Treatment of menstrual migraines often is more difficult than of non-menstrual attacks. A double-blind study by Marcelo Bigal and his collaborators just published in Headache shows that a combination of 10 mg of rizatriptan (Maxalt) and 4 mg of a steroid medication, dexamethasone (Decadron) is more effective than either drug alone. Both drugs are effective in treating many refractory migraine attacks (although I usually use 8 mg of dexamethasone), this is the first trial of two drugs together. While the results are not very surprising, the study may lead to wider acceptance of combination therapy and better relief for many women. While in the past the emphasis was placed on finding a single drug to treat a disease, in recent years combination therapy has become a standard approach in many conditions. Treximet, a combination of sumatriptan (Imitrex) and naproxen (Aleve) was also shown to be better than either of the two ingredients alone.
Read MoreMenstrual migraines are at times very difficult to treat. Triptans, such as Maxalt, Imitrex and other are usually very effective, but in some patients do not provide sufficient relief. Corticosteroid drugs, such as prednisone and dexamethasone can help some patients. Marcelo Bigal and his colleagues compared treatment of menstrual migraines with Maxalt alone, dexamethasone alone, and combination of the two. Maxalt was much better than dexamethasone, providing sustained 24-hour relief in 63% of patients vs 33%, but the combination was better than Maxalt alone, giving relief to 82% of women. We would always try Maxalt or a similar drug alone, but if one drug is insufficient a combination with dexamethasone should be tried. Corticosteroids should not be used for more than a few days a month because frequent and prolonged use can lead to serious side effects.
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