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Migraine Associated With Menstruation

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To the Editor:–A woman aged 45 has had at each regular menstrual period
since the birth of her only child sixteen years ago, attacks of migrainous
headache. These are accompanied by vomiting and some dizziness.
Occasionally she may go through the menses without symptoms. I have
given her estrogenic substance, as high as 50,000 units twice weekly and
no results, although for the first few months after beginning treatment
she had much diminution of her symptoms but lately they have again
recurred severely. I have also tried vitamin Bo to no avail; also thyroid.
There is no anatomic or physiologic abnormality in the pelvis.
G. E. Michell, M.D., Hackettstown, N. J.
Answer.–The patient has the type of migraine (hemicrania)
that is associated with the menses. Migraine is a protean dis¬
order and may be a simple or an extremely complex condition.
The present concept is that the periodic headaches are due to
a vasomotor disturbance. Nothing positive is known regarding
the active cause. This type of headache usually disappears
during pregnancy and after the climacteric. Estrogens and
vitamin B9 are almost always ineffective. Rest, proper bowel
hygiene, abstinence from alcoholic beverages and some sedative
are cardinal points in the management of the usual case. In
this instance the patient may be given either sodium bromide
or fluidextract of cannabis three days before the onset of the
menstrual period, continued daily until three days after the
menstrual period. The dose of sodium bromide is 1 Gm.
(15 grains) three times daily. The dose of the fluidextract of
cannabis is five drops three times daily, increased daily by one
drop until eleven drops, three times daily, are taken. Then the
dosage is reduced by one drop daily until five drops are taken
three times daily and so on. In a few cases ligating the middle
meningeal artery on the affected side has been tried. This
procedure is not without danger and is not recommended.
Ergotamine tartrate may also be used.


Source: Migraine Associated With Menstruation