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Reader’s Mail: How Can I Prevent Menstrual Headaches?

Q. I have been dealing with migraines that I inherited from my mother, who got them from her mother, for almost 20 years now. I lose a week of my life every month when I get my menstrual cycle. I’ve been looking for a way to prevent this without the use of birth control pills because they only seem to aggravate my condition.  When I was pregnant with my son, the second half of my pregnancy was incredible. I had no headaches and never felt better. I should also add that once my mother and grandmother went through menopause, their headaches disappeared. Is there anything that you could recommend?  I seem to do pretty well the rest of the month due to some dietary changes I’ve made over the past year.

A. The most common way to prevent these headaches is a strategy called “mini prophylaxis,” which means that you take a medication preventatively for 4 to 5 days before and during your menstrual period in order to prevent or reduce the severity of these headaches. You would take medication starting 1 or 2 days prior to the onset of the migraine and stop the medication 4 to 5 days later. These medications are generally given 2 to 3 times per day depending on the medication, and you take them whether you have a headache or not for that 4- to 5-day time period.

One group of medications that can be used is the triptans, such as naratriptan, frovatriptan, zolmitriptan, and sumatriptan. Another possibility is the nonsteroidal anti-inflammatories, such as naproxen. Whether this treatment is appropriate for you should be determined by your physician.

Vincent Martin, MD
Headache and Facial Pain Program
University of Cincinnati Neuroscience Institute
Cincinnati, OH

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