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.

When treated with a low-dose of hormones from a contraceptive device, women with migraine with aura and menstrual-related migraine experienced significant improvement in both disorders. These results in a recent study bring potentially good news for many women, but the lead author of the study, Anne Calhoun, MD, of the University of North Carolina in Chapel Hill, tempered her enthusiasm. “I first urge caution,” she told Reuters Health, stressing that the study was small—just 23 subjects—and intended to guide future research. “Good science requires larger and more rigorous trials before definitive conclusions can be gained.”

Taking the triptan medications eletriptan (Relpax®) or sumatriptan (Imitrex®) before menstruation may reduce the severity and duration of menstrual migraine attacks, and possibly prevent them altogether. Triptans are usually taken to stop migraine attacks, but some healthcare providers use them as "mini-preventives" to ward off attacks. A recent study compared the effect of the two triptans, with half of the 90 women enrolled receiving eletriptan and half receiving sumatriptan.

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.