I am 45 and I noticed a shift in my migraine patterns in the last year. Before that, my migraine triggers were mainly stuff like stress, weather changes, and taking too much/too strong medications (over the counter only - I have never had anything prescribed for my migraines and I really don't want to go that route if I can avoid it). About 3 years ago, after having read some books on migraines and also discovered this website, I realized that the Excedrine Migraine I was taking (and taking way too much of it) was doing me more harm than good, so I slowly weaned myself off of it completely. I switched to taking Advil, which, although it has the same hit-and-miss relief, has been much better. I also made some shifts in diet and have discovered some of my food triggers (bananas are a big no-no for me - instant migraine). All of this has done a great deal to reduce my migraine episodes, both in intensity and frequency.
That's the good news.
The bad news is that in the last year, my migraine patterns seems to have shifted completely. Before, I would get migraines that would last about 2-3 days about 2-3 times a month. Now, I get them only once a month but they are like clockwork. Basically, I now get menstrual migraines. I can usually count on the first day being migraine free. But the second day, I start to develop the migraine around the afternoon and in the evening it is in full swing along with some lovely nausea for good measure. The next morning, if I'm lucky, the migraine will have gone away only to return again in the afternoon or, if I'm unlucky (like today), it will have stuck around to remain probably the entire day (with perhaps an hour or two of relief). I usually have the migraine on the third day but it will go away around evening and then, thank goodness, the rest of the days of my period (which is usually about another 1-2 days - mine don't last very long), I am migraine-free.
I know I shouldn't complain, since this means that the migraines are coming less frequently, but it's actually more frustrating because now I can predict them and I feel powerless to stop it because, obviously, I can't do anything about not getting my period (I don't take birth control pills nor do I want to begin to). I've been reading up a bit on menstrual migraines and I do see that people recommend starting to take medication a few days prior to the period and a few days into it and that helps. But the problem is that I've never been very regular with my cycle because I've been overweight/obese all my life and that's really screwed up my cycle. I do get PMS symptoms but sometimes they occur a week before my cycle begins, sometimes a few days, sometimes one day - it's inconsistent so I can't really rely on it as an indicator of just when my period will come.
I might try taking Aleve when I start to get PMS but I'm also worried that it might cause rebound headaches if I don't have a migraine at the time (I' had that happen). So I'm not sure what I can really do.