From the Guidelines
Hormonal treatments and preventive measures for migraine headaches are essential for women whose migraines are clearly related to their menstrual cycle.
Key Treatment Options
- The use of estrogen therapy, such as estrogen patches or oral contraceptives, to stabilize estrogen levels and prevent migraine attacks, as seen in 1.
- Combined hormonal contraceptives can be beneficial for women with pure menstrual migraine without aura, but are contraindicated in women with migraine with aura, as noted in 1.
- Perimenstrual preventive treatment with daily intake of a long-acting NSAID, such as naproxen, or triptan, such as frovatriptan or naratriptan, for 5 days, beginning 2 days before the expected first day of menstruation, is also a viable option, as mentioned in 1.
Important Considerations
- It's crucial to work with a healthcare provider to determine the best course of treatment and to monitor for potential side effects and interactions with other medications, as emphasized in 2, 3, 4.
- The treatment plan should be individualized based on the woman's specific needs, medical history, and the severity and frequency of her migraines.
- Starting with low doses and gradually increasing as needed, under close medical supervision, is generally recommended, as seen in 3, 4.
- The duration of treatment will depend on the individual's response and the severity of her migraines, but typically ranges from a few months to several years.
Additional Preventive Measures
- Beta blockers, such as atenolol, bisoprolol, metoprolol, or propranolol, can be used as first-line medications for migraine prevention, as recommended in 1, 2.
- Topiramate and candesartan are also effective first-line medications, as noted in 1, 2.
- Amitriptyline, flunarizine, and sodium valproate can be used as second-line medications, as seen in 1, 2.
From the Research
Hormonal Treatments for Migraine Headaches
- Hormonal therapies, such as continuous combined hormonal contraceptives (CHCs), can be used to prevent menstrual migraine 5, 6
- Minimizing or eliminating monthly declines in estrogen concentration may be effective in preventing menstrual-related migraine (MRM) 6
- Hormone-containing preparations can be used for short-term perimenstrual prevention of migraine headaches 7
Preventive Measures for Migraine Headaches
- Nonsteroidal anti-inflammatory medications, triptans, or hormone-containing preparations can be used for short-term perimenstrual prevention of migraine headaches 7
- Continuous prevention using hormonal therapies or standard anti-migraine prophylaxis can be considered for patients with menstrual migraine 7, 5
- Miniprophylaxis can be used in pure menstrual migraine (PMM) rather than daily preventive treatment 8
- Oral contraceptives may be considered if patients do not respond to or cannot tolerate typical migraine preventive medications 8
Acute Treatments for Migraine Headaches
- Triptans, such as sumatriptan, rizatriptan, naratriptan, and frovatriptan, have shown efficacy in the acute treatment of menstrual migraine 9
- Rizatriptan has the best overall evidence for acute treatment of menstrual migraine, with pain-free responses of 33-73% at 2 hours 9
- Non-triptans, such as magnesium, estrogen, naproxen sodium, and dihydroergotamine, may also be useful for short-term prevention of menstrual migraine 9