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Stephen D Silberstein - One of the best experts on this subject based on the ideXlab platform.
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Menstrual Migraine an updated review on hormonal causes prophylaxis and treatment
Expert Opinion on Pharmacotherapy, 2014Co-Authors: Stephen D Silberstein, Sumit PatelAbstract:Introduction: In this article, we will discuss pure Menstrual Migraine without aura (PMM) and Menstrually related Migraine without aura (MRM). Depending on the frequency and severity of their attacks, patients with PMM will likely need an acute treatment and/or short-term preventive plan. Of note, with the use of acute treatments and short-term preventive therapy there is risk of medication overuse if the patient does have pure Menstrual Migraine and is being treated for Menstrually related Migraine.Areas covered: A PubMed, Cochrane Central, Medline, Ovid search provided articles relating to Menstrual Migraine pathophysiology and treatment.Expert opinion: Long-term daily preventive treatment should be considered for patients with MRM and those with severe PMM. Miniprophylaxis can be used in PMM rather than daily preventive treatment. When considering the use of short-term miniprophylaxis, sumatriptan, zolmitriptan, naratriptan, and frovatriptan have shown efficacy; however, frovatriptan appears to be the ...
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short term frovatriptan for the prevention of difficult to treat Menstrual Migraine attacks
Cephalalgia, 2009Co-Authors: Jan Lewis Brandes, E A Macgregor, Stephen D Silberstein, A C Poole, M Kallela, C P Schreiber, J Tobin, R ShawAbstract: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 doc...
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diagnosis and treatment of the Menstrual Migraine patient
Headache, 2008Co-Authors: Stephen D Silberstein, Susan HutchinsonAbstract:Women presenting with recurrent disabling headache frequently have Migraine; but physicians need to rule out other headache disorders before they reach a diagnosis of Migraine with or without aura. Many women who experience Migraine in close association to their Menstrual cycle may meet the diagnostic criteria for either Menstrually related Migraine (MRM), or pure Menstrual Migraine (PMM). Once an accurate diagnosis is made, treatment may be established to best suit the individual needs of that patient. Most women will find that Migraine associated with hormone fluctuations respond well to standard treatment approaches including pharmacological and nonpharmacological treatments. Pharmacological approaches include acute, preventive, and short-term prophylaxis. Herein we review the difference between non-Menstrual Migraine, PMM, and MRM and identify effective treatment strategies for appropriate management of Migraine associated with hormonal fluctuations.
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oral zolmitriptan in the short term prevention of Menstrual Migraine a randomized placebo controlled study
CNS Drugs, 2008Co-Authors: Michael Tuchman, Ugochi Emeribe, Stephen D SilbersteinAbstract:Objective: To evaluate the efficacy and tolerability of oral zolmitriptan as a short-term preventative therapy for Menstrual Migraine.
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efficacy and tolerability of zolmitriptan oral tablet in the acute treatment of Menstrual Migraine
CNS Drugs, 2006Co-Authors: Michael Tuchman, Ugochi Emeribe, Stephen D SilbersteinAbstract:Objective: To determine the efficacy and tolerability of zolmitriptan 2.5mg oral tablet as an acute treatment for Menstrual Migraine attacks.
Bella T Altura - One of the best experts on this subject based on the ideXlab platform.
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serum ionized magnesium levels and serum ionized calcium ionized magnesium ratios in women with Menstrual Migraine
Headache, 2002Co-Authors: Alexander Mauskop, Bella T AlturaAbstract:Objective It has been suggested that magnesium deficiency may play an important role in Menstrual Migraine and that the serum ionized calcium (ICa2+)/ionized magnesium (IMg2+) ratio is important in Migraine headache. Studies were designed to test these hypotheses. Design We prospectively evaluated 270 women seen at a headache clinic and in 61 women with Menstrual Migraine measured IMg2+, total magnesium, and ICa2+ levels so as to calculate the ICa2+/IMg2+ ratio. Results The incidences of IMg2+ deficiency were 45% during Menstrual attacks, 15% during nonMenstrual attacks, 14% during menstruation without a Migraine, and 15% between menstruations and between Migraine attacks. The serum ICa2+ levels were within our reference range, but the ICa2+/IMg2+ ratio was elevated (P Conclusions The high incidence of IMg2+ deficiency and the elevated ICa2+/IMg2+ ratio during Menstrual Migraine confirm previous suggestions of a possible role for magnesium deficiency in the development of Menstrual Migraine.
