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HeadWay Issue #223 - Menstrual Migraine and CGRP Meds
May 22, 2023

In this issue:

Menstrual Migraine and CGRP Meds

New @ Headache and Migraine News

Say what?!

Menstrual Migraine and CGRP Meds

A recent study continues our research into menstruation and CGRP - calcitonin gene-related peptide. Could this be a good reason to try an anti-CGRP medication?

Since 1986, there has been a special interest in the link between female sex hormones and CGRP levels. As more studies have been done on CGRP levels and migraine, the natural question arises - could drugs related to CGRP levels be helpful to those with menstrual migraine?

Menstrual migraine is generally diagnosed when you only have migraine attacks during day -2 to day +3 of your cycle. This is different but related to menstrually related migraine - also related to hormone changes, but attacks can also happen at other times of the month.

The recent explosion in new anti-CGRP medications has not been a silver bullet for migraine, but has been a help to many. So what about those with menstrual migraine?

A study published earlier this year suggests that levels of CGRP in migraine patients are actually different, rising higher during menstruation. The American Academy of Neurology press release summarizes the possible implication: "Low estrogen levels paired with higher CGRP levels may jump start migraine".

CGRP Levels: Only Part of the Story...

You'll notice the caution about making this overly simple. It's not that CGRP "causes" migraine, or even that high levels do. However, higher than normal levels may be a part of the migraine chain-reaction, which is why certain medications may help.

After all, CGRP is natural in the body and an important part of our biology, although we still have a lot to learn. It seems to play a large role in cardiovascular health.

In researching new anti-CGRP drugs, scientists have especially focused on whether or not these medications could cause problems in patients with cardiovascular problems - and in the short term, these drugs seem to be fairly safe in that regard.

However, the goal is certainly not to eliminate CGRP as if it's evil, but to regulate it. And if patients with migraine already have levels that are too high - it may be that breaking that part of the chain will lessen migraine attacks.

There is a lot of research yet to be done, but in this case there is enough information to consider trying a CGRP medication if you are struggling with menstrual migraine. Talk to your doctor about which medication may work best for you.

Because everyone is different, there may be a lot of customization required. But this study is another hint that these meds may be of special help to a form of migraine that has been traditionally very hard to treat.

New @ Headache and Migraine News

It's been a particularly busy time in my personal life, and so I haven't been able to post as much as I would like. However, here are some recent articles that may be of interest:

Say what?! Menstrual Migraine

There is still a lot of discussion about how to classify menstrual migraine. The International Classification of Headache Disorders 3 includes "pure menstrual migraine" in their appendix, with the explanation that the migraine attack is Occurring exclusively on day 1 ± 2 (ie, days −2 to +3)2 of menstruation1 in at least two out of three menstrual cycles and at no other times of the cycle.

This may be migraine with or without aura.

To learn more, check out the appendix of ICHD3 here.

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