Frovatriptan for Menstrual Migraine: The Six-Day Trial

A six-day course of frovatriptan reduced menstrual-migraine occurrence in a 2004 trial, but did not prevent every attack. The preventive schedule began before the expected headache. It differs from taking a tablet once an attack has started.¹

What the crossover study compared

The published abstract reports 546 women, with a mean age of 37.6. In the randomized, double-blind study, participants used placebo, frovatriptan 2.5 mg once daily and 2.5 mg twice daily across three menstrual windows. Each six-day course started two days before the anticipated migraine.¹

Migraine occurred during 67% of placebo windows, 52% with once-daily treatment and 41% with twice-daily treatment. Both schedules outperformed placebo, and twice-daily treatment outperformed once daily.¹

The twice-daily comparison gives a 26-percentage-point reduction from placebo. It does not mean that migraine was permanently cured: the endpoint concerned those six days, and attacks still occurred with treatment. These figures come from the original abstract, rather than a full-paper assessment of every subgroup.¹

Who the guideline recommendation concerns

NICE² recommends considering frovatriptan for predictable menstrual-related migraine that has not responded adequately to standard acute treatment. Its recommendation specifies 2.5 mg twice daily on the days migraine is expected, and identifies this preventive use as off-label in its June 2025 note. That is a clinician-led treatment option, not a reason to copy the trial schedule yourself.²

Predictability matters. NICE² recommends a headache diary covering at least two menstrual cycles when diagnosing the pattern. Record the headache dates alongside the first day of bleeding, including attacks elsewhere in the month. If cycles have become irregular, show that variation rather than assuming the next attack will follow an app’s predicted date.²

Our menstrual-migraine overview covers the broader diagnosis and treatment discussion.

Ask for a plan for attacks during the course

The US prescribing information lists frovatriptan for acute migraine treatment, not migraine prevention. It also contraindicates taking another triptan or an ergot-type migraine medicine within 24 hours. An acute-treatment prescription therefore cannot simply be turned into a preventive course with your usual second triptan added for an attack.³

Before starting a prescribed course, ask: “If I get a migraine while taking this, which rescue medicine can I use, at what dose, and when?” Have the answer written down. Include every migraine medicine and antidepressant in the medication review.

The label’s contraindications include coronary artery disease or coronary spasm, previous stroke or TIA, certain other vascular conditions and uncontrolled high blood pressure. It calls for cardiovascular assessment in people new to triptans who have multiple cardiovascular risk factors. A short course still requires that suitability check.³

Count treatment days across the whole month

The label warns that acute migraine drugs, including triptans, used on 10 or more days a month may worsen headaches through medication overuse. Count days used outside the menstrual course as well. This threshold is a warning to discuss the overall plan, not permission to take any combination on nine days.³

Period, Handled includes a Period Scorecard with cycle start dates and the variation between cycles. Put those dates beside a headache diary and medicine-day record for the appointment. Agree on the course’s start and stop rules, rescue treatment and review date before the next predicted window.