Would love to give suggestions. I m a headache specialist in the Cleveland, OH area. Premenstrual migraines are common and although the treatment recommended (at least for prophylaxis ) is an excellent choice, obviously you can t tolerate it very well. My daughter has the same problem and it s taken a while to figure things out for her because we ve needed to experiment here and there with different combinations of medications for the premenstrual type of problem. In this particular forum it is very hard for me to have continuous contact with you because these questions are picked up by any one of hundreds of physicians as soon as they re posted. Is there any chance you can either post specifically to my attention in the premium segment of this forum? Make sure you put the consult request to my attention: DARIUSH SAGHAFI, MD. In general, the way we treat menstrual migraines is to track them first with a headache log. It s important we detail the headaches, when they start, when they end, symptoms associated, how far before the period, how many into, etc. Once this information is known then, we can start a treatment plan to PRIME the woman BEFORE her headaches would normally be expected to begin. Of course, there are lots of things over the counter that you can try and there are even triptans which are known to have a more robust effect than others for menstrual or premenstrual migraines such as Axert and Amerge. The problem is we don t really want to wait until the headaches hit but rather we want to head them off at the pass and prevent them from starting. Does this make sense? The general idea for the premenstrual strategy is to combine several days of continuous triptan use with several days of either an antispasmodic agent such as Tizandine or possibly an NSAID. Sometimes the combo of Tizanidine and Ibuprofen is also good in certain women. There is another alternative to this forum if you would like a personal consult using a WEBCAM platform (in other words real time live consult session) and that is to look for me on www.healthTap.com/drsaghafi We could then, work to set up a convenient time where I can speak you either by webcam or just by texting along with voice connection if you prefer not to do the camera connection. I am on shift normally Wed-Sat in the wee hours of the morning (Cleveland time that is: New York City Time Zone) 3a-7a. If this information was of value to you would you mind leaving a STAR RATING of our transaction? I hope things go better for you.