E. Anne MacGregor

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Queen Mary University of London | QMUL · Centre for Neuroscience Surgery and Trauma

Background We evaluated galcanezumab for migraine prevention in patients who met International Classification of Headache Disorders, 3rd edition criteria for menstrually related migraine (MRM). Methods Patients were identified post hoc from three double‐blind, randomized, phase 3 clinical trials in patients with episodic migraine. Patients complet...

Objective: To evaluate the efficacy and safety of ubrogepant for the acute treatment of perimenstrual migraine (pmM) attacks. Background: Ubrogepant is an oral calcitonin gene-related peptide receptor antagonist approved for the acute treatment of migraine in adults. Methods: After completing one of two phase 3 trials, participants could enrol...

Background Perimenstrual migraine attacks in women with menstrual migraine is difficult to treat. This post-hoc analysis evaluated the efficacy of lasmiditan, a high affinity and selective 5-HT 1F receptor agonist, for perimenstrual attacks. Methods Patients from two randomized, double-blind, placebo-controlled clinical trials (MONONOFU and CENTUR...

There is an unmet need for effective diagnosis and management of migraine in perimenopausal women. Menstrual cycle hormone disruption during perimenopause is associated with an increase in migraine and menstrual migraine prevalence, together with other more commonly recognised menopause symptoms. Women of perimenopause age, i.e., early 40s to mid 5...

Background Over the last 20 years, new contraceptive methods became available and incentives to increase contraceptive uptake were introduced. We aimed to describe temporal trends in non-barrier contraceptive prescribing in UK primary care for the period 2000–2018. Methods A repeated cross-sectional study using patient data from the IQVIA Medical...

Background Migraine affects 80.8 million people in Western Europe and is the first cause of disability among people between ages 15 and 49 worldwide. Despite being a highly prevalent and disabling condition, migraine remains under-diagnosed and poorly managed. Methods An international, online survey was conducted among 201 general practitioners (G...

The term menstrual migraine refers to migraine that is associated with menstruation by more than chance, but it does not define pathophysiology. Menstrual migraine affects about 20–25% of female migraineurs in the general population, and 22–70% of patients presenting to headache clinics. In women diagnosed with menstrual migraine, perimenstrual mig...

Background Migraine is a prevalent and disabling headache disorder that affects more than 1.04 billion individuals world-wide. It can result in reduction in quality of life, increased disability, and high socio-economic burden. Nevertheless, and despite the availability of evidence-based national and international guidelines, the management of migr...

Migraine is affected by the changing hormone environment, with perimenopause associated with increased migraine, particularly menstrual migraine. Menstrual attacks are recognised to be more disabling and less responsive to treatment compared with non-menstrual attacks. Perimenstrual estrogen ‘withdrawal’ is implicated in the pathophysiology of mens...

Background: Many studies have described the features of menstrually-related migraines (MRM) in the natural cycle and the efficacy of prevention. MRM in combined hormonal contraceptive (CHC) users has scarcely been researched. Estrogen and progestin withdrawal in CHC users are both more abrupt and from higher hormone levels compared with the natura...

To ensure reproducibility in research quantifying episodic migraine attacks, and identifying attack onset, a sound theoretical model of a migraine attack, paired with a uniform standard for counting them, is necessary. Many studies report on migraine frequencies—e.g. the fraction of migraine-days of the observed days—without paying attention to the...

Introduction. Migraine and combined hormonal contraceptives (CHCs) increase the risk of ischemic stroke in young women; however, the contribution of low-dose (<50 μg ethinylestradiol) CHCs to the risk of ischemic stroke in young women with migraine is not well defined. Areas covered. The authors performed a systematic review of observational studie...

The Aids to Management are a product of the Global Campaign against Headache, a worldwide programme of action conducted in official relations with the World Health Organization. Developed in partnership with the European Headache Federation, they update the first edition published 11 years ago.The common headache disorders (migraine, tension-type h...

Objective: To develop a robust statistical tool for the diagnosis of menstrually related migraine. Background: The International Classification of Headache Disorders (ICHD) has diagnostic criteria for menstrual migraine within the appendix. These include the requirement for menstrual attacks to occur within a 5-day window in at least [Formula: s...

