Effective treatment of severe menstrual migraine headaches with gonadotropin-releasing hormone agonist and “add-back” therapy

• Published in: Fertility and sterility Vol. 67; no. 2; pp. 390 - 393
• Main Authors: Murray, Shona C., Muse, Ken N.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.1997; Elsevier Science
• Subjects: Administration, Cutaneous; Adult; Biological and medical sciences; Drug Administration Schedule; Drug Therapy, Combination; Estradiol - administration & dosage; Estradiol - therapeutic use; Female; GnRH agonist; Gonadotropin-Releasing Hormone - agonists; headache; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Leuprolide - administration & dosage; Leuprolide - therapeutic use; Medical sciences; Medroxyprogesterone Acetate - administration & dosage; Medroxyprogesterone Acetate - therapeutic use; menstrual migraine headache; Menstruation Disturbances - drug therapy; Menstruation Disturbances - physiopathology; migraine; Migraine Disorders - drug therapy; Migraine Disorders - physiopathology; Nervous system (semeiology, syndromes); Neurology; Progesterone Congeners - administration & dosage; Progesterone Congeners - therapeutic use; Prospective Studies; Treatment Outcome; migraine; headache; menstrual migraine headache; GnRH agonist; Agonist; Estrogen; 17β-Estradiol; Gonadotropin RH; Cardiovascular disease; Vascular disease; Pain; Estroprogestagen; Medroxyprogesterone; Female; Hormone releasing factor; Cerebrovascular disease; Human; Nervous system diseases; Drug combination; Leuprorelin; Menstrual cycle; Treatment efficiency; Migraine; Cerebral disorder; Hypothalamic hormone; Chemotherapy; Treatment; Central nervous system disease; Progesterone; Sex steroid hormone
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/S0015-0282(97)81928-0

To determine the efficacy of treating women with severe menstrual migraine headaches with GnRH agonist (GnRH-a) therapy, alone and combined with continuous estrogenprogestin “add-back.” Nonrandomized, prospective treatment study. Outpatient clinic in a university medical center. Five women who had repetitive, severe, migraine headaches limited to the perimenstrual period were selected carefully. After 2 months of basal evaluation, all subjects received GnRH-a (leuprolide acetate depot formulation, 3.75 mg IM, monthly) for 10 months. Beginning with the 5th month, “add-back” therapy (the addition of transdermal E 2, 0.1 mg daily, and oral medroxyprogesterone acetate, 2.5 mg daily) was initiated. Patients rated headache severity from 0 (absent) to 3 (severe) each day; these were combined each month to obtain a cumulative score for that month. In addition, patients were asked their overall assessment of the treatments. The mean headache scores for the GnRH-a treatment months (4.0 ± 1.5, mean ±SEM) and for the GnRH-a and “add-back” treatment months (3.1 ± 0.7) were each significantly lower than those of the control months (15.3 ± 2.4). The patients uniformly found both treatments to be well tolerated and near-curative for their condition. Gonadotropin-releasing hormone agonist administration, alone or with “addback” therapy, is a very effective treatment for carefully selected patients with severe, perimenstrual migraine headaches.