there are several aspects to treating menstrual migraines: to treat menstrual migraine take medications after the onset. generally medications that are effective in stopping nonmenstrual migraines are effective at also treating menstrual migraines. to prevent menstrual migraine take medications just before the onset of menstruation and continue for the duration of the expected headache. taking hormones such as estrogens or estrogen-related medications also help to prevent migraine. to reduce the frequency and duration of menstrual migraine take prophylactic medications (such as beta-blockers calcium channel blockers anticonvulsants tricyclic antidepressants) that are normally used on a continuous basis to prevent nonmenstrual migraines. nsaids such as naproxen sodium (aleve) or ibuprofen (advil motrin) have been used effectively to treat menstrual migraines. a combination analgesic containing acetaminophen aspirin and caffeine (acc) can also be used to treat menstrual migraines. for women whose menstruation and menstrual migraines occur on a regular and predictable pattern nsaids may be used 24 hours before the expected onset of menstrual migraine and continued for the expected duration of the headache. since nsaids inhibit prostaglandins they have the added benefit of relieving menstrual cramps as well. triptans (naratriptan rizatriptan sumatriptan zolmitriptan) have been found to be effective in treating menstrual migraines as well as controlling the associated nausea and vomiting. sumatriptan given two to three days before and continued for the duration of the expected headache is effective in reducing the frequency and severity of menstrual migraine. naratriptan used in the same manner has also been found to be effective in preventing menstrual migraine. however in those cases where breakthrough headaches occurred they were just as severe as in patients taking placebo. dihydroergotamine (dhe) can be used as a nasal spray or given intramuscularly or intravenously to stop menstrual migraines. ergotamine (oral rectal or intranasal) and dhe (intranasal intramuscular or intravenous) can be used around the time of menstruation (several days before and continued for the duration of the expected headache) to prevent menstrual migraines. if these medications are ineffective doctors may try daily preventive medications such as beta-blockers anticonvulsants calcium channel blockers and tricyclic antidepressants to reduce the frequency and the severity of menstrual migraines. the choice of the preventive medications is based on the experiences and preferences of the doctor the medication side effects and the woman's other associated medical conditions. for women already taking preventive medications who still experience headaches the doses of preventive medications can be increased around the time of menstruation. (some doctors use preventive medications only around the time of menstruation. ) alternatively doctors may try hormone treatment. since a drop in estrogen level just prior to menstruation is the trigger for menstrual migraines estrogen replacement before menstruation has been used in preventing menstrual migraines. for some women with menstrual migraine estradiol skin patches (such as tts 50 tts 100) applied two days before menstrual migraine and continued for seven days during the expected headache period is effective. however the dose of estrogen must be closely monitored as too high of a dose can actually trigger migraine in susceptible individuals. some women with difficult-to-treat menstrual migraines may be helped by using low-dose oral contraceptives to reduce the estrogen fluctuations. other less frequently used medications for menstrual migraines include tamoxifen bromocriptine danazol and gonadotropin-releasing hormone (gnrh).
what is the treatment for menstrual migraine?