How is menstrual migraine treated?
About 50% of female migraineurs report migraines with their menses, and 14% have MM only.
Many women respond to the usual acute medications. For nonresponders, perimenstrual prevention with triptans may be effective beginning 2 to 3 days prior to the expected onset of the menses and continuing for a total of 5 days (frovatriptan 2.5 mg bid or zolmitriptan 2.5 mg three times a day [tid] or bid).
Transcutaneous estradiol gel 1.5 mg or a 0.1 mg/24 h patch applied 2 days prior to the onset of menses and continued for 7 days may also be effective.
For those with refractory MM or with irregular menses, daily migraine prevention can be tried.
For those already using estrogen–progestin oral contraceptives, continuous contraception for 3 months or more can be effective.
