Triptans in prevention of menstrual migraine: a systematic review with meta-analysis

Migraine, a primary headache disorder, is more common in women (14.5-18%) than in men (4.5-6%) [1,2], and it is often associated with sensory symptoms, nausea or vomiting, and disability [3,4]. Female migraineurs frequently experience headache in association with their menstrual cycles [5,6], which is also known as menstrual migraine (MM). MM includes menstrually-related migraine, defined as migraine with menstruation as well as at other times of the cycle, and pure MM, in which migraine occurred only in association with menstruation on or between day ？2 to day +3 [7,8]. MM has been reported to be longer, more disabling, less responsive to acute therapy, and more prone to recurrence than non-menstrual migraine attacks. Effective preventive strategies are key for the management of MM [9-12]. Rofecoxib [13], estradiol [14,15], topiramate [16,17], magnesium [18], nimesulide [19] and naproxen sodium [20] have been used in the treatment of migraine.Triptans, such as frovatriptan, naratriptan and zolmitriptan, are a class of highly selective serotonin receptor agonists, which can interfere with the pathogenesis of migraine and are effective in relieving the associated neurovegetative symptoms [21-23]. They have been recommended as first-line drugs for the treatment of moderate to severe migraine, including MM [24,25]. In recent years, triptans have been extensively proposed for the prevention of menstrual migraine attacks.To date, no systematic review has been done to investigate the efficacy and tolerability of triptans in the prevention of MM. This review was undertaken to evaluate the efficacy and tolerability of triptans at different doses in randomized controlled trials (RCTs). Our findings may offer an updated reasonable guide for the treatment of MM in clinical practice.We searched the Cochrane Central Register of Controlled Trials, Medline and Embase using the terms “migraine”, “migraine disorders”, “prevention”, “prophylaxis”, ” menstrual”, “menstrually” and “men