. Author manuscript; available in PMC: 2022 Sep 8.

Published in final edited form as: Continuum (Minneap Minn). 2021 Jun 1;27(3):703–731. doi: 10.1212/CON.0000000000000993

TABLE 9–3.

Strategies for Perimenstrual Migraine Prophylaxis

Class	Specifics

Nonsteroidal anti-inflammatory drugs	Naproxen 550 mg 2 times a day for 5–6 days, ideally starting 1 day before expected headache onset⁸¹
	Mefenamic acid up to 500 mg 3 times a day from the start of headache through menses⁸²
	The cyclooxygenase-2 (COX-2) inhibitor celecoxib has shown promise⁸³ in pilot studies
Triptans ⁸¹	Frovatriptan 2.5 mg 2 times a day for up to 6 days, ideally beginning 1 day before expected headache onset
	Naratriptan 1 mg 2 times a day for 5–6 days, ideally beginning 1 day before expected headache onset
	Zolmitriptan 2.5 mg 2 to 3 times a day for up to 7 days, ideally beginning 1 day before expected headache onset
Magnesium ⁸¹	Specific formulation studied is not available in the United States, but it is reasonable to use available forms perimenstrually; can also help with perimenstrual syndrome
Vitamin E	400 IU/d for 5 days beginning 2 days before menses⁸⁴
Estrogen	Supplementation (“add back”) via patch or gel in teenagers who have migraine without aura⁸³