Menstrual
migraine (MM) is a highly prevalent condition associated with considerable disability.
Migraine attacks occur exclusively around the menstrual period in approximately 10% of women with
migraine, that is, pure menstrual
migraine, while at least 50% of them also experience
migraine at other times of the month, that is, menstrually related
migraine (MRM). The therapeutic approach to patients with MRM is based on treatment of the attack, or prophylactic strategies.
Triptans are recommended as first-line treatments for moderate to severe
migraine attacks, including MM.
Frovatriptan is one of the newest
triptans. Its high affinity for 5-HT1B/1D receptors and long half-life contribute to its distinctive clinical effect, characterized by a more sustained and prolonged effect than other
triptans. Indeed,
frovatriptan proved to be effective in treating the acute attack, but was particularly effective in the short-term preventive
therapy of MM. In addition,
frovatriptan is one of the safest
triptans, with the lowest risk of treatment-emergent adverse events. Following extensive evidence from randomized pharmacological trials,
frovatriptan has now gained a grade A recommendation from the guidelines for short-term prophylaxis of MM. Recent post-hoc analyses of direct comparative trials also suggest that
frovatriptan might have an important role in the acute treatment of MRM. In these studies,
frovatriptan showed
pain relief and
pain-free rates similar to those of
zolmitriptan,
rizatriptan, and
almotriptan, but with significantly lower recurrence rates. More well-designed, randomized, prospective studies, specifically enrolling women with MM, will be needed in the near future to confirm the efficacy of
frovatriptan in this
migraine subtype.