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Ask the Pharmacist: OTC Medications for Menstrual Migraine

Migraine occurs approximately three times more frequently in women than men. The exact reason(s) for this difference is not completely understood, but hormone fluctuations are considered to be a main culprit. Approximately three out of four women with migraine experience attacks that correspond to their menstrual cycle or endure their most severe attacks during this time.

Menstrual migraine typically occurs in a predictable pattern. Headache diaries are useful for discerning this pattern, which is necessary for diagnosis and to time treatment appropriately. Once menstrual migraine is confirmed, drug treatments can be taken in an anticipatory manner to help maximize their ability to reduce or eliminate migraine pain and associated symptoms.

Medications used to treat migraine basically fall into one of two groups: acute and preventive. Acute drugs (sometimes called abortive drugs) are intended to stop or relieve an attack that is occurring or about to occur. Acute drugs should only be used on an “as needed” basis and limited to no more than three days per week. Preventive medications are intended to reduce the frequency, severity and duration of attacks and should be taken every day, regardless of whether or not a migraine is occurring.

That said, menstrual migraine is one of the few situations in which acute medications, including over-the-counter (OTC) agents, can actually be used preventively, i.e., taken every day for a limited amount of time. For example, a woman with migraine attacks that occur predictably with menses could begin an OTC anti-inflammatory agent two days prior to the first expected attack. Examples of OTC use for this situation are naproxen 500 mg orally twice daily or ibuprofen 200-400 mg orally three times daily. Regardless of whether an attack occurs (and hopefully none will), she should continue the medication for a total of three to five days. Then she should discontinue the daily use and only take these drugs on an ‘as needed’ basis for the remainder of the month.

For many women, using OTC agents for menstrual migraine is an effective, low-cost, self-treatment option. Individuals who do not sufficiently ‘respond’ (significant reduction or elimination of migraine pain and associated symptoms) to one OTC can consider using a different product. Women who find that two or more products fail to improve their menstrual migraines should consider seeking the assistance of a healthcare provider. A number of prescription drugs can be used in a similar fashion and may be more effective.

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