Menstruelle Migräne – Herausforderungen und Therapieansätze

Migraine is a frequent neurological disorder that affects approximately 15% of the global population. It is characterized by recurrent, often pulsating and unilateral headache that, if untreated, can last 4–72 h and is accompanied by photophobia, phonophobia and nausea. Of those affected one third experience auras, i.e. temporary neurological deficits before the headaches start. Women are affected 2–3 times more frequently than men, a discrepancy partly attributed to hormonal fluctuations. Menstrual migraine attacks, which occur between days −2 and +3 of the menstrual cycle, are often more intense and prolonged. Perimenstrual hormonal changes are linked to an increased susceptibility to migraine. Treatment options include classical analgesics, such as nonsteroidal anti-inflammatory drugs (NSAID) and paracetamol as well as triptans for acute treatment. A short-term prophylaxis for menstrual migraine can be helpful during the perimenstrual phase but carries a high risk of medication overuse. Long-term prophylaxis includes beta blockers, tricyclic antidepressants, anticonvulsants, calcium channel blockers and calcitonin gene-related peptide (CGRP, receptor) antibodies. Continuous hormonal treatment can also be considered for menstrual migraine, with estrogen-free options preferred for migraine with aura to minimize the risk of ischemic insults. Migraine, particularly in women, poses a significant challenge in outpatient care. Despite advances in research, the exact pathophysiology of menstrual migraine and the role of hormonal influences remain largely unclear. Further studies are necessary to develop more targeted and effective treatment options.