An anonymised data set of headache diaries from women attending the City of London Migraine Clinic during the period 1998---1999. Data include 121 women with diaries for at least 3 cycles. For these women the median age was 42.5 years (range 14 to 57 years).The women were not using any hormone treatment, continued their usual migraine treatment and...

Background: To ensure reproducibility in research quantifying episodic migraine attacks, and identifying attack starts, a sound theoretical model of a migraine attack is necessary, paired with a uniform standard for counting attacks. Many studies report on migraine frequencies -e.g. number of migraine-days-without paying attention to the number of...

Migraine is known to be affected by sex hormones, with the higher prevalence in women during the reproductive years considered to be due to the effects of oestrogen. Hence, migraine is likely to be affected by hormones used for transgender treatment. Of the very limited data available, the prevalence of migraine increases in transgender women using...

This book focuses on the influence of sex and gender in migraine, presenting new insights in basic science as well as their clinical relevance. As migraine is roughly three times more common in women than in men, and also highly depends on hormonal milestones – such as menarche, menstruation, pregnancy and menopause – particular attention is devote...

Background: Menstrual migraine (MM) and premenstrual syndrome (PMS) are two conditions linked to specific phases of the menstrual cycle. The exact pathophysiological mechanisms are not fully understood, but both conditions are hypothesized to be triggered by female sex hormones. Co-occurrence of MM and PMS is controversial. The objective of this p...

Following the publication of this article [1], the authors noticed that they incorrectly reported the Absolute risk of ischemic stroke in women aged 20 to 44 years in relation to the use of hormonal contraception and migraine status due to a miscalculation. They apologize for this misreported result.

We systematically reviewed data about the effect of exogenous estrogens and progestogens on the course of migraine during reproductive age. Thereafter a consensus procedure among international experts was undertaken to develop statements to support clinical decision making, in terms of possible effects on migraine course of exogenous estrogens and...

Aim This review summarises the available data on the disadvantages of the 7-day contraceptive-free interval (CFI) of combined oral contraceptives (COCs), in contrast to shorter CFIs or continuous use – including flexible regimens – and provides recommendations for practice. Methods Relevant papers were identified by Medline and PubMed. The final r...

Background: In 2016, a large meta-analysis brought the number of susceptibility loci for migraine to 38. While sub-type analysis for migraine without aura (MO) and migraine with aura (MA) found some loci showed specificity to MO, the study did not test the loci with respect to other subtypes of migraine. This study aimed to test the hypothesis tha...

Background: Headache disorders are both common and burdensome but, given the many people affected, provision of health care to all is challenging. Structured headache services based in primary care are the most efficient, equitable and cost-effective solution but place responsibility for managing most patients on health-care providers with limited...

Several data indicate that migraine, especially migraine with aura, is associated with an increased risk of ischemic stroke and other vascular events. Of concern is whether the risk of ischemic stroke in migraineurs is magnified by the use of hormonal contraceptives. As migraine prevalence is high in women of reproductive age, it is common to face...

Perimenopause marks a period of increased migraine prevalence in women and many women also report troublesome vasomotor symptoms. Migraine is affected by fluctuating estrogen levels with evidence to support estrogen ‘withdrawal’ as a trigger of menstrual attacks of migraine without aura, while high estrogen levels can trigger migraine aura. Maintai...

For the majority of women, oral contraception is safe, convenient and effective, but users should be counselled about potential adverse effects and the importance of good adherence. This review discusses the efficacy, advantages and disadvantages of both combined and progestogen-only oral contraceptives.

This issue provides a clinical overview of migraine, focusing on risk, prevention, diagnosis, treatment, follow-up, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals...

Migraine is a common, disabling headache disorder, which is influenced by multiple genes and environmental triggers. After puberty, the prevalence of migraine in women is three times higher than in men and > 50% of females suffering from migraine report a menstrual association, suggesting hormonal fluctuations can influence the risk of migraine att...