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Serum ionized magnesium levels and serum ionized calcium/ionized magnesium ratios in women with Menstrual Migraine.
Headache, 2002Co-Authors: Alexander Mauskop, Bella T AlturaAbstract:Objective.—It has been suggested that magnesium deficiency may play an important role in Menstrual Migraine and that the serum ionized calcium (ICa2+)/ionized magnesium (IMg2+) ratio is important in Migraine headache. Studies were designed to test these hypotheses. Design.—We prospectively evaluated 270 women seen at a headache clinic and in 61 women with Menstrual Migraine measured IMg2+, total magnesium, and ICa2+ levels so as to calculate the ICa2+/IMg2+ ratio. Results.—The incidences of IMg2+ deficiency were 45% during Menstrual attacks, 15% during nonMenstrual attacks, 14% during menstruation without a Migraine, and 15% between menstruations and between Migraine attacks. The serum ICa2+ levels were within our reference range, but the ICa2+/IMg2+ ratio was elevated (P
Vincent T. Martin - One of the best experts on this subject based on the ideXlab platform.
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changes in salivary prostaglandin levels during Menstrual Migraine with associated dysmenorrhea
Headache, 2010Co-Authors: Paul L Durham, Roger K Cady, Frederick J Derosier, Susan A Mcdonald, Carrie V Vause, Vincent T. MartinAbstract:(Headache 2010;50:844-851) Objective.— To measure prostaglandin levels in the saliva of individuals during Menstrual Migraine associated with dysmenorrhea (MMaD) and in response to treatment with a single tablet combination of sumatriptan succinate and naproxen sodium. Background.— Prostaglandins are thought to play a role in MMaD as elevated serum prostaglandin levels have been reported during attacks of Menstrual Migraine and are increased in the Menstrual fluid of women with dysmenorrhea. While triptans are the primary line of Migraine treatment, nonsteriodal anti-inflammatory drugs are the most commonly prescribed therapy for dysmenorrhea symptoms. Data from recent clinical studies have provided evidence that treatment with a single tablet combination of sumatriptan and naproxen sodium is an effective abortive therapy for attacks of MMaD. Methods.— Women diagnosed with MMaD were treated with a sumatriptan succinate and naproxen sodium single tablet combination or placebo at time of Migraine attack. Saliva samples were collected at time of attack as well as 2 and 4 hours after treatment. PGD2, PGE2, PGF2, PGI2, and TXA2 levels were determined by enzyme-linked immunosorbent assay. Results.— Elevated levels of PGD2, PGF2, and TXA2 at 2 and 4 hours and PGE2 at 4 hours were found in saliva obtained from placebo subjects when compared with onset of attack levels. However, in subjects treated with a single tablet combination of sumatriptan and naproxen sodium, the levels of PGD2, PGF2, and PGE2 were not elevated at either time point while TXA2 levels were still elevated at 4 hours. Conclusions.— Data from this pilot study provide evidence that saliva levels of several prostaglandins increase during attacks of MMaD and that treatment with a single tablet combination of sumatriptan and naproxen sodium prevents elevation of prostaglandin levels.
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combination treatment for Menstrual Migraine and dysmenorrhea using sumatriptan naproxen two randomized controlled trials
Obstetrics & Gynecology, 2009Co-Authors: Lisa K. Mannix, Vincent T. Martin, Roger K Cady, Merle L Diamond, Shelly E Lener, Jonathan White, Frederick J Derosier, Susan A McdonaldAbstract:OBJECTIVE:To evaluate the efficacy and tolerability of sumatriptan–naproxen during the mild pain phase of a single Menstrual Migraine attack associated with dysmenorrhea.METHODS:Two replicate randomized, multicenter, double-blind, placebo-controlled, trials of adults with Menstrual Migraine and dysm
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New Theories in the pathogenesis of Menstrual Migraine
Current Pain and Headache Reports, 2008Co-Authors: Vincent T. MartinAbstract:Hormonal and nonhormonal factors play a role in the pathophysiology of Menstrual Migraine, but estrogen withdrawal appears to be the most potent of these factors. It is postulated that estrogen withdrawal directly enhances excitability of trigeminal afferents, modulates the synthesis of neuropeptides, activates/deactivates specific neurotransmitter systems, and influences the function of microglia. These changes could activate and/or sensitize the trigeminal system and increase the likelihood of Migraine headache during periMenstrual time periods. Three new theories are advanced in this article to explain the pathophysiology of Menstrual Migraine. Only through an understanding of the mechanisms involved in Menstrual Migraine can we gain insight into the management of this severe and debilitating form of Migraine headache.
