A review and meta-analysis of therapy trials for menstrual-related migraine headache (MRM) and evidence-based recommendations for acute and short-term preventive treatment are reported from Toronto Western Hospital, ON, Canada. Nineteen prospective, doubleblind, randomized controlled trials of medications for relief or prevention of MRM were included in the guideline. For 9 acute treatment trials that met inclusion criteria, outcome considered was pain response and pain-free response at 2 hours. For 10 short-term prevention trials, the response criteria were the incidence of MRM or number of headache days. Trials involved women aged 18 to 65 with a history of MRM in at least two or 3 previous regular menstrual cycles. Trial quality was based on US Task Force criteria. Grade B recommendations (good evidence to treat - benefits outweigh harms) for use of sumatriptan, mefenamic acid, and rizatriptan in acute management of MRM in adult patients. Grade B recommendations for premenstrual use of transcutaneous estrogen, frovatriptan, and naratriptan in preventive treatment of adults with MRM. Choice of evidence-based regimens for MRM is based on clinical considerations. [1]

COMMENT. The above report concerns adults, and sumatriptan is much less effective against migraine in children and adolescents. Sumatriptan is not licensed for use in patients <18 years of age in the US. In 23 children, aged 8 to 16 years, a randomized placebo-controlled, crossover trial of oral sumatriptan in Finland showed no significant differences in pain relief, although 13 preferred sumatriptan [2]. A failure of response to oral sumatriptan is reported by others. In contrast, a placebo-controlled, crossover trial in Germany found nasal sumatriptan to be effective and well tolerated in children over 8 years of age [3, 4]. A search of the literature found no study of effects of triptans in children with menstrual-related migraine.