Migraine is two to three times more prevalent in women than men, and women report a longer attack duration, increased risk of headache recurrence, greater disability, and a longer period of time required to recover. Conditions recognised to be comorbid with migraine include asthma, anxiety, depression, and other chronic pain conditions, and these c...

Migraine is a common headache disorder, particularly in women. It usually starts during the teens and twenties, a time when many women are seeking contraception advice. Migraine without aura is the most prevalent type of migraine, affecting up to 70% of people with migraine, while the remainder experience attacks with and/or without aura. Aura is a...

Background Methysergide has been as an effective treatment for migraine and cluster headache for over 50 years but has recently been investigated by the European Medicines Agency due to safety concerns. Methods To assess the need for continuing availability of methysergide, the International Headache Society performed an electronic survey among th...

Migraine is prevalent in women during the reproductive years and attacks are likely to continue during pregnancy. As medication is usually necessary to control symptoms effectively, management during pregnancy and lactation can be a cause of concern to both the woman and her healthcare providers. There is often confusion regarding which medicines a...

Headache is the most common neurological condition in the world, with more than 90% of the population reporting headaches at some time in their lives. Among primary headache disorders, tension-type headache is the most prevalent worldwide, but in patients seeking medical help, migraine is by far the most frequently presenting headache subtype. Migr...

Migraine is most prevalent in women during their reproductive years. An understanding of the effects of menstruation and menopause on migraine can enable neurologists to provide targeted and appropriate medical and hormonal strategies, enabling their patients to achieve better control of migraine and reduced disability. This article reviews the eff...

Progestogen-only oral contra ceptives are a useful alternative to combined oral contraceptives but adherence is more important.

The aim of this article is to evaluate the safety and efficacy of perimenstrual telcagepant, a CGRP receptor antagonist, for headache prophylaxis. We conducted a randomized, double-blind, placebo-controlled, six-month trial in women with migraine for ≥3 months who experienced perimenstrual headaches. Women were randomized to telcagepant 140 mg or p...

The objective of this article is to compare clinical characteristics of menstrual and non-menstrual attacks of migraine without aura (MO), prospectively recorded in a headache diary, by women with and without a diagnosis of menstrual migraine without aura (MM) according to the International Classification of Headache Disorders (ICHD). A total of 23...

Background Menstrual migraine (MM) encompasses pure menstrual migraine (PMM) and menstrually-related migraine (MRM). This study was aimed at investigating genetic variants that are potentially related to MM, specifically undertaking genotyping and mRNA expression analysis of the ESR1, PGR, SYNE1 and TNF genes in MM cases and non-migraine controls....

Objective: The objective of this article is to compare clinical characteristics of menstrual and non-menstrual attacks of migraine without aura (MO), prospectively recorded in a headache diary, by women with and without a diagnosis of menstrual migraine without aura (MM) according to the International Classification of Headache Disorders (ICHD). Ma...

Objectives: The objective of this article is to compare the diagnosis of menstrual migraine without aura (MM) from a clinical interview with prospective headache diaries in a population-based study. Material and methods: A total of 237 women with self-reported migraine in at least half of menstruations were interviewed by a neurologist about hea...

The objective of this review is to provide an overview of menstrual migraine (MM) and of frovatriptan and to assess clinical trial data regarding the efficacy and safety of frovatriptan for the acute and short-term prophylaxis of MM. Randomized controlled trials comparing frovatriptan with placebo or a triptan comparator for the acute or prophylact...

Background Menstrual migraine without aura (MM) affects approximately 20% of female migraineurs in the general population. The aim of the present study was to investigate the influence of contraception on the attacks of migraine without aura (MO) in women with MM. Findings 141 women from the general population with a history of MM according to the...

Migraine in pregnancy can cause considerable concern to both patient and doctor, particularly if migraine starts for the first time during pregnancy or if the woman has her first attack with aura. There is often confusion regarding which medicines are safe to use during pregnancy and breastfeeding, leaving many women unable to control their attacks...

PURPOSE OF REVIEW: This article provides an overview of the diagnosis and management of primary and secondary headaches that may occur during pregnancy and postpartum. Headache presenting in pregnancy is of significant concern to the affected woman. Quick and correct diagnosis leads to the optimal management, minimizing risks to the pregnancy. RECE...

