Menstrual migraine | Right Decisions

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Pharmacological management of migraine (SIGN)
Menstrual migraine

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

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SIGN decision support

The drop in oestrogen just prior to menstruation is a known trigger for migraine and in women migraine is more frequent, more severe and harder to treat just before and during menstruation.

In some women migraine only occurs (pure menstrual migraine) or predominantly occurs (menstrually-related migraine) from two days before the start of bleeding until three days after. In these women perimenstrual strategies may be used instead of, or in addition to, standard, continuous prophylaxis. The menstrual cycle has to be regular for treatment to be effective.

Consider frovatriptan (2.5 mg twice daily) as a prophylactic treatment in women with perimenstrual migraine from 2 days before until 3 days after bleeding starts.

Consider zolmitriptan (2.5 mg three times daily) or naratriptan (2.5 mg twice daily) as alternatives to frovatriptan as prophylactic treatment for 2 days before until 3 days after bleeding starts.

Women with menstrual-related migraine who are using triptans at other times of the month should be advised that additional perimenstrual prophylaxis increases the risk of developing medication-overuse headache.