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 menstrual migraine headaches with GnRH agonist (GnRH-a) therapy, alone and combined with continuous estrogen-progestin ''add-back.'' Design: Nonrandomized, prospective treatment study. Setting: Outpatient clinic in a university medical center. Patient(s): Five women who had repetitive, severe, migraine headaches limited to the perimenstrual period were selected carefully. Intervention(s): After 2 months of basal evaluation, all subjects received GnRH-a (leuprolide acetate depot formulation, 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, and 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 cumulative score for thai; month. In addition, patients were asked their overall assessment of the treatments. Result(s): The mean headache scores for the GnRH-a treatment months (4.0+/-1.5, mean+/-SEM) and for the GnRH-a and ''add-back'' treatment months (3.1+/-0.7) were each significantly lower than those of the control months (15.3+/-2.4). The patients uniformly found both treatments to be well tolerated and near-curative for their condition. Conclusion(s): Gonadotropin-releasing hormone agonist administration, alone or with ''add-back'' therapy, is a very effective treatment for carefully selected patients with severe, perimenstrual migraine headaches.