Naproxen sodium in short-term prophylaxis of pure menstrual migraine: pathophysiological and clinical considerations

We investigated the biological and clinical effects of naproxen sodium (NxS) in the short-term prophylaxis of pure menstrual migraine (PMM) in 25 women suffering from migraine without aura, occurring exclusively from 2 days before to 5 days after menstruation onset. Daily oral NxS (550 mg) from 7 days before menstruation to 7 days after menstruation onset was given for 3 menstrual cycles, and 5 days before menstruation to 5 days after menstruation onset over the next 3 menstrual cycles. In the month before initiation of treatment and in the third month of treatment, 6-keto-PGF1 alpha, TXB2 and PGE(2) were measured in plasma before menstruation (day -2) and on the second day (day +2) after bleeding onset. In the 20 women analysed, 6-keto-PGF1(alpha) was 17% lower (p < 0.0001) and TXB2 was 30% lower (p < 0.0001) on day -2 during treatment than the same day pretreatment; TXB2 was also lower (p < 0.02) on day +2 during treatment than day +2 pretreatment. The 6-keto-PGF1(alpha)/TXB2 ratio was higher (p < 0.01) on day -2 treatment than day -2 pretreatment. PGE(2) levels were significantly lower (p < 0.002) on day +2 than pre-treatment values on the same day. The number of attacks reduced from 1.7 +/- 0.11 pretreatment to 1.2 +/- 0.10 at the 3rd month (p < 0.001), to 1.1 +/- 0.06 at the 6th month (p < 0.0001). The duration reduced from 25.6 +/- 4.42 h pretreatment to 15.5 +/- 4.43 h in the 3rd month (p < 0.02), to 13.35 +/- 4.26 h in the 6th month (p < 0.001). The intensity reduced from 2.4 +/- 0.11 pretreatment, to 1.2 +/- 0.10 in the 3rd month of treatment (p < 0.0001), and 1.1 +/- 0.07 in the 6th month (p < 0.0001).