How Can I Stop Menstrual Migraines? 7 Treatment Options

1. Nonsteroidal anti-inflammatory drugs

Acetaminophen, ibuprofen, and naproxen can help prevent menstrual migraines or make them less severe. Take them twice a day, starting 2-3 days before your period begins and then for another 3-5 days after it starts.

2. Triptans

Triptans help prevent menstrual migraines if administered 2 days before your period and continued for 6-7 days after your period. They can be used as oral, injectable, and nasal sprays. Side effects include nausea, dizziness, a stuffy nose, cramps, and rebound headaches when overused.

Examples include:

• Axert (almotriptan)
• Relpax (eletriptan)
• Frova (frovatriptan)
• Amerge (naratriptan)
• Maxalt (rizatriptan)
• Imitrex (sumatriptan)
• Zomig (zolmitriptan)

3. Calcitonin gene-related peptide receptor antagonists

Examples include:

• Ubrelvy (ubrogepant)
• Nurtec ODT (rimegepant)

4. Estrogen pills, gels, or patches

A steady dose of estrogen throughout the menstrual cycle may prevent the dip in estrogen levels that acts as a triggering factor.

5. Magnesium supplements

Some studies have linked the onset of a migraine to low levels of magnesium. 

Magnesium supplementation is typically started on the day 15 of the menstrual cycle until the start of your period. It is a versatile and safe intervention for women without regular cycles because it is not necessary to have regular cycles to time this prevention.

6. Preventive drugs

Preventive drugs used to stop menstrual migraines before they start include the following:

• Tricyclic antidepressants
  • Amitriptyline
  • Fluoxetine
• Ant-iseizure medications
  • Topamax
  • Qudexy XR (valproate and topiramate)
• Beta-blockers (propranolol) and calcium channel blockers (verapamil)
• CGPR monoclonal antibodies
  • Aimovig (erenumab-aooe)
  • Ajovy (Fremanezumab-vfrm)
  • Emgality (Galcanezumab-gnlm)
  • Vyepti (Eptinezumab-jjmr)
• Dihydroergotamine
• Contraceptives

Lifestyle changes

• Keep a diary tracking your symptoms for at least 3 months, recording both migraine attacks and menstrual cycles
• Try to get 7-8 hours of sleep every night
• Minimize stress and practice relaxation techniques such as yoga and meditation
• Eat several small meals throughout the day to avoid getting too hungry
• Avoid triggering foods such as caffeine, alcohol, and processed foods
• Exercise on regular basis

According to the American Migraine Foundation, 1 in every 5 women experience migraine. Nearly 2 out of every 3 women with migraine get attacks that coincide with their periods.

Menstrual migraine is caused by several factors. One is fluctuations in hormone levels, especially estrogen, which affects the gray matter of the brain, blood vessels in the central nervous system, and the central pain pathways (midbrain), which during their lifetime can bring on new migraine symptoms and changes in symptom severity. The role of estrogen in menstrual migraine involves the following mechanisms:

• Estrogen deficiency leads to abnormal neural impulses in the midbrain (brainstem) due to disturbed physiology of the trigeminal nerve, which supplies the structures of the face and neck and innervates the blood vessels of the brain.
• In the midbrain, the abnormal neuronal firing causes a massive release of vascular inflammatory substances, such as calcitonin gene-related peptide, cytokines, and prostaglandins, which causes hyperalgesia (increased sensitivity to painful stimuli) and allodynia (pain produced by normally non-noxious stimulation) at the level of pain receptors in the body.
• Over time, the trigeminal nerve becomes increasingly sensitive to the estrogen fluctuations and inflammatory markers, causing the migraine attack to recur.
• Moreover, estrogen alters neurotransmitters, such as serotonin and dopamine levels, in the brain, which are responsible for mood and pain perception.
• Estrogen deficiency triggers depressed mood, minute changes in blood vessel caliber, and an increase in sensitivity to nociceptive responses to the peripheral and central stimuli, thus lowering the pain threshold.

In addition to estrogen deficiency, birth control pills and hormone replacement therapy (for menopause) can change the frequency or severity of migraines.

Warning signs of an impending migraine may include:

• Increased urination
• Constipation
• Food cravings
• Mood changes
• Tiredness
• Frequent yawning
• Sensitivity to light or sound
• Blurred vision
• Flashes of light or zigzag shapes
• Numbness or tingling

During a menstrual migraine, you may experience the following symptoms:

• Throbbing or pulsating headache (mostly one-sided, shifting from one side of the head to the other or affecting the front or back of the head)
• Nausea
• Vomiting
• Numbness and tingling
• Fatigue
• Irritability
• Difficulty speaking
• Sensitivity to light, noise, and smell
• Visual disturbances
• Blurred vision
• Upset stomach
• Abdominal pain
• Decreased or loss of appetite
• Pale skin
• Neck stiffness
• Dizziness or lightheadedness
• Feeling warm (increased sweating) or cold (chills)
• Insomnia