Introduction: Chronic migraine is a condition that causes significant impairment. Women are three times more likely to suffer from migraines than men. Up to 70% of these women have migraines associated with menstruation. Botulinum toxin is FDA approved to treat chronic migraines and given a possible similar pathophysiological mechanism, it could also be a therapeutic option in menstrual related migraines. To date, no studies have specifically evaluated the efficacy of botulinum toxin in the treatment of menstrual related migraines. The purpose of this study was to assess the efficacy of using botulinum toxin in the treatment of specific menstrual related migraines.

Methods: This was a retrospective study of the efficacy botulinum toxin in menstrual related migraines at the Naval Hospital Jacksonville from January, 2018 to August, 2019. We included patients who were diagnosed with chronic migraine, received botulinum toxin per the PREEMPT protocol, and also reported a history of menstrual related migraine.

Results: 11 patients were included in this study. Despite an average decrease in headache days per month of 14.3 (65% improvement on average), there was no change in the duration or severity of each patient's menstrual related migraines.

Conclusion: This is the first study of the efficacy of botulinum toxin in chronic migraineurs with comorbid menstrual related migraines. Despite its clear efficacy in chronic migraine, botulinum toxin may not be as effective in treating menstrual related migraines. Female patients should be counseled regarding their menstrual related migraines when instituting this therapy. Future studies should evaluate different treatment modalities in treating this common and debilitating condition.