Level 1: Likely reliable evidence
Two similar randomized trials show that rizatriptan (Maxalt) relieves menstrual migraine (Cephalalgia. 2007;27:414-421). Both trials evaluated women 18 years and older with menstrual migraine (based on International Classification of Headache Disorders-II 2004 definition) for at least six months who were randomized to rizatriptan 10 mg vs. placebo to treat a single moderate-to-severe menstrual migraine within the next three menstrual cycles. Participants were not randomized at time of enrollment.
Rescue medication was allowed for persistent or recurrent headache two hours after administration of the study medication. A modified intention-to-treat analysis included all randomized patients who had at least one pain severity rating within two hours of taking rizatriptan.
The first trial randomized 403 patients, of whom 357 (89%) were treated for a qualifying migraine. Comparing rizatriptan vs. placebo, 70% vs. 53% had pain relief at two hours (P = .001, NNT 6), 46% vs. 33% had sustained pain relief for 24 hours (P = .016, NNT 8), and 19% vs. 11% had adverse effects (NNH 12).
In the second trial, 348 patients completed post-treatment assessment. Comparing rizatriptan vs. placebo, 73% vs. 50% had pain relief at two hours (P <.001, NNT 5), 46% vs. 33% had sustained pain relief for 24 hours (P = .024, NNT 8), and 18% vs. 11% had adverse effects (NNH 14).