From the Guidelines
Menstrual headaches can be effectively treated with a combination of medication and lifestyle modifications, with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen sodium being first-line options for acute treatment, as recommended by the most recent and highest quality study 1.
Treatment Options
- For acute treatment, NSAIDs like ibuprofen (400-600mg every 6-8 hours) or naproxen sodium (500mg followed by 250mg every 6-8 hours) are first-line options, ideally started 1-2 days before expected headache onset.
- Triptans such as sumatriptan (50-100mg orally) or rizatriptan (10mg) can be used for more severe headaches, as supported by earlier studies 1.
Prevention
- Continuous or extended-cycle hormonal contraceptives can help maintain stable estrogen levels, preventing the drop that triggers headaches.
- Supplemental estrogen via patches (0.1mg) during the hormone-free week of oral contraceptives may also help, as mentioned in the context of menstrual migraine management 1.
Lifestyle Modifications
- Non-pharmacological approaches include maintaining regular sleep patterns, staying hydrated, managing stress through relaxation techniques, and avoiding known triggers like alcohol or certain foods.
- Magnesium supplementation (400-600mg daily) may reduce frequency and severity of menstrual headaches, although the evidence for this is not as strong as for NSAIDs and triptans.
Important Considerations
- These headaches occur due to fluctuating estrogen levels, particularly the drop before menstruation, which affects serotonin and other neurotransmitters involved in pain regulation.
- If headaches are severe or unresponsive to these treatments, consult a healthcare provider for personalized management, considering the latest guidelines for migraine management 1.
From the FDA Drug Label
The efficacy of sumatriptan tablets was unaffected by ... relationship to menses; The recommended dose of sumatriptan tablets is 25 mg, 50 mg, or 100 mg. Doses of 50 mg and 100 mg may provide a greater effect than the 25 mg dose, but doses of 100 mg may not provide a greater effect than the 50 mg dose.
The treatment for menstrual (migraine) headache associated with the menstrual cycle is sumatriptan tablets with a recommended dose of 25 mg, 50 mg, or 100 mg.
- The dose can be repeated after at least 2 hours if the migraine has not resolved or returns after a transient improvement.
- The maximum daily dose is 200 mg in a 24-hour period.
- There is evidence that doses above 50 mg do not provide a greater effect than 50 mg 2, 2.
From the Research
Treatment Options for Menstrual Migraine
The treatment for menstrual migraine can be divided into several categories, including:
- Acute treatment: This involves the use of medications to relieve symptoms once they have started. According to 3, 4, 5, 6, 7, triptans, such as sumatriptan and rizatriptan, are effective for acute treatment of menstrual migraine.
- Short-term prophylaxis: This involves the use of medications to prevent menstrual migraine attacks. Options include:
- Triptans, such as frovatriptan, zolmitriptan, and naratriptan, taken twice daily 5
- Non-triptans, such as magnesium, estrogen, naproxen sodium, and dihydroergotamine 5
- Hormone-containing preparations, such as continuous combined hormonal contraceptives (CHCs) with no placebo pills or using just two days of placebo pills 3
- Daily prevention: This involves the use of medications to prevent menstrual migraine attacks on a daily basis. Options include:
Hormone Therapies
Hormone therapies, such as CHCs, can be effective in preventing menstrual migraine attacks. According to 3, the withdrawal of estrogen has been correlated with the onset of menstrual migraine, providing an opportunity for specific treatment with hormone therapies. However, the use of CHCs is not recommended for women with a history of menstrual migraine with aura, especially when other risk factors such as smoking are present 3.
Other Treatments
Other treatments, such as GnRH agonists, selective estrogen receptor modulators, and bilateral oophorectomy, have limited evidence and are not commonly recommended for the treatment of menstrual migraine 3.