Orofacial pain represents a significant burden in terms of morbidity and health service utilization. It includes very common disorders such as toothache and temporomandibular disorders, as well as rare orofacial pain syndromes. Many orofacial pain conditions have overlapping presentations, and diagnostic uncertainty is frequently encountered in cli...

To present data from a population-based epidemiological study on menstrual migraine. Altogether, 5000 women aged 30-34 years were screened for menstrual migraine. Women with self-reported menstrual migraine in at least half of their menstrual cycles were invited to an interview and examination. We expanded the International Classification of Headac...

For the majority of women the Pill is a safe and effective contraceptive, but users should be counselled about potential side‐effects and the importance of adherence. Our Drug review considers the properties of both combined and progestogen‐only pills, followed by sources of further information and an analysis of the prescription data.

Most women have used at least 1 method of contraception during their reproductive years, with the majority favoring combined oral contraceptives. Women are often concerned about the safety of their method of choice and also ask about likely effects on their pre‐existing headache or migraine and restrictions on using their headache medication. While...

The HURT Questionnaire consists of eight questions which the patient answers as a measure of effectiveness of intervention against headache. This first assessment of clinical utility was conducted in headache specialist centres in three countries in order to demonstrate that HURT was responsive to change induced by effective management. We administ...

Steve Chaplin and Professor Anne MacGregor provide an overview of the properties of triptans and how they compare in the treatment of acute migraine.

Purpose of review: This article provides an overview of the diagnosis and management of primary and secondary headaches that may occur during pregnancy and postpartum. Headache presenting in pregnancy is of significant concern to the affected woman. Quick and correct diagnosis leads to the optimal management, minimizing risks to the pregnancy. Re...

Although more than 50% of women with migraine report an association between migraine and menstruation, menstruation has generally considered to be no more than one of a variety of different migraine triggers. In 2004, the second edition of the International Classification of Headache Disorders introduced specific diagnostic criteria for menstrual m...

To assess efficacy and tolerability of rizatriptan orally disintegrating tablet (ODT) for treatment of acute migraine in patients using topiramate for migraine prophylaxis. There are limited data from prospective controlled trials demonstrating the benefit of triptans in patients who experience migraine attacks while taking prophylactic medication....

Botulinum toxin type A (Botox) has been licensed for the prophylaxis of headaches in chronic migraine. In our New products review Steve Chaplin presents the clinical data relating to its efficacy and adverse events and Professor Anne MacGregor discusses its place in the treatment of migraine. Copyright © 2011 Wiley Interface Ltd

Menstrual migraine is a common neurological condition reported to affect up to 60% of women with migraine. Most women manage migraine adequately with symptomatic treatment alone. However, in women with menstrual migraine, menstrual attacks are recognised to be more severe, last longer, and are less responsive to treatment compared with attacks at o...

Telcagepant (MK0974) is one of several calcitonin-gene-related peptide antagonists in development as a potential treatment for acute migraine attacks and is the first orally available drug in this class. Preclinical and clinical data are reviewed, which support the efficacy and tolerability of telcagepant for the treatment of migraine, particularly...

(Headache 2011;51:839-842) Significant sex differences exist in migraine and other headache disorders. Several hypotheses have been proposed to explain these differences, including fluctuations in sex hormones and receptor binding, genetic factors, differences in exposure to environmental stressors, as well as differences in response to stress and...

( Headache 2011;51:843‐859) This manuscript discusses sex‐related differences in headache prevalence, the symptoms and natural history of migraine, associated disability, and co‐morbid disorders. The role of sex hormones is discussed with reference to the effects of hormonal events across the reproductive years and the specific effects of the menst...

Oral contraceptives are effective, reversible, independent of intercourse and for the majority of users safe with added health benefits. Our Drug review considers the properties and efficacy of both combined and progestogen-only pills, followed by sources of further information and an analysis of the prescription data. Copyright © 2011 Wiley Interf...

