Reviewed by Julie Boora, Superintendent Pharmacist, TribElle Health Ltd (GPhC Reg. 9012688)
Migraine · Prescription treatment
How acute and preventive medicines work, what is available in the UK, and what helps when your migraines follow your hormones.
1 in 7
people in the UK live with migraine
2 to 3×
more common in women than men
4+ days
a month is when prevention is usually considered
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.
Three questions, and you will know which part of this guide applies to you and what a clinician is likely to discuss.
1 · How many days a month do you get migraine?
2 · Do your attacks follow your hormones?
3 · How well is your current treatment working?
What usually applies
Where attacks track your cycle, clinicians often use short-term prevention around menstruation with frovatriptan, naratriptan or zolmitriptan, and review HRT or contraception where relevant. Frequent attacks may also warrant a daily preventive.
Start a migraine consultation →This is general information, not a prescription or a diagnosis. Any prescription treatment follows a clinical assessment.
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.
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.
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.
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.
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.
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.
The most suitable prescription depends on your migraine pattern, medical history, age, other conditions, and whether you are pregnant or planning pregnancy.
Occasional migraine
Sumatriptan, rizatriptan, zolmitriptan, or NSAIDs where appropriate.
Menstrual migraine
Frovatriptan, naratriptan, zolmitriptan, or naproxen where appropriate.
Frequent migraine
Preventive medicines: propranolol, candesartan, amitriptyline, or topiramate with important pregnancy precautions.
Chronic migraine
After specialist assessment: Botox®, CGRP monoclonal antibodies, atogepant or rimegepant.
The best treatment is always individual, and it should be reviewed regularly with a healthcare professional. What worked at 30 may not be the right choice at 45.
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:
For many people, triptans are the first prescription treatment recommended for acute migraine. The most appropriate medicine depends on your symptoms, your response to previous treatment and your medical history.
Women with menstrual migraine may benefit from specific triptans such as frovatriptan or naratriptan used around their cycle. Women with frequent hormone-related attacks may also benefit from preventive treatment after assessment by a healthcare professional.
Yes. Preventive medicines such as propranolol, candesartan, amitriptyline, Botox® and CGRP-targeted treatments are designed to reduce how often migraines happen, rather than treat a single attack.
Some triptans may be available from UK online pharmacies following a clinical assessment to confirm they are safe and appropriate for you.
Women's migraine treatment often takes hormonal triggers into account, including menstruation, perimenopause and menopause. Treatment plans may differ depending on whether attacks are linked to hormonal changes.
Seek specialist assessment if you have headaches on 15 or more days each month, your migraine medicines no longer work, your attacks are becoming more frequent, you have unusual neurological symptoms, or your headaches are affecting your quality of life.
Hormone-aware migraine care and prescription options, reviewed by clinicians. Managing attacks also starts with having the right products to hand.
See migraine treatments →Hormonal Migraine Support UK
A community for women navigating hormone-related migraines.
Join group →TribElle Weight Management Support
Connect with other women on their weight management journey.
Join group →© 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.