Migraine affects 10-15% of the adult population, with women being affected about 3 times more than men, although in children, migraine is equally common among boys and girls. Several women suffer from migraine which occurs in relation to the menstrual cycle. The headache usually occurs within 2 days before the onset of menstrual bleeding, and can be extremely disabling. The acute treatment of menstrual migraine (MM) attacks is usually unsatisfactory, and prophylactic treatment for MM relies on naproxen sodium, estrogen supplementation, and triptans. Now Guidotti et al have shown that short-term prophylaxis of MM with frovatriptan may be more effective than prophylaxis using transdermal oestrogens or naproxen sodium (Journal of Headache and Pain, 2007).

This was an open-label, non-randomized, parallel group study which evaluated 38 women with a history of MM. The patients received either frovatriptan (n=14, 2.5 mg orally) or transdermal oestrogen (n=10, 25 mug) or naproxen sodium (n=14, 500 mg orally) once-daily, beginning 2 days prior to the expected onset of the headache. The total duration of treatment was 6 days, and headache severity was scored for each patient.

All the women taking transdermal oestrogens or naproxen sodium, and 13 out of the 14 patients (93%) taking frovatriptan had at least one migraine attack during the study period (P= 0 .424). However, the daily incidence of migraine was significantly (P = 0.045) lower in patients taking frovatriptan, compared to women taking transdermal oestrogens or NS. The median headache score during treatment was also significantly lower in patients taking frovatriptan.

In a previous study assessing the efficacy of frovatriptan in MM, Silberstein et al (Neurology, 2004) reported similar beneficial effects, and also observed that a twice-daily dose (2.5mg BID) was superior to a once-a-day dose (2.5mg OD).

Frovatriptan is a new selective 5HT (1B/1D) receptor agonist. Naratriptan is another drug from the same group that has shown good efficacy in short-term prevention of menstrual-related migraine, but there have been reports of increase in the post-treatment attacks with this drug. However, no significant adverse events have been reported with the short term use of frovatriptan. Better results, in terms of efficacy, than transdermal estrogen and naproxen indicate that frovatriptan may become the drug of choice for the prophylaxis of MM.

References

1. Guidotti M, Mauri M, Barrilà C, Guidotti F, Belloni C. Frovatriptan vs. transdermal oestrogens or naproxen sodium for the prophylaxis of menstrual migraine. Headache Pain. 2007 Oct 23; [Epub ahead of print].

2. Silberstein SD, Elkind AH, Schreiber C, Keywood C. A randomized trial of frovatriptan for the intermittent prevention of menstrual migraine. Neurology. 2004 Jul 27;63(2):261-9.

3. Mannix LK, Savani N, Landy S. Efficacy and tolerability of naratriptan for short-term prevention of menstrually related migraine: data from two randomized, double-blind, placebo-controlled studies. Headache. 2007 Jul-Aug;47(7):1037-49.