There are several ways to manage menstrual migraines as they happen.
Triptans
Non-hormonal drugs and are the first-line treatment for cluster headaches or migraines once they have developed. They work by binding to serotonin receptors in the brain, narrowing blood vessels and reducing the release of inflammatory molecules in the blood that are causing nerve sensitivity.
Beta-blockers
Typically prescribed for heart related conditions, specifically for high blood pressure, but doctors can prescribe them for migraines too. Unlike triptans, these drugs are taken regularly to prevent the onset of a migraine attack. It works by reducing blood vessel dilation and suppressing the electrical brain wave activity related to migraines.
Oral contraceptive pills
Oral contraceptive pills can actually worsen migraines on days without hormones, especially during the 7-day "placebo week" break. If you reduce the hormone-free interval from 7 days to 3 or 4 days, or even skip the break altogether, you can prevent these oestrogen-related migraines.
Patches or gel contraceptives
The NHS recommends that if you suffer from menstrual migraines, it is best to use patch or gel contraceptives instead of oral contraceptives, because they keep hormone levels more stable.
NSAIDs
Non-steroidal anti-inflammatory drugs are painkillers that can offer relief by blocking the COX pathway and reducing the production of inflammatory molecules, prostaglandins, that make the nerves sensitive to pain. Some NSAIDs can be sold over the counter like ibuprofen, paracetamol, naproxen, or aspirin, but some are prescription based.
Acupuncture
You may prefer an alternative to drug treatments. A randomised clinical trial found that acupuncture treatments for migraines was just as effective as taking beta-blockers when done over 8 weeks. This research showed that acupuncture resulted in reduced days with migraines and reduced frequency of migraine attacks.