Nineteen trials were included in the review (n=4,296 participants). Three trials were rated good, six were fair and 10 were poor.
Short-term prevention of menstrually related migraine: (10 trials)
Four RCTs compared transdermal oestradiol to placebo. The trials were too clinically heterogeneous to combine in meta-analysis. The three trials rated fair found statistically significant results in favour of oestradiol when compared to placebo. One trial rated good found statistically significant differences between frovatriptan 2.5mg twice daily when compared to placebo. Adverse events did not vary significantly between groups. One fair trial assessed naratriptan and found statistically significant differences from placebo for the naratriptan 1mg twice daily group, but not for the group treated with 2.5mg. Other agents were assessed only in single poor-quality trials.
Acute treatment of menstrually related migraine: (nine trials)
Sumatriptan at 100mg was found to be superior to placebo (OR 4.33, 95% CI 2.96 to 6.32; two trials (one good, one poor) 509 patients). Sumatriptan at 50mg was found to be superior to placebo (OR 3.02, 95% CI 2.08 to 4.38; two trials (one good, one poor) 516 patients). Adverse events were not statistically significantly different between treatment groups.
Zolmitriptan was superior to placebo (OR 2.97, 95% CI 1.98 to 4.45; two trials (one fair, one poor) 1,519 menstrually related migraine). Adverse events were mild and there were no statistically significant differences between groups.
One RCT of poor quality was located for naratriptan. One fair quality trial was located for mefenamic acid and found a statistically significant difference between treatment groups in relation to two-hour pain free rates (66.6% versus 8.3%, p<0.05). Mild epigastric pain occurred in 8% of patients who took mefenamic acid, but did not cause treatment discontinuation.
Rizatriptan at 10mg was found to be superior to placebo (OR 2.34, 95% CI 1.68 to 3.25; two trials (both good) 707 patients). Adverse events were significantly less in the placebo group; no serious adverse events were reported.