tracked for three cycles now and the pattern is stupid clear. same 6-day window every time: 2 days before my period starts, 4 days after. stacking up abt 10-12 attacks in that span. literally nothing the rest of the month.
i’m on Ajovy - three years at this point - and it works fine for 22 days. then that week hits and i’m basically back to baseline. neuro said hormonal surge just overpowers the preventive, which… yeah, i get it mechanically, but it doesn’t solve the problem.
so actual question: does anyone have a strategy for that window? switching to harder abortives that week, changing preventive timing, adding something temporary? or is it just accepted that period week is gonna be migraines no matter what? feel like knowing the exact window should mean there’s a smarter approach than just surviving it.
The fact that you have three cycles of data showing a “stupid clear” pattern is the most important part of your post, it moves the problem from a vague complaint to a specific, targetable physiological event. Your neuro’s explanation is the simple version, but the estrogen withdrawal right before your period is the more specific trigger known to modulate CGRP sensitivity, so you’re seeing a predictable pharmacology failure where your steady-state Ajovy concentration is just not enough to cover that peak. This is a known issue, and the strategy you’re looking for is usually called mini-prophylaxis or perimenstrual prophylaxis.
It’s a conversation to have with your doctor, but it often involves adding a different class of drug, like a specific NSAID or a long-acting triptan, just for that 5-7 day window to bridge the gap. Bringing that tracked data is key. A friend in one of my supervisor’s patient advisory groups mentioned that being able to export the log from an app was what finally got her doctor to change tactics, I think she used CareClinic bc it makes a PDF you can just send them.
Having the dates and attack frequency graphed out makes the case better than any description can. The practical question for your neuro is what agent is safe to stack with a CGRP monoclonal for a week per month.
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