Nurtec for Menstrual Migraine prevention and treatment during acute attacks: It can be used alone or in combination with an NSAID such as Naproxen or a triptan, Rizatriptan in particular.
Nurtec (Rimegepant) is a CGRP receptor agonist. It is a different class of medicine that has been approved for the treatment and prevention of chronic migraine headaches.
For the treatment of acute attack, it is taken as soon as the signs and symptoms of migraine headache are noticed by the patient.
It takes about two hours to relieve the symptoms of migraine headache, primarily the pain. However, it may take up to five hours for complete relief.
Recently, it has also been approved for the prevention of migraine headaches. For migraine prevention, it can be administered every other day, not exceeding 15 to 18 doses per month.
Nurtec for Menstrual migraine:
Although the pathogenesis of all migraine headaches is nearly the same. It is characterized by vasodilation of the intracranial blood vessels and hypersensitive cranial nerves, importantly the trigeminal nerve.
However, in patients with menstrual migraine, there are lots of hormonal changes which might alter the efficacy of Nurtec.
Because of the limited data regarding Nurtec use in patients with menstrual migraine, we analyzed real-life patient reviews from Reddit to see how patients responded to Nurtec.
Nurtec Reviews of patients with Menstrual Migraine Headaches:
A total of four patients used Nurtec either for the treatment or prevention of menstrual migraine.
Almost all patients had a positive review about Nurtec use during menstrual migraine. However, most patients found the best results when Nurtec was used in combination with either a “Triptan” or “NSAID”.
Nurtec Use with Triptans for Menstrual Migraine:
One patient did not mention which triptan she was using with Nurtec for menstrual migraine. Nevertheless, she found Nurtec quite effective when used in combination with a Triptan.
Here is what she posted:
“Nurtec works wonderfully for my regular migraines but it doesn’t touch my menstrual migraines, I still need my triptan for those.”
Nurtec Use with Rizatriptan for menstrual migraine:
While analyzing the data to evaluate the efficacy of Nurtec in the treatment of migraine, we found that most patients were either using Sumatriptan or Rizatriptan.
Most patients on Rizatriptan had a positive review about the drug, especially when given in combination with Nurtec, Ubrelvy, or other preventive migraine medicine (Ajovy, Aimovig, and Emgality).
Even patients who switched to Nurtec or other drugs from the same class did it not because of the lack of efficacy but because of the side effects.
Furthermore, Zomig (Zolmitriptan) and other triptans are not available in the US, hence there haven’t been any reviews about them.
Regarding Nurtec and Rizatriptan for menstrual migraine, this is what the patient wrote:
“I thought I would give my experience with hormonal migraines and what has helped me. Let me say that it certainly may not work for everyone since everyone is different! But I would like to share my personal account.
“I’ve been getting post-period migraines for the last 2 years. They come on when my period is ending and last 2-3 days. They are BRUTAL. I’m 33 with no kids yet. I have regular menstrual cycles and chart like crazy”
Nothing would help my migraines when I got them (prior to migraine meds). This is what I tried (and still keep up with):
low sugar diet
very limited grains
no canned food (BPA)
lots of vegetables and meat
natural house products, makeup, no fragrances, etc.
I tried to get all ewg certified clean products.
iron supplement (post-period migraine are said to be from low iron but I got my iron/ferritin levels checked and were totally normal)
As a side note, since implementing the above I feel great! Lots of energy – something I struggled with.
I also tried the beam supplement by cove and unfortunately, it didn’t help. Advil, Excedrin, Aleve, and other natural supplements (turmeric, ginger, coq12, etc) also gave me zero relief!
Finally, I signed up with cove migraine online while I was waiting to see a neurologist. I was prescribed rizatriptan 5mg and it took my migraine away within 1 hour! I couldn’t believe it.
It worked so well – however, it made me really tired and I slept for a few hours (I’m sensitive to meds!) and it was short-acting (~worked for 9 hrs). Other than that, it works very well for my menstrual migraines.
I then saw a neurologist and I told him I loved the rizatriptan however it made me really tired and only lasted so long. He told me there’s a “cousin” to rizatriptan called Nurtec that can last up to 48 hours with little to no side effects. He gave me a few samples.
Yesterday my post menstrual migraine started to come on. It always starts off as a bad headache and then progresses quickly. I thought maybe it might be a fluke (no it was not of course 🤣) and 3 hours in I decided to try the Nurtec.
Within 30 mins I can feel it very slowly start to work. At 1 hour I felt more relief (50%). After 2 hours I felt 95% better with only a TING of a headache. I went to bed for the night and had no migraine this morning. I didn’t have any side effects (I was scared since I’m so sensitive).
I wanted to share my experience with others since I have learned a lot through others’ experiences on Reddit 🙏 I was very nervous to try migraine meds since I can be very sensitive.
That’s why I exhausted all other options first. I think rizatriptan and Nurtec can be great options for hormonally related migraines.
Nurtec use with Naproxen Vs Ibuprofen for Menstrual Migraine:
NSAIDs are commonly used to treat an acute attack of migraine headache. NSAIDs are also preferred for dysmenorrhea and premenstrual syndromes.
Although all NSAIDs have the same mechanism of action, they differ in their efficacies and side effects profiles.
Among NSAIDs, Naproxen is considered more potent and preferred for the treatment of dysmenorrhea and perimenstrual syndrome.
Naproxen is also one of the neurologists’ preferred drugs for the treatment of migraine headaches in general.
One patient reviewed her experience about Naproxen vs Ibuprofen for the treatment of menstrual migraine.
Here is what she wrote:
“Naproxen works WAY better with my Nurtec than Ibuprofen does. Never considered using it because it does nothing for my menstrual cramps so I never bought it”.
“Read something on this sub about Naproxen being someone’s favorite in combination with their abortive and decided to give it a try. Now I always have it on hand!”
Nurtec Vs Ubrelvy for menstrual Migraine:
During our review of patients using the CGRP receptor agonists, some patients found Nurtec better than Ubrelvy, others found Ubrelvy better.
However, both drugs are from the same class. One might work for some and not for others. There are no special recommendations detailing the switching of Nurtec to Ubrelvy and vice versa, However, there is no constraint and one can switch from one to another to get full relief.
For final words, this patient used Nurtec for migraine prevention as it helped her during the acute episodes. However, she needed an extra dose during the menstrual attack.