Few people (1%) were using testosterone and, appropriately, this wasn’t a treatment of interest for most (83% did not want to try this). More people (40%) were interested in trying melatonin, although only 7% were currently using it and 18% had previously tried it and stopped for various reasons.
The prevalence of menstrual migraine amongst women with migraine is estimated to be around 25% and older women with migraine may also take hormone replacement therapy, which is consistent with our finding that 30% of survey respondents were taking female hormones for migraine prevention. However, another 30% of respondents had stopped taking estrogen and 25% had stopped taking progesterone because of side effects, lack of effectiveness or another reason.
This raises the question of whether those people found an alternative treatment for hormonally-sensitive migraine attacks. There aren’t many options. For menstrual migraine, you can try taking non-steroidal anti-inflammatories before the period starts, or a long-acting triptan (naratriptan or frovatriptan). Unfortunately, we don’t have long-acting triptans in New Zealand, so this isn’t an option here. Naratriptan used to be available but is no longer, possibly because an application to Pharmac to fund naratriptan was declined in 2021 (after a huge delay – the application was made in 1997).
There’s a lot more we need to know about hormonally-sensitive migraine in New Zealand, especially menstrual migraine, including its impact on people and its treatment. But we already know that, as usual, New Zealand is behind on access to treatments used elsewhere.
Grøtta Vetvik, K. & Anne MacGregor, E. Menstrual migraine: a distinct disorder needing greater recognition. www.thelancet.com/neurology 20, (2021).
Ahmad, S. R. & Rosendale, N. Sex and Gender Considerations in Episodic Migraine. Curr Pain Headache Rep (2022) doi:10.1007/S11916-022-01052-8.
Tsai, C. K., Tsai, C. L., Lin, G. Y., Yang, F. C. & Wang, S. J. Sex Differences in Chronic Migraine: Focusing on Clinical Features, Pathophysiology, and Treatments. Curr Pain Headache Rep 26, 347–355 (2022).
Puliappadamb, H., Maiti, R., Mishra, A., Jena, M. & Mishra, B. Efficacy and Safety of Melatonin as Prophylaxis for Migraine in Adults: A Meta-analysis. J Oral Facial Pain Headache 36, 207–219 (2022).