What medicines help prevent migraines with my menstrual period?

Effective therapy to prevent migraine aggravation with your menstrual period is call mini-prophylaxis. Prophylaxis is another word for prevention, so mini-prophylaxis means a short course of a prevention therapy. Menstrual migraines may improve by using mini-prophylaxis with hormonal therapy or standard migraine drugs.

Consider mini-prophylaxis only if your headache diary consistently shows a strong link between migraine aggravation and your menstrual periods:

• Mini-prophylaxis with perimenstrual hormone therapy: 1.5 mg transdermal estrogen patch worn for 7 days, starting 2-5 days before your period is expected to begin
  
  

• Mini-prophylaxis with standard headache therapies: All medications should be used at standard migraine treatment doses (unless otherwise specified by your healthcare provider) for 2-3 days before the expected menstrual period and during the first 2-4 days of menses.

Standard acute headache medications include:

• Nonsteroidal anti-inflammatory drugs (for example, naproxen sodium550 mg twice daily with food or mefenamic acid (Ponstel) 500 mg three times daily with food)
• 1 mg naratriptan (Amerge) twice daily
• 2.5 mg frovatriptan (Frova) once or twice daily
• Sumatriptan (Imitrex) 25 mg three times daily

Standard headache preventive medications include:

• Beta-blockers, such as propranolol (Inderal)
• Antidepressants, such as amitriptyline (Elavil) or imipramine
  (Tofranil)
• Calcium-channel blockers, such as verapamil (Calan and Isoptin), and flunarizine (Sibelium; not available in the United States)
• Neurostabilizing antiepileptics, such as topiramate (Topamax)