Menstrual migraines are at times very difficult to treat. Triptans, such as Maxalt, Imitrex and other are usually very effective, but in some patients do not provide sufficient relief. Corticosteroid drugs, such as prednisone and dexamethasone can help some patients. Marcelo Bigal and his colleagues compared treatment of menstrual migraines with Maxalt alone, dexamethasone alone, and combination of the two. Maxalt was much better than dexamethasone, providing sustained 24-hour relief in 63% of patients vs 33%, but the combination was better than Maxalt alone, giving relief to 82% of women. We would always try Maxalt or a similar drug alone, but if one drug is insufficient a combination with dexamethasone should be tried. Corticosteroids should not be used for more than a few days a month because frequent and prolonged use can lead to serious side effects.