What are the treatment options for menstrual migraines?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Abortive therapy for menstrual migraine is the same as for nonmenstrual migraine. Patients with frequent and severe attacks may benefit from short-term, perimenstrual use of preventive agents (eg, frovatriptan [128] ). Patients with menstrual and nonmenstrual migraine who are receiving continuous preventive therapy and experiencing breakthrough menstrual migraine headaches may benefit from perimenstrual elevation of the dose of the preventive medication.

Patients who do not respond to standard preventive measures may benefit from hormonal therapy. Perimenstrual estrogen supplementation with estradiol (0.5 mg orally twice a day, or a 1-mg transdermal patch) may be beneficial. A study by De Leo et al of oral contraceptive use in women with menstrual migraine without aura found that a regimen of 24 ethinyl estradiol/drospirenone pills and 4 inert pills was more effective than a regimen of 21 active pills and 7 inert pills. [129]


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