The prevalence of migraine is highest during the peak reproductive years and many women report its association with their menstrual periods. In this review, Professor MacGregor discusses the diagnosis, pathophysiology and management of menstrual migraine. Copyright © 2011 Wiley Interface Ltd

Migraine is a prevalent headache disorder affecting three times more women than men during the reproductive years. Menstruation is a significant risk factor for migraine, with attacks most likely to occur on or between 2 days before the onset of menstruation and the first 3 days of bleeding. Although menstrual migraine has been recognized for many...

Triptans are a recommended first-line treatment for moderate to severe migraine. Using clinical trial data, we evaluated the safety and tolerability of frovatriptan as acute treatment (AT) and as short-term preventive (STP) therapy for menstrual migraine (MM). Data from 2 Phase III AT trials (AT1: randomized, placebo controlled, 1 attack; AT2: 12-m...

To compare, using a within-woman analysis, the severity, duration, and relapse of menstrual vs nonmenstrual episodes of migraine during treatment with usual migraine therapy. Studies comparing the clinical characteristics of menstrual and nonmenstrual migraine attacks have yielded conflicting results, contributing to disagreement regarding whether...

A number of women with migraine experience increased incidence of attacks during the perimenstrual period. The Appendix of the International Classification of Headache Disorders (ICHD II) describes two types of migraine without aura related to menstruation: pure menstrual migraine (PMM) and menstrually related migraine (MRM). The phrase "menstrual...

Migraine is a common disorder that is highly co-morbid with psychopathological conditions such as depression and anxiety. Despite the extensive research and availability of treatment, migraine remains under-recognised and undertreated. The aim of this study was to design a short and practical screening tool to identify migraine for clinical and res...

Structured Migraine Interview. The file contains the structured migraine interview ten questions.

Perimenopause marks a time of change in a woman's hormonal environment, which is apparent from the resultant irregular periods and vasomotor symptoms. These symptoms can start in the early 40s and continue through to the early 50s. Migraine is also affected by hormonal fluctuations, particularly the natural decline in estrogen in the late luteal ph...

The efficacy of a 6-day regimen of frovatriptan for menstrual migraine (MM; attacks starting on day -2 to +3 of menses) prevention in women with difficult-to-treat MM was assessed. Women with a documented inadequate response to triptans for acute MM treatment were included in this placebo-controlled, parallel-group trial. Women were randomized to d...

To assess the safety and tolerability profile of the 5-HT(1B/1D) agonist frovatriptan (Frova(R), Endo Pharmaceuticals Inc., Chadds Ford, PA, USA) when used as a 6-day regimen for the short-term prevention of menstrual migraine scheduled over multiple perimenstrual periods. Two randomized controlled trials have established the efficacy of a 6-day re...

In Pregnancy is a series of reviews focusing on the management of women with psychiatric and neurological conditions during pregnancy. In this article, Dr MacGregor discusses the effect of pregnancy on migraine and the treatment choices available to women during pregnancy and lactation. Copyright © 2009 Wiley Interface Ltd

The development of diagnostic criteria has enabled greater recognition of menstrual migraine as a highly prevalent and disabling condition meriting specific treatment. Although few therapeutic trials have yet been undertaken in accordance with the criteria, the results of those published to date confirm the efficacy of acute migraine drugs for symp...

Four of every 10 women will experience migraine at some time in their lives, with peak prevalence in middle life. Evidence supports estrogen 'withdrawal' as one of the important triggers of menstrual attacks of migraine without aura. Improvement of migraine without aura postmenopause is generally attributed to the absence of variations in sex hormo...

Headache and migraine are common symptoms of the menopause, often associated with irregular periods, hot flashes, and night sweats. Perimenopausal women should routinely be asked about headache and migraine, so that they can be offered appropriate advice. If attacks are infrequent, it may be sufficient to optimize acute treatment strategies. Lifest...

The risk of migraine is increased among women during a 5-day perimenstrual window that starts 2 days before the onset of menses and continues through the first 3 days of menstruation. For some women with menstrual migraine, headaches that occur at this time are more severe, of longer duration, and more disabling. Although it is recognized that mens...