Treatment options for menstrual migraines begin with over-the counter (OTC) medications, and in particular non-steroidal anti-inflammatory drugs (NSAIDs). These will bring relief to some percentage of women, especially for associated non-headache symptoms. As with migraines not associated with the menstrual cycle, including those in men, OTC medications do not always bring relief for the migraine headache itself. There is some evidence for efficacy of compound medications, such as aspirin, acetaminophen and caffeine, as found in ‘extra strength’ OTC pain medicines. Some women experience good results with taking an OTC medicine in anticipation of their menstrual flow. For those on birth control pills, doctors recommend starting an NSAID on day 19 of the cycle and continuing to day two of the next cycle. Since the menstrual period is by nature time-limited, there is a reduced risk of gastro-intestinal side effects or of medication overuse/rebound headaches when using OTC remedies. Severe menstrual migraines not responding to OTC drugs are sometime amenable to calcium channel blockers such as verapamil, beta-blockers such as propranalol, or even an anticonvulsant like valproate. These drugs too can be started in day or two in anticipation of a woman’s menstrual flow – or as soon as possible upon the start for those with less regular cycles.
Patients with menstrual migraines may also attempt relief with onset-abortive drugs, which act as serotonin receptor agonists. In this regard, use of ergotamine-based drugs has declined in favor of triptan medications, which similarly target the same serotonin receptor subtypes but with less of a side effect profile. The main drawback of triptans remains their very high cost; even when covered by an insurance plan, the copay for triptans is typically higher than for many other medications, including other non-generic medicines. Because of the apparent role of serotonin receptor signaling in menstrual migraines, some women experience a benefit from taking anti-depressants in the selective serotonin reuptake inhibitor (SSRI) group. Patients receiving an anti-depressant medication for an off-label purpose, such as headache relief, likely benefit from caregiver reassurance that this is NOT an indication they are suffering from depression or any other ‘mental’ condition. This is indeed even a potential “teachable moment” in clarifying the biochemical basis of nervous system problems, including those formerly and erroneously thought to be associated with attributes of character and will.
If you are suffering from one or more of these conditions, and you would like us to help, please call our office today at 713.467.4082.