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  • Title: Effective treatment of severe menstrual migraine headaches with gonadotropin-releasing hormone agonist and "add-back" therapy.
    Author: Murray SC, Muse KN.
    Journal: Fertil Steril; 1997 Feb; 67(2):390-3. PubMed ID: 9022620.
    Abstract:
    OBJECTIVE: 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. PATIENT(S): Five women who had repetitive, severe, migraine headaches limited to the perimenstrual period were selected carefully. INTERVENTION(S): 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. RESULT(S): 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 +/- 2.4). 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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