From the Guidelines
Frovatriptan is the most effective triptan for preventing menstrual migraines due to its longer half-life and extended protection during vulnerable hormonal periods. When considering preventive treatment for menstrual migraines, it's essential to weigh the benefits and risks of different triptans. According to the study published in Nature Reviews Neurology 1, initiation of perimenstrual preventive treatment should be considered, and this approach typically involves daily intake of a long-acting NSAID or triptan for 5 days, beginning 2 days before the expected first day of menstruation. Some key points to consider when using triptans for preventive treatment include:
- Frovatriptan has a longer half-life of approximately 26 hours, providing extended protection during vulnerable hormonal periods.
- The recommended dosage for frovatriptan is 2.5 mg once or twice daily, starting two days before expected menstruation and continuing through the first few days of the period (typically 5-6 days total).
- Naratriptan (1-2.5 mg twice daily) is a good alternative with a similar longer duration of action.
- Side effects may include dizziness, fatigue, dry mouth, and chest tightness.
- Triptans should be avoided if you have cardiovascular disease, uncontrolled hypertension, or hemiplegic migraines. It's crucial to track your menstrual cycle carefully to time the medication properly and discuss this approach with your healthcare provider to ensure it's appropriate for your specific situation and to determine the optimal dosing schedule, as mentioned in the study 1.
From the FDA Drug Label
The efficacy of zolmitriptan tablets was unaffected by ... relationship to menses; The FDA drug label does not answer the question.
From the Research
Best Triptan for Preventing Headaches before Menstruation
- The most effective triptan for preventing headaches before menstruation is frovatriptan, as it has been shown to be well-tolerated and effective in reducing the incidence and severity of menstrual migraine 2, 3, 4, 5.
- Frovatriptan has a longer terminal elimination half-life in blood than other triptans, which may contribute to its sustained effect and lower rate of relapse over 48 hours 3, 6.
- Studies have demonstrated that frovatriptan is effective in preventing menstrual migraine when taken as a 6-day regimen, starting 2 days before the anticipated onset of menstruation 2, 4.
- Compared to other triptans, frovatriptan has been shown to have a lower headache recurrence rate and is considered the triptan of choice for short-term prevention of menstrual migraine 3, 5.
- The safety and tolerability of frovatriptan for short-term prevention of menstrual migraine have been established, with most adverse events being mild or moderate in severity and no evidence of an increased risk of cardiovascular adverse events 2, 4.