A Guide to Managing Frequent & Hormone-Related Migraine

Reviewed by Julie Boora, Superintendent Pharmacist, TribElle Health Ltd (GPhC Reg. 9012688)

Migraine affects around 1 in 7 people in the UK and is two to three times more common in women than men, largely because of the hormonal changes that run through a woman's life. For many women, attacks cluster around menstruation, become unpredictable in perimenopause and menopause, or shift when hormonal contraception changes.

Over-the-counter painkillers may be enough for the occasional migraine. If attacks are frequent or disabling, prescription treatment can either stop an attack once it starts or reduce how often attacks happen at all.

This guide explains how prescription migraine treatments work, what is available in the UK, and how they help women whose migraines are hormone-related.

Find your migraine pattern

Three questions, and you will know which part of this guide applies to you and what a clinician is likely to discuss.

This is general information, not a prescription or a diagnosis. Any prescription treatment follows a clinical assessment.

How prescription migraine treatments help women with frequent attacks

Prescription migraine medicines work in two ways.

The right treatment depends on how often attacks come, how disabling they are, and whether your current medication still works.

Acute treatments: taken at the first sign of an attack

Triptans are usually the first prescription medicine recommended for moderate to severe migraine: sumatriptan, rizatriptan, zolmitriptan, eletriptan, naratriptan and frovatriptan. They stimulate serotonin (5-HT1B/1D) receptors, reducing inflammation around blood vessels and interrupting pain signalling in the brain. Many women find them most effective taken as early as possible, before the pain becomes severe.

Gepants, a newer group of CGRP receptor antagonists, may suit people whose migraines are not controlled with triptans or who cannot take them. Rimegepant is used for acute treatment and prevention; atogepant for prevention. Both block calcitonin gene-related peptide, a protein involved in migraine attacks.

Preventive treatments: taken daily to reduce attacks

Prevention may be considered if your migraines:

Common preventive medicines include propranolol, candesartan, topiramate and amitriptyline. For chronic migraine, meaning 15 or more headache days a month, specialist treatment may include botulinum toxin (Botox®), CGRP monoclonal antibodies, atogepant, or rimegepant where clinically appropriate.

Hormone-related migraine: why it is different

Hormonal migraine is extremely common. Many women notice attacks before or during their period, through perimenopause, around menopause, after childbirth, or following a change to hormonal contraception. These attacks are usually triggered by changes in oestrogen levels rather than by consistently high or low hormones, which is why they can feel so unpredictable.

Menstrual migraine

Some women benefit from short-term preventive treatment around the time of their period. NICE and the British Association for the Study of Headache (BASH) note that suitable women may be offered frovatriptan, naratriptan or zolmitriptan, taken for several days around menstruation to head off an attack.

Perimenopause and menopause

Fluctuating hormone levels can make migraines more frequent or harder to predict. Management may involve optimising your migraine medication, reviewing hormone replacement therapy where appropriate, identifying lifestyle triggers, and considering preventive medicines if attacks become more frequent. For many women, effective control means treating both the migraine and the hormonal change behind it.

Which treatments suit which pattern

The most suitable prescription depends on your migraine pattern, medical history, age, other conditions, and whether you are pregnant or planning pregnancy.

Can an online pharmacy prescribe migraine medication?

Yes. Many UK online pharmacies, including TribElle, can assess suitable adults for acute migraine treatment following an online consultation.

You should be assessed by your GP or a specialist headache clinic first if you have:

Frequently asked questions

Key takeaways

You do not have to go through this alone

References

1. National Institute for Health and Care Excellence (NICE). Headaches in over 12s: diagnosis and management (CG150). www.nice.org.uk/guidance/cg150
2. Scottish Intercollegiate Guidelines Network. SIGN 155: Pharmacological management of migraine. www.sign.ac.uk
3. British Association for the Study of Headache. National Headache Management System. bash.org.uk
4. International Headache Society. The International Classification of Headache Disorders, 3rd edition. ichd-3.org
5. NICE Technology Appraisal TA764. Erenumab for preventing migraine. www.nice.org.uk
6. NICE Technology Appraisal TA973. Atogepant for preventing episodic migraine. www.nice.org.uk
7. The Migraine Trust. Migraine treatments. migrainetrust.org

© TribElle Health Ltd · GPhC Registration 9012688 · tribelle.co.uk · This content is for informational purposes only and does not replace individual medical advice. Always read the patient information leaflet and consult a qualified healthcare professional.