New York Headache Center

Treatment of menstrual migraines often is more difficult than of non-menstrual attacks.  A double-blind study by Marcelo Bigal and his collaborators just published in Headache shows that a combination of 10 mg of rizatriptan (Maxalt) and 4 mg of a steroid medication, dexamethasone (Decadron) is more effective than either drug alone.  Both drugs are effective in treating many refractory migraine attacks (although I usually use 8 mg of dexamethasone), this is the first trial of two drugs together.  While the results are not very surprising, the study may lead to wider acceptance of combination therapy and better relief for many women.  While in the past the emphasis was placed on finding a single drug to treat a disease, in recent years combination therapy has become a standard approach in many conditions.  Treximet, a combination of sumatriptan (Imitrex) and naproxen (Aleve) was also shown to be better than either of the two ingredients alone.

Migraines may be helped by omega-3 fatty acids, a supplement that has gained well deserved popularity.  Several recent studies suggesting benefits for the cardiovascular system prompted me to look at the headache literature.  An article in Cephalalgia in 2001 by Pradalier and his colleagues concluded that this supplement is ineffective, at least when they looked at the number of headaches in the last 4 weeks of treatment.   However, the active treatment with 6 grams of omega-3 fatty acids was significantly better than placebo when they looked at the total number of attacks during the entire 4 months of treatment.  Taking into account this finding and considering that omega-3 fatty acids have other benefits while being very safe, it is worth trying to take daily 6 grams of omega-3 fatty acids if you suffer from migraine headaches.

Refractory migraines may respond to occipital nerve stimulation, according to Dr. Joel Saper who led a multicenter trial of this treatment.  An electrode was surgically implanted in the back of the head, where the occipital nerve is located, and a pacemaker-size device was implanted under the skin.  The trial looked at 110 patients who had more than 15 days with migraines each month and who did not respond to a variety of medications.  66 patients completed the diary information for three months following the start of treatment.  The results were encouraging - 39% of patients improved, compared with 6% in the control group.  None of the patients had any adverse events.

Patients who suffer from migraine headaches are 30% less likely to develop breast cancer.  It is well established that fluctuating estrogen levels throughout the menstrual cycle can trigger migraine attacks.  These fluctuations are reduced during pregnancy and menopause, resulting in cessation of migraine attacks in two thirds of women.  At this point it is not clear what common estrogen-based mechanisms are responsible for the reduction of breast cancer risk in migraine sufferers.

It is well known that if you take a snapshot of the population, about 18% of women and 6% of men suffer from migraine headaches.   However, a report by Dr. Stewart and his colleagues in the latest issue of Cephalalgia indicates that cumulative lifetime migraine incidence is much higher - 43% of women and 18% of men have migraine headaches at some point in their lives.  Migraine incidence peaked between the ages of 20 and 24 in women and 15 and 19 in men.  In 75% of cases migraine started before the age of 35.