of menstrual migraine, and clinical trials toevaluate this approach are underway. Potential problems withtriptan prophylaxis of menstrual migraine that deserve attentioninclude the lack of consensus on the definition of menstrualmigraine and the difficulty in making a reliable diagnosis ofthe disorder. Unconvincing demonstrations of efficacy and unresolvedcost and safety concerns should temper enthusiasm for theiruse in this manner. Further studies, using a consistent definitionof menstrual association and employing diary validation of thediagnosis, are needed to determine the efficacy of the triptansin women who consistently experience migraine attacks associatedwith menstruation. Triptans would have to show compelling advantagesover other therapy to be a plausible prophylactic treatmentfor menstrual migraine.
