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Hormonal Migraine info

My mom forwarded this link to me on hormonal migraines (menstrual migraines) that I found interesting because it lays out treatments that I have not heard of and some I had. National Headache Foundation: Menstrual Migraine I'd heard of taking NSAIDs for the duration to help prevent and treat and for a bit that is what I did back when I was able to take them... but those meds eat your stomach to hell.  Or maybe it was just what I was on, or just that I have IBS because of FM that makes my digestive system a little more finicky, either way, that is a no go for me.  I had not heard of taking magnesium preventatively, but I know it is good for migraines... as I mentioned a bit back it can be difficult to find the right magnesium to take if you have digestive compaints and I have been having problems with that, but it is definately a good idea to do so.  Also had not heard DHE referenced in regards to hormonal migraines... the only triptan I remember doctors mention was good for hormonal migraines specifically was amerge.  I'd actually heard in regards to some doctors recommendations they suggest taking amerge, or maybe even DHE I guess by the sounds of it, every day for the three to four days needed... because the hormonal trigger is consistent and the migraines acute so you need to be aggressive.  Doctors do not always get that.  I try and tell my primary that all the time... I say these migraines are the worst of all my migraines, they last days, they are in fact One migraine, they are acute and I can get quite sick if they persist.  I miss the most work from them and if I do not get a handle on them off the get go then I'm screwed for the duration, but I can't take antinflamatories and I have been told not to take my triptan more than three times a week or more than once a day and my painkiller is a rescue med that is not rescuing me from anything and certainly does not even touch these nasty bastards.  Seriously these migraines are in a class of their own.
Acute Treatment Medications that have been proven effective or that are commonly used for the acute treatment of MRM include nonsteroidal anti-inflammatory drugs (NSAIDs), dihydroergotamine (DHE), the triptans, and the combination of aspirin, acetaminophen, and caffeine (AAC). If severe attacks cannot be controlled with these medications, consider treatment with analgesics, corticosteroids, or dihydroergotamine.

Preventive Treatment

Women with very frequent and severe attacks are candidates for preventive therapy. For sufferers taking preventive medications who experience migraine attacks that break through the preventive therapy perimenstrually, the dose can be raised prior to menstruation. For sufferers not taking preventive medication, or for those with true menstrual migraine, short-term prophylaxis taken perimenstrually can be effective. Agents that have been used effectively perimenstrually for short-term prophylaxis include: naproxen sodium (or another NSAID) 550 mg twice a day; a triptan, such as frovatriptan 2.5 mg twice on the first day and then 2.5 mg daily/ naratriptan 1 mg twice a day/ sumatriptan 25 mg twice a day/ or, methylergonovine 0.2 mg twice a day; DHE either via nasal spray or injection 1 mg twice a day; and magnesium, equivalent to 500 mg twice a day.
The triptans, ergotamine, and DHE can be used at the time of menses without significant risk of developing dependence. As with the NSAIDs, these drugs will also be more effective as preventive medications if started 24 to 48 hours before the onset of the expected MRM.
Fluoxetine, especially if the headache is associated with other premenstrual dysphoric disorder (PMDD) symptoms, can be an effective headache preventive between ovulation and menses.

Hormonal Therapy

If standard preventive measures are unsuccessful, hormonal therapy may be indicated. This may involve the use of a supplemental estrogen taken perimenstrually either by mouth or in a transdermal patch. Estradiol (0.5 mg tablet twice a day, or 1 mg patch) is the preferred form of estrogen because it does not convert to the other active forms of estrogen.
For women using traditional estrogen/progesterone oral contraceptives for 21 days per month, the supplemental estrogen may be started on the last day of the pill pack. Another approach for women who take an estrogen/progesterone oral contraceptive is to take it daily - that is, without the monthly break - for 3 to 6 months. This has become accepted as a standard practice, and in Europe this approach has been used for up to a year with safety. The reduction in menstrual periods provides a method of preventive treatment. National Headache Foundation: Menstrual Migraine
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