From the Guidelines
For menstrual-related migraines, frovatriptan (2.5mg) is considered a highly effective treatment option due to its longer half-life, making it suitable for preventive mini-prophylaxis when taken twice daily for 5 days starting 2 days before expected menstruation. This approach is supported by the study published in Nature Reviews Neurology in 2021 1, which highlights the importance of initiation of perimenstrual preventive treatment.
Key Considerations
- The use of long-acting NSAIDs, such as naproxen, is also recommended for daily intake for 5 days, beginning 2 days before the expected first day of menstruation, as an alternative to triptans 1.
- Combined hormonal contraceptives may be beneficial for women with pure menstrual migraine without aura, but are contraindicated in women with migraine with aura due to the increased risk of stroke 1.
Treatment Options
- Triptans: frovatriptan (2.5mg) is a preferred option due to its longer half-life, allowing for effective preventive mini-prophylaxis.
- NSAIDs: naproxen sodium (550mg twice daily) can be effective when started before menstruation begins.
- Hormonal treatments: continuous or extended-cycle birth control pills may help stabilize estrogen levels and prevent migraines.
Important Notes
- It is essential to consider the individual patient's medical history and potential contraindications when selecting a treatment option.
- Consulting with a healthcare provider is recommended if over-the-counter options and triptans do not provide relief, to discuss prescription options or hormonal management strategies.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medication Options for Menstrual Related Migraine
- Frovatriptan is considered a mainstay of short-term prevention for menstrual related migraine, as stated in 2 and 3.
- Rizatriptan has the best overall evidence for acute treatment of menstrual migraine, with pain-free responses of 33-73% at 2 hours, as mentioned in 4.
- Sumatriptan and lasmiditan demonstrated superior pain relief at 2 and 24 hours, making them effective first-line treatments for acute menstrual migraine, as found in 5.
- Frovatriptan exhibited effectiveness in preventing headache recurrence, whereas galcanezumab and erenumab displayed significant preventive benefits in reducing headache days per month, as reported in 5.
- Estrogen-containing contraceptive treatment may be effective in appropriately selected patients, as noted in 2.
Key Characteristics of Effective Medications
- Long elimination half-life, such as frovatriptan's 26 hours, can confer a longer duration of action, as mentioned in 6.
- Lower relapse rates, such as those seen with frovatriptan, can be beneficial in treating menstrual migraine, as stated in 6.
- Significant reduction in risk of menstrual migraine, such as that seen with frovatriptan, can support its use as a first-line acute treatment and for perimenstrual prophylaxis, as found in 6.
Treatment Strategies
- Acute treatment, short-term preventive treatment, and daily preventive treatment may be used depending on the patient's pattern of migraine and occurrence of migraine outside the menstrual period, as discussed in 2.
- Short-term preventive treatment started 2 days prior to the onset of migraine and continued for 5-6 days may be effective for patients with pure menstrual migraine, as mentioned in 2.
- Daily preventive treatment may be beneficial for patients who experience additional attacks outside the menstrual period, as noted in 2.