Authors:
Murray SC. Muse KN.
Institution:
Dr. S.C. Murray, Department of Obstetrics/Gynecology, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0084; United States. E-Mail: murrays@pop.uky.edu.
Title:
Effective treatment of severe menstrual migraine headaches with gonadotropin-releasing hormone agonist and 'add-back' therapy (1997-2025).
Source:
Fertility and Sterility. Vol 67(2) (pp90-393), 1997.
Abstract:
Objectives:
To determine the efficacy of treating women with severe menstrual migraine headaches with GnRH agonist (GnRH-a) therapy, alone and combined with continuous estrogen-progestin 'add-back.'
Design:
Nonrandomized, prospective treatment study.
Setting:
Outpatient clinic in a university medical center.
Patients:
Five women who had repetitive, severe, migraine headaches limited to the perimenstrual period were selected carefully.
Interventions:
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 E2, 0.1 mg daily, and oral medroxyprogesterone acetate, 2.5 mg daily) was initiated.
Main Outcome Measure(s):
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.
Results:
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 +/- 24). The patients uniformly found both treatments to be well tolerated and near- curative for their condition.
Conclusion(s):
Gonadotropin-releasing hormone agonist administration, alone or with 'add-back' therapy, is a very effective treatment for carefully selected patients with severe, perimenstrual migraine headaches.
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