Update on Migraine Management

Lisa Larkin, MD, FACP, NCMP, IF


Menopause. 2022;29(5):606-608. 

In This Article

Menstrual Migraine

In women with PMM and EM with MRM, preventive interventions, including hormone manipulation, should be considered.[5] In women with regular menstrual cycles and PMM or MRM, the long-acting triptan frovatriptan, with a half-life of 26 hours started 2 to 5 days and taken daily before menses, is often very effective. Continuous or extended-cycle oral contraceptives (COCs), with associated ovulatory suppression, may also be effective. It is important to note that migraine with aura is associated with an increased risk of stroke, and guidelines recommend against the use of COCs in smokers and in women with MRM with aura. Ultralow-dose COCs containing 10 μgor20 μg ethinyl estradiol do not pose an increased risk of stroke in nonsmokers and are an excellent option for prevention. Progestin-only contraceptive pills and intrauterine devices are unlikely to help with MRM because they do not reliably suppress ovulation.

Two FDA-cleared devices, a transcutaneous electrical neuromodulation device (Nerivio) and a transcutaneous electrical nerve stimulation device (Cefaly), are approved for acute treatment of migraine and are more effective than sham treatment in reducing pain.[4] Supplements such as riboflavin, magnesium, feverfew (Tanacetum parthenium), butterbur (Petastites hybridus), and coenzyme Q10 have limited data but may be recommended.[2] The benefit of acupuncture remains uncertain, but two recent studies suggest that it is superior to no treatment, sometimes superior to pharmacologic treatment, and occasionally superior to sham treatment.[6]