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epidemiology and biology of Menstrual Migraine
Headache, 2008Co-Authors: Vincent T. Martin, Richard B LiptonAbstract:Migraine is frequently associated with menstruation in female Migraineurs, and consequently it is commonly referred to as Menstrually associated Migraine. The trigger thought to be partially responsible for Menstrually associated Migraine is a significant drop in circulating estrogen that is noted during 2-3 days prior to onset of menses. It is estimated that approximately 50% of women have an increased risk of experiencing Migraine during the preMenstrual phase of decreasing estrogen levels. Understanding the biological basis of Migraine associated with menses will facilitate an accurate diagnosis and help patients recognize time susceptible to Migraine exacerbations. This paper will review the biological bases for the hormonal changes that occur during the Menstrual cycle and review the prevalence and burden of Menstrual Migraine among female headache sufferers.
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efficacy of rizatriptan for Menstrual Migraine in an early intervention model a prospective subgroup analysis of the rizatriptan tame treat a Migraine early studies
Headache, 2007Co-Authors: Vincent T. Martin, Roger K Cady, Anthony Rodgers, Carolyn M. Hustad, Karen E. Ramsey, Alexander Mauskop, Larry S Seidman, Franck SkobierandaAbstract:OBJECTIVE: A prospective subgroup analysis of the TAME (Treat A Migraine Early) studies examined the efficacy of rizatriptan in patients treating a Menstrual Migraine attack. METHODS: Both TAME studies were randomized, placebo-controlled, and double-blind. Adults with Migraine were assigned (2:1) to either rizatriptan 10-mg tablet or placebo. Patients were instructed to treat within 1 hour of Migraine onset and when the pain was mild. The primary endpoint was 2-hour pain freedom. The diagnosis of Menstrual Migraine was established according to the revised 2004 International Headache Society (IHS) diagnostic criteria. Data from both studies were pooled for logistic regression analyses. A test for interaction was performed to compare rates of 2-hour pain freedom between patients treating a Menstrual and non-Menstrual attack. RESULTS: A total of 94 patients (63 in the rizatriptan group and 31 in the placebo group) met IHS criteria for Menstrual Migraine and treated a Menstrual attack. The percentage of patients reporting 2-hour pain freedom was significantly greater for rizatriptan than for placebo (63.5% vs 29.0%; odds ratio = 4.5; 95% confidence interval: 1.7, 11.9; P = .002) in those treating a Menstrual attack. In those treating with rizatriptan, the percentage of patients with 2-hour pain freedom did not statistically differ between those treating a Menstrual or non-Menstrual Migraine attack (63.5% vs 57.5%; P = .454). CONCLUSION: Rizatriptan 10 mg was effective for the treatment of Menstrual Migraine in an early intervention model, as measured by 2-hour pain freedom. Rates of 2-hour pain freedom were comparable for patients treating Menstrual and non-Menstrual Migraine attacks with rizatriptan.
Roger K Cady - One of the best experts on this subject based on the ideXlab platform.
