What medications can help with menstrual cycle headaches?

Medications for Menstrual Cycle Headaches

For menstrual migraine headaches, NSAIDs like naproxen sodium (500mg) or ibuprofen are first-line treatments, with triptans as effective second-line options when taken perimenstrually starting 2 days before expected headache onset. 1

First-Line Treatment Options

NSAIDs

• Naproxen sodium: 500mg once daily, starting 2 days before expected headache onset and continuing through the first 3 days of menstruation 2, 3
• Ibuprofen: 400-800mg every 6-8 hours as needed during the vulnerable period 4
• Combination of acetaminophen + aspirin + caffeine: Effective for acute treatment of menstrual migraine 1

NSAIDs work by inhibiting prostaglandin synthesis, which is particularly relevant for menstrual migraine as prostaglandin levels are elevated during menstruation 1.

Second-Line Treatment Options

Triptans

If NSAIDs are ineffective, consider short-term prophylaxis with:

• Frovatriptan: 2.5mg twice daily, starting 2 days before expected headache onset and continuing for 6 days 2, 3
• Naratriptan: 1mg twice daily, using the same perimenstrual schedule 3
• Sumatriptan: 50-100mg as needed for breakthrough headaches 3

Research shows frovatriptan may be more effective than naproxen sodium for short-term prophylaxis of menstrual migraine, with significantly lower headache severity scores (2.5 vs 3.9) 2.

Hormonal Options

For women whose headaches remain uncontrolled with the above options:

• Transdermal estradiol: 1.5mg patch applied 2 days before expected headache onset 3
  • Works by preventing the estrogen withdrawal that triggers menstrual migraine
  • Less effective than frovatriptan in comparative studies 2

Treatment Algorithm

1. Start with NSAIDs:

   • Begin with naproxen sodium 500mg once daily or ibuprofen 400-800mg every 6-8 hours
   • Start 2 days before expected headache onset and continue through first 3 days of menstruation

2. If NSAIDs ineffective:

   • Switch to triptan therapy (frovatriptan 2.5mg twice daily or naratriptan 1mg twice daily)
   • Use the same perimenstrual schedule

3. For severe, refractory cases:

   • Consider combination therapy with both NSAID and triptan
   • Or add transdermal estradiol 1.5mg patch

Special Considerations

• Women with cardiovascular risk factors: Use caution with triptans as they are contraindicated in patients with heart disease, uncontrolled hypertension, or hemiplegic/basilar migraine 1
• Women using hormonal contraception: Be aware that combined hormonal contraceptives may worsen migraine with aura and increase stroke risk 5
• Pregnancy planning: Topiramate (sometimes used for regular migraine prevention) is contraindicated in pregnancy and reduces efficacy of hormonal contraceptives 5

Monitoring and Follow-up

• Keep a headache diary tracking relationship of headaches to menstrual cycle
• Document severity, duration, and response to treatment
• Evaluate effectiveness after 2-3 menstrual cycles and adjust treatment as needed

Menstrual migraines are often more severe, longer-lasting, and less responsive to treatment than non-menstrual attacks, making preventive strategies particularly important for this type of headache 3.