This protocol targets migraine without aura in patients whose attacks occur exclusively in the perimenstrual window — a predictable pattern that enables a specific preventive strategy distinct from standard migraine management.
Menstrually associated migraine is defined by attacks that occur exclusively from 2 days before up to 3 days after the onset of menstrual bleeding, in at least 2 out of 3 cycles. This strict temporal definition separates it from non-menstrual migraine and directly informs the treatment strategy.
The predictable onset relative to menstruation makes this subtype particularly amenable to short-term, cycle-timed prevention rather than continuous prophylaxis.
Management relies on short-term prevention initiated before the expected start of migraine. The strategy involves triptans or NSAIDs used in a defined perimenstrual window. Among the available options, evidence supports specific agents over others — and the selection depends on which agent has the strongest evidence base for this indication. The complete algorithm, agent hierarchy, and supporting data are in the full protocol.
DOI: 10.1177/2514183X1882337