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sumatriptan naproxen sodium for Menstrual Migraine and dysmenorrhea satisfaction productivity and functional disability outcomes
Headache, 2011Co-Authors: Roger K Cady, Merle L Diamond, Jonathan White, Frederick J Derosier, Susan A Mcdonald, Michael P. Diamond, Jeanne E. Ballard, Michelle E. Lener, Deborah P. Dorner, Chris M RunkenAbstract:(Headache 2011;51:664-673) Objective.— To evaluate the impact of a sumatriptan/naproxen sodium combination tablet on patient satisfaction, productivity, and functional disability in Menstrual Migraine treated during the mild pain phase of a single Menstrual Migraine attack associated with dysmenorrhea. Background.— Menstrual Migraineurs with dysmenorrhea represent a unique patient population not previously studied. When health outcomes end points are analyzed alongside traditional efficacy end points in Migraine studies, a more comprehensive and robust understanding of the many factors that may influence patients' choice of and adherence to pharmacological treatments for Migraine is observed. Methods.— In 2 replicate, multicenter, randomized, double-blind, placebo-controlled trials, participants with Menstrual Migraine and dysmenorrhea treated a single Menstrual Migraine attack with a single fixed-dose tablet of sumatriptan 85 mg formulated with RT Technology™ and naproxen sodium 500 mg (sumatriptan–naproxen sodium) or placebo. Results.— Participants randomized to sumatriptan–naproxen sodium were significantly more satisfied than those randomized to placebo at 24 hours post dose, as demonstrated by higher satisfaction subscale scores for efficacy (P < .001 for both studies), functionality (P = .003 for study 1; P < .001 for study 2), and ease of use (P = .027 for study 1; P = .011 for study 2). There was little bothersomeness of side effects associated with either treatment. Use of sumatriptan–naproxen sodium was also associated with lower reported “lost-time equivalents” in work and leisure time (pooled analysis, P = .003) and lower rates of functional disability (P = .05, study 1; P < .001, study 2) compared with placebo. Conclusion.— A fixed-dose combination tablet containing sumatriptan and naproxen sodium significantly improved patient satisfaction, productivity, and restoration of normal functioning in Menstrual Migraineurs with dysmenorrhea.
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Sumatriptan-naproxen sodium for Menstrual Migraine and dysmenorrhea: satisfaction, productivity, and functional disability outcomes.
Headache, 2011Co-Authors: Roger K Cady, Merle L Diamond, Jonathan White, Frederick J Derosier, Susan A Mcdonald, Michael P. Diamond, Jeanne E. Ballard, Michelle E. Lener, Deborah P. Dorner, M. Chris RunkenAbstract:(Headache 2011;51:664-673) Objective.— To evaluate the impact of a sumatriptan/naproxen sodium combination tablet on patient satisfaction, productivity, and functional disability in Menstrual Migraine treated during the mild pain phase of a single Menstrual Migraine attack associated with dysmenorrhea. Background.— Menstrual Migraineurs with dysmenorrhea represent a unique patient population not previously studied. When health outcomes end points are analyzed alongside traditional efficacy end points in Migraine studies, a more comprehensive and robust understanding of the many factors that may influence patients' choice of and adherence to pharmacological treatments for Migraine is observed. Methods.— In 2 replicate, multicenter, randomized, double-blind, placebo-controlled trials, participants with Menstrual Migraine and dysmenorrhea treated a single Menstrual Migraine attack with a single fixed-dose tablet of sumatriptan 85 mg formulated with RT Technology™ and naproxen sodium 500 mg (sumatriptan–naproxen sodium) or placebo. Results.— Participants randomized to sumatriptan–naproxen sodium were significantly more satisfied than those randomized to placebo at 24 hours post dose, as demonstrated by higher satisfaction subscale scores for efficacy (P
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changes in salivary prostaglandin levels during Menstrual Migraine with associated dysmenorrhea
Headache, 2010Co-Authors: Paul L Durham, Roger K Cady, Frederick J Derosier, Susan A Mcdonald, Carrie V Vause, Vincent T. MartinAbstract:(Headache 2010;50:844-851) Objective.— To measure prostaglandin levels in the saliva of individuals during Menstrual Migraine associated with dysmenorrhea (MMaD) and in response to treatment with a single tablet combination of sumatriptan succinate and naproxen sodium. Background.— Prostaglandins are thought to play a role in MMaD as elevated serum prostaglandin levels have been reported during attacks of Menstrual Migraine and are increased in the Menstrual fluid of women with dysmenorrhea. While triptans are the primary line of Migraine treatment, nonsteriodal anti-inflammatory drugs are the most commonly prescribed therapy for dysmenorrhea symptoms. Data from recent clinical studies have provided evidence that treatment with a single tablet combination of sumatriptan and naproxen sodium is an effective abortive therapy for attacks of MMaD. Methods.— Women diagnosed with MMaD were treated with a sumatriptan succinate and naproxen sodium single tablet combination or placebo at time of Migraine attack. Saliva samples were collected at time of attack as well as 2 and 4 hours after treatment. PGD2, PGE2, PGF2, PGI2, and TXA2 levels were determined by enzyme-linked immunosorbent assay. Results.— Elevated levels of PGD2, PGF2, and TXA2 at 2 and 4 hours and PGE2 at 4 hours were found in saliva obtained from placebo subjects when compared with onset of attack levels. However, in subjects treated with a single tablet combination of sumatriptan and naproxen sodium, the levels of PGD2, PGF2, and PGE2 were not elevated at either time point while TXA2 levels were still elevated at 4 hours. Conclusions.— Data from this pilot study provide evidence that saliva levels of several prostaglandins increase during attacks of MMaD and that treatment with a single tablet combination of sumatriptan and naproxen sodium prevents elevation of prostaglandin levels.
