Medication Strategies for Menstrual Migraine: What Works?

Menstrual migraine attacks can be especially debilitating, but targeted medication strategies can help prevent and effectively treat them. Understanding the various types of medications available, how they function, and when to use them can empower women to manage their migraine attacks more effectively and lessen their impact on daily life.

Preventive Medications for those who only experience migraine around their period

For women who suffer from frequent or severe menstrual migraine attacks, preventive medications can be helpful. These medications are taken prior to the expected onset of a migraine to lessen its severity or prevent it altogether altogether.

Triptans for Short-Term Prevention

Certain long-acting triptans have been shown to be effective in preventing menstrual migraine attacks. These include:

• Frovatriptan (Frova) – Typically taken twice a day, starting two days before the anticipated migraine and continuing through menstruation.
• Naratriptan (Amerge) – Also taken preventively in a similar schedule to Frova.

These triptans aid in stabilizing blood vessel function and preventing migraine attacks during the high-risk window around menstruation.

NSAIDs for Short-Term Preventive Use

Nonsteroidal anti-inflammatory drugs (NSAIDs) can also be used preventively for menstrual migraine attacks. Common options include:

• Naproxen (Aleve) – Taken twice daily, starting 2-3 days before menstruation.
• Ibuprofen (Advil, Motrin) – Also effective when taken regularly before the migraine onset.

NSAIDs help reduce inflammation and pain sensitivity, making migraine attacks less severe when they do occur.

Hormonal Therapy for people without complex Aura

For women whose menstrual migraine attacks are strongly linked to hormonal fluctuations, hormonal therapy may be an option. This can include:

• Continuous low-dose birth control pills – Helps maintain steady hormone levels and prevent estrogen withdrawal migraine attacks.
• Estrogen patches or gels – Can be used in the days leading up to menstruation to prevent the drop in estrogen that triggers migraine attacks.

Acute Medications

When a migraine does occur, fast-acting treatment is essential to reduce its intensity and duration.

Triptans for Acute Treatment

Triptans are one of the most effective treatments for menstrual migraine attacks. Common options include:

• Sumatriptan (Imitrex) – Available as a pill, nasal spray, or injection.
• Rizatriptan (Maxalt) – Quick-dissolving tablet for fast relief.
• Zolmitriptan (Zomig) – Can be taken as a pill or nasal spray.

Gepants and Other New Treatments

Gepants are a newer class of migraine medications that block CGRP, a protein involved in migraine pathways. Options include:

• Ubrelvy (ubrogepant) – Oral medication taken at migraine onset.
• Nurtec (rimegepant) – Can be taken as needed or as a preventive treatment.
• Zavzpret (zavegepant) – Nasal spray with rapid absorption for acute treatment. 

Prescription NSAIDs

For women who do not respond well to triptans or prefer an alternative, prescription-strength NSAIDs like

• Elyxyb (celecoxib oral solution)
• CAMBIA® (diclofenac potassium)
• Ketorolac oral, nasal, or injections

Tailoring the Right Strategy

The best medication strategy for menstrual migraine attacks varies from person to person. A combination of preventive and acute treatments may be necessary for optimal relief. Keeping a migraine diary can help track patterns and identify the most effective treatments.

When to Seek Medical Advice

If menstrual migraine attacks are frequent, severe, or not responding to over-the-counter treatments, consult a healthcare provider to explore prescription options and personalized strategies for relief.

Disclaimer

This article is for informational purposes only and should not be considered medical advice. If you experience menstrual migraine attacks or other severe headaches, consult your healthcare provider for a proper diagnosis and treatment plan. To explore treatment options, consider booking an appointment with Haven Headache for expert guidance and personalized care.

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