Treatment for Menstrual Migraine

Treatment for menstrual migraine (or menstrually related migraine) is available, and many women have found relief.  Menstrual Migraine - very often disabling, and lasting longer than the typical migraine attack - can't always be fought using the same medications as your friend uses for her headache.  

One of the reasons that menstrual migraine may seem so hard to treat is that attacks often don't respond well to short term treatment (ie just taking a "painkiller" won't necessarily help).  Because this seems to be the thing "everybody" does for headaches, it can be discouraging when nothing seems to work.  But there is hope!

Abortive Drugs

Though abortive drugs may not be as effective for menstrual migraine, they can be a help to some.  Often a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen is all that's needed.  There are many other options - the same for most other types of migraine - that you can try, such as ergots, triptans, and possibly another medication for nausea if needed.  Triptans have often been studied as treatment for menstrual migraine, and many of the different triptans seem to help.

Here's a quick summary of some of these medications.

Over the counter medications may work well if your symptoms are mild or moderate, and you're not using too much.  Otherwise, they could make the headache and other symptoms worse.

Non-drug options

As with other types of migraine, there are a variety of non-drug options you might want to try.  Magnesium therapy may be especially helpful for patients with menstrual migraine.  300-600mg is often recommended, though some with migraine use higher dosages.

There is some evidence that vitamin E could be a help as well.

Other treatments such as biofeedback could help to fight the symptoms as well.

One of the most important types of treatment for menstrual migraine is lifestyle change.  It can be something as simple as going to bed and getting up at the same time every day.  Of course exercise and diet are also key.

Hormonal Considerations

Hormonal changes and the use of certain contraceptives can make treatment a more complicated matter.  But if you have migraine attacks outside of certain times in your monthly cycle, your doctor will probably try regular migraine treatments for you.

If you use combined hormonal contraceptives (CHCs), and find that you only have migraine attacks during the hormone-free interval, your doctor may recommend long-cycle or continuous CHCs.  Otherwise, he may recommend you consider other options for contraception.

Hormone replacement therapy may be used for those experiencing symptoms of perimenopause.  (Find out why you shouldn't ignore migraine during perimenopause)

There are a number of hormonal treatments that you can discuss with your doctor, depending on your particular situation.  Some treatments carry more risk than others, so you need to talk to a doctor who knows your medical history.

Hysterectomy?

Generally speaking women are discouraged from trying to stop menstrual migraine with a hysterectomy.  There is, in fact, a risk that the migraine attacks may become worse.  The other options mentioned above are far better.  Beyond those there are many other options for treating migraine that can be tried.

To learn more...

Here's a quick summary of treatment for menstrual migraine from the City of London Migraine Clinic.  Also, find out 8 Reasons why Menstrual Migraine is "different".  Much of the above information comes from the very useful and scholarly book Menstrual Migraine edited by Susan Hutchison and B. Lee Peterlin.