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combination treatment for Menstrual Migraine and dysmenorrhea using sumatriptan naproxen two randomized controlled trials
Obstetrics & Gynecology, 2009Co-Authors: Lisa K. Mannix, Vincent T. Martin, Roger K Cady, Merle L Diamond, Shelly E Lener, Jonathan White, Frederick J Derosier, Susan A McdonaldAbstract:OBJECTIVE:To evaluate the efficacy and tolerability of sumatriptan–naproxen during the mild pain phase of a single Menstrual Migraine attack associated with dysmenorrhea.METHODS:Two replicate randomized, multicenter, double-blind, placebo-controlled, trials of adults with Menstrual Migraine and dysm
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efficacy of rizatriptan for Menstrual Migraine in an early intervention model a prospective subgroup analysis of the rizatriptan tame treat a Migraine early studies
Headache, 2007Co-Authors: Vincent T. Martin, Roger K Cady, Anthony Rodgers, Carolyn M. Hustad, Karen E. Ramsey, Alexander Mauskop, Larry S Seidman, Franck SkobierandaAbstract:OBJECTIVE: A prospective subgroup analysis of the TAME (Treat A Migraine Early) studies examined the efficacy of rizatriptan in patients treating a Menstrual Migraine attack. METHODS: Both TAME studies were randomized, placebo-controlled, and double-blind. Adults with Migraine were assigned (2:1) to either rizatriptan 10-mg tablet or placebo. Patients were instructed to treat within 1 hour of Migraine onset and when the pain was mild. The primary endpoint was 2-hour pain freedom. The diagnosis of Menstrual Migraine was established according to the revised 2004 International Headache Society (IHS) diagnostic criteria. Data from both studies were pooled for logistic regression analyses. A test for interaction was performed to compare rates of 2-hour pain freedom between patients treating a Menstrual and non-Menstrual attack. RESULTS: A total of 94 patients (63 in the rizatriptan group and 31 in the placebo group) met IHS criteria for Menstrual Migraine and treated a Menstrual attack. The percentage of patients reporting 2-hour pain freedom was significantly greater for rizatriptan than for placebo (63.5% vs 29.0%; odds ratio = 4.5; 95% confidence interval: 1.7, 11.9; P = .002) in those treating a Menstrual attack. In those treating with rizatriptan, the percentage of patients with 2-hour pain freedom did not statistically differ between those treating a Menstrual or non-Menstrual Migraine attack (63.5% vs 57.5%; P = .454). CONCLUSION: Rizatriptan 10 mg was effective for the treatment of Menstrual Migraine in an early intervention model, as measured by 2-hour pain freedom. Rates of 2-hour pain freedom were comparable for patients treating Menstrual and non-Menstrual Migraine attacks with rizatriptan.
Alexander Mauskop - One of the best experts on this subject based on the ideXlab platform.
