The abortive therapy follows the general abortive therapy for migraine. Cortisone (Prednisone, Decadron) is very effective for many women; it is utilized in very limited amounts. The severe intensity of menstrual migraines often dictates stronger abortive measures. Triptans (particularly Imitrex SQ) are particularly useful.
- NSAIDs (Naproxen, etc.): Effective for many women and usually well tolerated. These are started 3 days prior to the expected onset of the headache. Many NSAIDs have been utilized, including naproxen, ibuprofen, flurbiprofen, meclofenamate sodium, etc. GI upset is common.
- Ergotamine derivatives: the usual forms of ergots utilized include: ergotamine tartrate, Bellergal-S, ergonovine, DHE, and methysergide. These are started 1 to 3 days prior to the onset of the headache. Ergots are poorly tolerated, with frequent GI upset and nausea. Ergotamine rebound may occur, but it is unusual when ergots are used for menstrual migraine.
- Hormonal approaches: Tamoxifen (Nolvadex) is sometimes utilized for seven to fourteen days at 10 mg. per day. Estrogen has been used, but is questionably effective. Occasionally, the birth control pill, even on a cyclic basis, will reduce headaches. If used continuously (no break), it may also occasionally be effective. The birth control pill, however, can also increase migraines.
- Triptans: Amerge (naratriptan) is a long-acting, smooth, well tolerated triptan. Its utility in menstrual migraine is being investigated. The usual dose would be 2.5 mg once or twice a day for three to five days around the time that the menstrual migraine would occur. Occasionally, sumatriptan, which is shorter acting than naratriptan, has been used for this purpose. Rizatriptan (Maxalt) may also be useful in this regard.