EFFECTIVE TREATMENT OF SEVERE MENSTRUAL MIGRAINE HEADACHES WITH GONADOTROPIN-RELEASING-HORMONE AGONIST AND ADD-BACK THERAPY

Objective: To determine the efficacy of treating women with severe men strual migraine headaches with GnRH agonist (GnRH-a) therapy, alone an d combined with continuous estrogen-progestin ''add-back.'' Design: No nrandomized, prospective treatment study. Setting: Outpatient clinic i n a university medical center. Patient(s): Five women who had repetiti ve, severe, migraine headaches limited to the perimenstrual period wer e selected carefully. Intervention(s): After 2 months of basal evaluat ion, all subjects received GnRH-a (leuprolide acetate depot formulatio n, 3.75 mg IM, monthly) for 10 months. Beginning with the 5th month, ' 'add-back'' therapy (the addition of transdermal E(2), 0.1 mg daily, a nd 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 cum ulative score for thai; month. In addition, patients were asked their overall assessment of the treatments. Result(s): The mean headache sco res for the GnRH-a treatment months (4.0+/-1.5, mean+/-SEM) and for th e GnRH-a and ''add-back'' treatment months (3.1+/-0.7) were each signi ficantly lower than those of the control months (15.3+/-2.4). The pati ents uniformly found both treatments to be well tolerated and near-cur ative for their condition. Conclusion(s): Gonadotropin-releasing hormo ne agonist administration, alone or with ''add-back'' therapy, is a ve ry effective treatment for carefully selected patients with severe, pe rimenstrual migraine headaches.