Can Monthly Migraines Be Prevented

Neurologists at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, may have found a long-acting drug to stop monthly migraines that occur in some women around the time of their menstrual periods—before the headaches start.

Frovatriptan succinate (Frova®, Elan), was found in a nationwide study to prevent migraines associated with menstruation in as many as 50% of the women evaluated. Frovatriptan is in a class of drugs called triptans, which reduce inflammation of certain blood vessels in the brain that are thought to cause pain.

Participants had an average 12-year history of migraine, which affects more than five million American women. In the U.S. alone, approximately nine million women suffer from migraines; about 60% of them, or 5.4 million, report an increased number of headaches in association with their menstrual periods.

For the women in the study, the migraines typically began between two days before and one day after the start of menstruation. The average duration of these migraines in women who received placebo was 29 hours, and more than 75% of the patients reported moderate or severe headache pain.

In the trial, 545 women were treated two days before and four days during their menstrual periods with placebo, a once-daily dose of frovatriptan, or a twice-daily dose of the drug for three months. The study, based at Jefferson, was conducted at 36 centers nationwide.

Fifty percent of patients treated in the six-day period with 2.5 mg of frovatriptan twice daily had no headache. In addition, 39% of the patients taking 2.5 mg of frovatriptan once daily had no headache, compared with 26% taking placebo. Depending on the dose given, frovatriptan reduced the severity and duration of menstruation-associated migraines and decreased the degree and duration of functional impairment and the need for rescue medications.
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Each patient received the treatment regimens over the course of three menstrual periods. The incidence and type of side effects reported were similar to those caused by placebo, including nausea, dizziness, headache, and fatigue.

In another study conducted by the same author, frovatriptan also helped to prevent cluster headaches during the “transitional period,” the two or three weeks it takes for long-term preventive therapies (e.g., lithium or calcium-channel blockers) to begin working. Cluster headaches are characterized by intermittent, pulsing head pain that lasts as long as eight weeks and comes once or twice a year. Patients sometimes describe attacks as a stabbing pain around the eye. Cluster headaches are less common than migraines and can be very difficult to treat.