Bishnoi Anju1,Bishnoi Suresh2
Abstract: Migraine comprises a composite collection of symptoms, disturbing the nervous system, the gastro-intestinal tract and the vascular system. More than “just a headache” it is a disorder of central nervous system dysregulation. Migraine is three times more common in women than in men and is the 4th leading cause of disability in women. Onset of migraine increases at menarche, with peaks in prevalence in the late 30s, and a rapid decline after menopause.
Keywords: Menstrual migraine, Hormonal factors, Homoeopathy.
Migraine is a complex central nervous system disorder which is primarily characterized by headaches of long duration, with moderate to severe pain and associated symptoms such as light and sound sensitivity (photo- and phono phobia), nausea and vomiting . Abundant population data suggest that hormonal factors may trigger headache attacks and influence onset and remission. Drops in estrogen presumably lead to increased migraine attacks at the time of menses as well as during the menopausal transition.
Incidence and prevalence of menstrual migraine – Four of every ten women and two of every ten men will contract migraine in their lifetime, most before age 35 years. More than 50% of women with migraine, both in the general population and presenting to specialist clinics, report an association between migraine and menstruation.
The peak incidence of migraine during the menstrual cycle occurs on the days directly before and after the first day of menstruation.
Migraine subtypes– The two primary types of migraine are migraine without aura which accounts for the majority of cases (approximately 80%) and migraine with aura which accounts for about 20%. [1,5]
Migraine without aura: Is a clinical syndrome characterized by headache with specific features and associated symptoms. It is also known as common migraine or Hemicrania simplex.
Migraine with aura: It is primarily characterized by the transient focal neurological symptoms that usually precede or sometimes accompany the headache. It is also called Classical migraine or Complicated migraine. 
Of the two, migraine without aura is the type primarily associated with hormonal fluctuations, and thus is the primary focus of this review.[7,8] Among women, migraine can be further subdivided with respect to its relationship to menstruation (Table) [1,7]
Table -Diagnostic criteria for Menstrual Migraine
International Headache Society (ICHD-3beta) (Headache Classification, 2013)
|Pure menstrual migraine||Documented and prospectively collected evidence that attacks occur exclusively on day 1 ± 2 (i.e., days −2 to + 3)a of menstruation in at least two out of three menstrual cycles and at no other times of the cycle|
|Menstrually-related migraine||Documented and prospectively collected evidence that attacks occur on day 1 ± 2 (i.e., days −2 to + 3)a of menstruation in at least two out of three menstrual cycles and additionally at other times of the cycle|
|Non-menstrual migraine||Attacks have no menstrual relationship|
aThe first day of menstruation is day 1 and the preceding day is day − 1; there is no day 0
Diagnostic Criteria for Migraine: Repeated attacks of headache lasting 4–72 h in patients with a normal physical examination, no other reasonable cause for the headache, and: At least 2 of the following features: Unilateral pain, Throbbing pain, Aggravation by movement, Moderate or severe intensity. At least 1 of the following features: Nausea/vomiting, Photophobia and phonophobia
Representation of menstrual migraine in Repertories: [10,11,12,13,14]
- BOERICKE’S REPERTORY
HEAD, Headache (cephalalgia), Type, menstrual.
- KENT REPERTORY
HEAD, Pain, Menses , Commencement of, at-
- BOGER BOENNINGHAUSEN’S CHARACTERISTICS AND REPERTORY
HEAD – Internal – aggravation;menses after
- PHATAK CONCISE REPERTORY
HEAD: menses; before and after agg.
- MURPHY REPERTORY
- Avena sativa – Nervous headache at menstrual period with burning at top of head. Occipital headache with phosphatic urine. Nervous states of many female troubles.
- Joanesa asoca– Unilateral headache ,reflex uterine, congestive headache better open air and by free flow.
- Laurocerasus– Menses too frequent ,profuse, thin with tearing in vertex at night. Want of animal heat and reaction. Feeble circulation and weak heart.
- Allium sativum– Heavy; pulsation in temples; catarrhal deafness. Has vasodilatory properties. headache before menses, ceases during agg. afterwards.
- Glycerinum– Head full throbs, mentally confused. Severe headache two days before menstruation.
- Ustilago maydis– Full feeling, nervous headache from menstrual irregularities.
- Xanthoxyllum fraxineum – A tightening of scalp and heavy pain in temples, increase of head difficulties with great heat and quite flowing (menstrual),being two days in advance of proper time;
- Chionanthus– Often service in many types of headache, neurasthenic, periodical sick headache, menstrual and bilious.
- Lac vaccinum defloratum– Intense throbbing with nausea, vomiting, blindness and obstinate constipation; worse noise, light, motion, during menses with great prostration, better by pressure and bandaging head tightly.
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Anju Bishnoi (BHMS,MD)
PhD (persuing) Tantia University, SriGanganagar(Raj.)
Suresh Bishnoi (BHMS)
Homoeopathic Consultant, Jaipur (Raj.)