Menstrual headaches are often severe, prolonged and debilitating.  The abortive therapy follows the general abortive therapy for migraine.  In addition to the usual abortives, cortisone (Prednisone, Dexamethasone) is effective for many women; they are utilized in very limited amounts.  We use 10 or 20mg Prednisone or 2 to 4mg Dexamethasone every 8 to 12 hours, 3 tabs per month only.  The severe intensity of menstrual migraines often dictates stronger abortive measures.  Triptans are particularly useful.  Many women with severe menstrual migraines require combinations of triptans, low dose cortisone, analgesics, and antiemetics. 

Preventive Treatment: The timing of preventive therapy is difficult for most women; either their menstrual periods are irregular, or the headaches occur at different times.  However, in some women the following may be helpful:

1. NSAIDS (Naproxen, etc.):Effective for many women and usually well tolerated.  There are started one day prior to the expected onset of the headache.  Many NSAIDS have been utilized, including naproxen, ibuprofen, flurbiprofen, meclofenamate sodium, etc.  GI upset is common.

2. Triptans: Frova is a long-acting, smooth, well-tolerated triptan.  Its utility in menstural migraine has been established.  One method of dosing it is 2.5mg once or twice a day for three to five days around the time that the menstrual migraine would occur.  While not as well studied, the other triptans may also be helpful as menstrual migraine preventives.  They are started the day prior to headache onset.

3. Hormonal approaches: 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 provide some relief.  The birth control pill, however, can also increase migraines.  As with other preventives, hormonal approaches often are disappointing, or they may initially provide relief, with declining efficacy over months.  The most commonly utilized hormonal approach is the continuous b.c.p., with a menstrual period every four months.

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