From the Guidelines
Treatment options for premenstrual headaches include both medication and lifestyle approaches, with over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours), naproxen sodium (220-550mg twice daily), or acetaminophen (650-1000mg every 4-6 hours) providing relief when taken at the first sign of headache, as recommended by the American College of Physicians in their 2025 clinical guideline 1.
Medication Options
- Over-the-counter pain relievers: ibuprofen, naproxen sodium, or acetaminophen
- Triptans: sumatriptan (50-100mg) for more severe cases
- Hormonal treatments: combined oral contraceptives to stabilize estrogen levels
Lifestyle Modifications
- Staying hydrated (8-10 glasses of water daily)
- Maintaining regular sleep patterns
- Managing stress through meditation or yoga
- Avoiding known triggers like alcohol, caffeine, and processed foods
- Magnesium supplements (400-600mg daily) or vitamin B2 (400mg daily) for some women
- Applying cold or warm compresses to the head and neck These headaches occur due to the natural fluctuation of estrogen and progesterone before menstruation, which can affect blood vessels and pain sensitivity, as discussed in the Annals of Internal Medicine 1. Tracking headache patterns in relation to your menstrual cycle can help identify the most effective treatment timing and approach for your specific symptoms. It is essential to consider the potential risks and benefits of each treatment option, including the risk of medication-overuse headache, as highlighted in the clinical guideline 1 and other studies 1.
From the FDA Drug Label
Use temporarily relieves minor aches and pains due to: ... headache ... premenstrual and menstrual cramps The treatment options for premenstrual headaches include acetaminophen 2.
- Ibuprofen can be used to treat primary dysmenorrhea which is related to premenstrual headaches, but the label does not directly state it can be used for premenstrual headaches 3, 3.
- Acetaminophen can be used for premenstrual cramps which may be associated with premenstrual headaches 2.
From the Research
Treatment Options for Premenstrual Headaches
Premenstrual headaches, also known as menstrual migraines, can be treated with various options. These options include:
- Acute treatments: triptans, such as sumatriptan, rizatriptan, naratriptan, zolmitriptan, and almotriptan, have been shown to be effective in treating menstrual migraines 4
- Short-term prophylaxis: triptans, non-triptans, or combinations can be used to prevent menstrual migraines 4
- Daily prevention: some preventive medications may be used daily to prevent menstrual migraines, but caution is indicated when using anti-epileptic medications that can affect the efficacy of oral contraceptives and hormonal treatments 4
- Hormonal treatments: continuous combined hormonal contraceptives (CHCs) with no placebo pills or using just two days of placebo pills can help prevent menstrual migraines by avoiding the estrogen withdrawal trigger 5
- Non-steroidal anti-inflammatory drugs (NSAIDs): such as naproxen sodium, can be used for short-term prophylaxis of menstrual migraines 6, 7
- Magnesium and phytoestrogens: may be useful for patients who prefer a more "natural" approach 6
- Gonadotropin-releasing hormone agonists: followed by estrogen add-back therapy, can be used to prevent menstrual migraines, but have limited evidence 5, 6
Specific Treatments
Some specific treatments that have been studied for menstrual migraines include:
- Frovatriptan: has been shown to be effective in preventing menstrual migraines when taken twice daily 8, 7, 4
- Rizatriptan: has the best overall evidence for acute treatment of menstrual migraines, with pain-free responses of 33-73% at 2 hours 4
- Naratriptan: has been shown to be effective in preventing menstrual migraines when taken twice daily 6, 4
- Zolmitriptan: has been shown to be effective in preventing menstrual migraines when taken three times daily 4
- Estrogen replacement therapy: can be used to prevent menstrual migraines, but may have limited evidence 6