• Wed. Feb 1st, 2023

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Detailed Analysis of Menstrual Related Migraine (MRM)


Menstrual related migraine (MRM) without aura is characterised by the presence of attacks on other days of the cycle, whereas menstrual migraine (MM) without aura is defined as the exclusive incidence of attacks on day -2to +3 of menses in at least 2 of 3 consecutive menstrual cycles. MRM is present in more than 90% of women who get migraine headaches during their periods. Changes in oestrogen levels are to blame for these illnesses. 

Triptans, nonsteroidal anti-inflammatory drugs, and ergot derivatives—which are the same palliatives as for migraines without a menstrual cycle—are utilised for acute treatments. While continuous prophylaxis treatments like oral contraceptives offer continual exposure to treatment, short-term prophylactic medications, such as triptans, oestrogen, and naproxen, are only administered when necessary. The strongest available evidence for acute and preventive treatment of MM and MRM comes from triptan clinical studies, which support the use of almotriptan, sumatriptan, naratriptan, and zolmitriptan as acute treatments and of frovatriptan, naratriptan, and ziolmitriptan as preventive treatments.” He adds, “However, triptans have negative side effects and are dangerous if used excessively, and MM is somewhat resistant to their effects.

 Abnormal vasodilation causes acute, throbbing headaches. It is thought that the migraine headache-related vasodilation occurs after a period of vasoconstriction. Prodromal symptoms are typically but not always present before to migraine headaches (which may reflect the period of vasoconstriction). Stress, alcohol, foods high in tyramine or tryptophan, or foods high in tyramine or tryptophan can all cause significant vascular headaches (red wine, chocolate, ripe cheese). Vascular headaches can occur together with other issues such systemic viral infections, fever, or high blood pressure. The term ‘migraine without aura’ now refers to typical migraine headaches. Aura-related migraine is the term used to describe classic migraine (visual complaints, nausea or vomiting, paresthesias). Menstrual headaches caused by migraines are often migraines without aura.

The prolonged, excessive muscular contraction that causes tension headaches is to blame. Dull, constant, bilateral ache that worsens over the day. However, daily problems are a more significant influence in the aetiology of tension headaches than significant stressful events. The headache typically begins with concern or emotional stress and frequently lasts for hours or a few days. Headaches that come on later are caused by an underlying organic condition. Neurologic problems frequently accompany headaches linked to brain tumours.  

Attention should be paid to the sudden development of severe headache discomfort. Neck stiffness, changed mental status, localised neurological abnormalities, vision impairment, and fever are all warning indications of a dangerous condition. Meningeal symptoms need hospitalisation for any patient. Consider drug withdrawal and carbon monoxide exposure as causative factors. It is important to classify chronic headaches according to their location, quality, and course throughout time. When the headache is cyclic, with periodic total relief, one can confidently attribute the headaches to a vascular cause. Head trauma in the recent past raises the possibility of a subdural hematoma.

In the absence of relentless progression, tension headaches can be either intermittent or comparatively continuous. A neurologic examination is necessary for any persistent headache that keeps coming back or grows worse over time.

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