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efficacy of rizatriptan for Menstrual Migraine in an early intervention model a prospective subgroup analysis of the rizatriptan tame treat a Migraine early studies
Headache, 2007Co-Authors: Vincent T. Martin, Roger K Cady, Anthony Rodgers, Carolyn M. Hustad, Karen E. Ramsey, Alexander Mauskop, Larry S Seidman, Franck SkobierandaAbstract:OBJECTIVE: A prospective subgroup analysis of the TAME (Treat A Migraine Early) studies examined the efficacy of rizatriptan in patients treating a Menstrual Migraine attack. METHODS: Both TAME studies were randomized, placebo-controlled, and double-blind. Adults with Migraine were assigned (2:1) to either rizatriptan 10-mg tablet or placebo. Patients were instructed to treat within 1 hour of Migraine onset and when the pain was mild. The primary endpoint was 2-hour pain freedom. The diagnosis of Menstrual Migraine was established according to the revised 2004 International Headache Society (IHS) diagnostic criteria. Data from both studies were pooled for logistic regression analyses. A test for interaction was performed to compare rates of 2-hour pain freedom between patients treating a Menstrual and non-Menstrual attack. RESULTS: A total of 94 patients (63 in the rizatriptan group and 31 in the placebo group) met IHS criteria for Menstrual Migraine and treated a Menstrual attack. The percentage of patients reporting 2-hour pain freedom was significantly greater for rizatriptan than for placebo (63.5% vs 29.0%; odds ratio = 4.5; 95% confidence interval: 1.7, 11.9; P = .002) in those treating a Menstrual attack. In those treating with rizatriptan, the percentage of patients with 2-hour pain freedom did not statistically differ between those treating a Menstrual or non-Menstrual Migraine attack (63.5% vs 57.5%; P = .454). CONCLUSION: Rizatriptan 10 mg was effective for the treatment of Menstrual Migraine in an early intervention model, as measured by 2-hour pain freedom. Rates of 2-hour pain freedom were comparable for patients treating Menstrual and non-Menstrual Migraine attacks with rizatriptan.
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serum ionized magnesium levels and serum ionized calcium ionized magnesium ratios in women with Menstrual Migraine
Headache, 2002Co-Authors: Alexander Mauskop, Bella T AlturaAbstract:Objective It has been suggested that magnesium deficiency may play an important role in Menstrual Migraine and that the serum ionized calcium (ICa2+)/ionized magnesium (IMg2+) ratio is important in Migraine headache. Studies were designed to test these hypotheses. Design We prospectively evaluated 270 women seen at a headache clinic and in 61 women with Menstrual Migraine measured IMg2+, total magnesium, and ICa2+ levels so as to calculate the ICa2+/IMg2+ ratio. Results The incidences of IMg2+ deficiency were 45% during Menstrual attacks, 15% during nonMenstrual attacks, 14% during menstruation without a Migraine, and 15% between menstruations and between Migraine attacks. The serum ICa2+ levels were within our reference range, but the ICa2+/IMg2+ ratio was elevated (P Conclusions The high incidence of IMg2+ deficiency and the elevated ICa2+/IMg2+ ratio during Menstrual Migraine confirm previous suggestions of a possible role for magnesium deficiency in the development of Menstrual Migraine.
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Serum ionized magnesium levels and serum ionized calcium/ionized magnesium ratios in women with Menstrual Migraine.
Headache, 2002Co-Authors: Alexander Mauskop, Bella T AlturaAbstract:Objective.—It has been suggested that magnesium deficiency may play an important role in Menstrual Migraine and that the serum ionized calcium (ICa2+)/ionized magnesium (IMg2+) ratio is important in Migraine headache. Studies were designed to test these hypotheses. Design.—We prospectively evaluated 270 women seen at a headache clinic and in 61 women with Menstrual Migraine measured IMg2+, total magnesium, and ICa2+ levels so as to calculate the ICa2+/IMg2+ ratio. Results.—The incidences of IMg2+ deficiency were 45% during Menstrual attacks, 15% during nonMenstrual attacks, 14% during menstruation without a Migraine, and 15% between menstruations and between Migraine attacks. The serum ICa2+ levels were within our reference range, but the ICa2+/IMg2+ ratio was elevated (P