• Gianni Allais, Gennaro Bussone, Giovanni D'Andrea, Franca Moschiano, Florindo d'Onofrio, Fabio Valguarnera, Gian Camillo Manzoni, Licia Grazzi, Rita Allais, Chiara Benedetto, and Giancarlo Acuto.
• Women's Headache Center, Department of Gynecology and Obstetrics, University of Turin, Italy. gb.allais@tiscali.it
• Cephalalgia. 2011 Jan 1; 31 (2): 144-51.

BackgroundMenstrually related migraine (MRM) affects more than half of female migraineurs. Because such migraines are often predictable, they provide a suitable target for treatment in the mild pain phase. The present study was designed to provide prospective data on the efficacy of almotriptan for treatment of MRM.MethodsPremenopausal women with MRM were randomized to almotriptan (N = 74) or placebo (N = 73), taken at onset of the first perimenstrual migraine. Patients crossed over to the other treatment for the first perimenstrual migraine of their second cycle, followed by a two-month open-label almotriptan treatment period.ResultsSignificantly more patients were pain-free at two hours (risk ratio [RR] = 1.81; p = .0008), pain-free from 2-24 hours with no rescue medication (RR = 1.99; p = .0022), and pain-free from 2-24 hours with no rescue medication or adverse events (RR = 1.94; p = .0061) with almotriptan versus placebo. Nausea (p = .0007) and photophobia (p = .0083) at two hours were significantly less frequent with almotriptan. Almotriptan efficacy was consistent between three attacks, with 56.2% of patients pain-free at two hours at least twice. Adverse events were similar with almotriptan and placebo.ConclusionAlmotriptan was significantly more effective than placebo in women with MRM attacks, with consistent efficacy in longer-term follow-up.

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