Treating Menstrual Migraine

mentrual migraineContributed by: Vincent Martin, MD, Professor of Medicine

The discomfort of menstrual migraine makes life miserable for millions of American women. Luckily, many treatment options can help to prevent or ease them.

Menstrual migraine begins two days before to three days after menstruation and they occur in about 7 percent of the female population and in more than half of women who suffer from migraine. These migraines tend to be much worse than those experienced during other times of the menstrual cycle.

Menstrual migraine is thought to occur as a result of falling estrogen levels at the time of menstruation and the possible release of chemicals called prostaglandins from a shedding uterus.

Hormonal therapies can treat menstrual migraine. For example, estrogen patches can prevent the fall of estrogen levels and are used two days before the onset of menstrual migraine and continued for a 10-day period. Additionally, women taking oral contraceptives can be placed on extended duration oral contraceptives.

The key is to prevent falls in estrogen that occur when the active hormones are withdrawn. Non-hormonal therapies for managing menstrual migraine include daily preventive medications and mini-prophylaxis (short-term therapies only given around the time of menstruation to prevent migraine during menstruation).

Non-steroidal anti-inflammatory drugs (NSAIDS) such as naproxen and triptans such as naratriptan and frovatriptan can also be given prior to and during menstruation for five days to prevent menstrual migraine. Other preventive medications like topiramate can be given daily to prevent menstrual and non-menstrual migraine.

Menstrual migraine gets most of the publicity, but headache is one of many other symptoms that occur as a result of changes in hormone levels at the time of menstruation.   Other symptoms include painful menstrual cramps, abdominal and back pain, bloating, irritability and mood changes. To achieve optimal pain relief, one may need to treat all the headaches and these other symptoms as they can be extremely impactful on a patient.

To learn more about how you can treat menstrual migraine, please call (513) 475-UC4U (8248).

Vincent Martin, MD, is an expert in headache and migraine at UC Health Women’s Center and co-director of the Headache and Facial Pain Program at the UC Neuroscience Institute.

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