Catamenial or menstrual migraine

For many migraine sufferers (from 20% to 60%), although there are crises outside the cycle, menstruation is a trigger for migraine attacks.
For other migraine sufferers, the migraine crisis occurs exclusively between the day 2 before and the day 3 after the menstruation onset. The is the catamenial migraine (CM) or « menstrual migraine ».
The headache of CD is more severe, more disabling, longer and less responsive to treatment than usual migraine. Some of the women with MC are terrified by the occurrence of the menstrual period and lose, every month, 3-5 days of work or social life.
MC is due to the physiological decline of estradiol before the onset of menses. It can also occur with the combined estroprogestative contraceptive treatment at the time of the window.
These women often do not know who can help because the neurologist is the expert of the headache but not of hormones and the gynecologist vice versa. Now we are in the field of the neuro-gynecology !!!
For MC a specific preventive treatment with a low dose estrogen patch may be proposed.
The patch is applied 48 hours before menstruation and continued for 7 days. In the case of MC during the window of interruption of combined pills it would be useful switching to the lowest dose estrogen pills with a shorter or without interruption (with abolition of the menses).

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