Weekly Homeschool Wrap-Up 3/13

Outside my window:

Last week it was below-freezing winter in which we craved a blanket at every turn. What a change a week makes when it's March! In like a lion indeed; out like a lamb, thank the Lord. There is still snow on the ground, for it started in mid-January and really didn't stop, so there are layers and layers of melting to accomplish, but this week's high thirties to mid-forties certainly made a dent. 

Underneath of course, is mud, which will last a while. The kids are already bringing mud in on their clothes and boots. Spring is exciting but messy in Ohio.

On my mind:

I couldn't help feeling discouraged this week regarding school. I felt like we didn't accomplish enough. We were back at the hospital for Beth's infusion Tuesday (after this we go to thirty-day increments), and Wednesday I had a much-needed eye appointment. Friday morning we take husband to the airport for his trip to Florida to check on and visit his 92-year-old father.

Running around because of an over-scheduled week is fine for families in which everyone is working ahead, but with dyslexia and OCD and ADHD making things more difficult here, we can't afford the luxury of frequent outings, no matter the reason. So there's that.

I turned 49 this week so there's that too. Getting old is cruel. It just is, unless your children have left or will be leaving the nest soon. I am trying hard to trust God for the future and for today's peace. I never would have chosen to start a family so late, but I wasn't saved until age 31 and not married until 33, so this is my life and mostly, I do love it immensely. 

I was emotionally lost in my twenties, even though I had a professional job and took good care of myself and didn't drink, smoke or take drugs. I was still lost due to having grown up with an addicted parent. Lost people ideally shouldn't get married, so I am grateful the Lord, even though I didn't know Him yet, kept me single until I was saved and ready.

So...forgive me for that sob story. The Lord is good all the time, even when you have messed-up parents. I am going to be okay and so are my children.

The other discouraging thing is that the girls are just not making progress with their numbers (or at least it's extremely slow), and I've given up hope that the addition facts will be memorized according to Saxon math's plan, in which you memorize all the doubles and build on from there. 

Saxon seems like a curriculum that must be supplemented...but then, I've never met a math curriculum, other than Teaching Textbooks, that didn't need supplementing.

Spending the money was painful, but I bought some TouchMath which will allow Mary and Beth to add and subtract numbers quickly without memorization, without fingers, and without objects being necessary. I use this method myself when I have a long column of numbers to add. Not having a mathematical mind myself, I can only keep so many numbers in my head before messing up.

TouchMath is the only multisensory, hands-on program out there that includes a manipulative you always have available--the touch points on the numbers 1 - 9. The numbers one through five have single points to touch and count, and 6, 7, 8, and 9 have a combination of double-count points--a dot with a circle around it--and single-count points.

If you want to add 9 and 7, you say the nine and count the seven dots onto it to arrive at the answer. So, you're teaching the counting-on method, but with a "manipulative", and with a visual cue of what the number means, rather than two random symbols, which kids aren't necessarily ready for in the primary years. All kids can be taught to add, but can they really visualize what they're doing, with the numbers being mere symbols?

Special-needs kids need another option, other than memorizing or using fingers, to solve facts. It may take years for the memorization to occur, and in the meantime, they need to be able to cipher.

To subtract using TouchMath, you say the top number, and count backwards using the dots on the bottom number. So if your top number is 9, and you want to take 6 from it, you touch and say the 9 (without actually counting nine) and then touch the dots on the six, counting down to the answer. "Nine--eight, seven, six, five, four, three.

I also like the way it teaches double-digit addition/subtraction and place value. Saxon is weak in these two areas, especially.

Like Saxon, it doesn't feature overly-busy, overly-colored worksheets designed to impress parents and overwhelm kids. Simple is better, when it comes to a worksheet.

It may seem like the dots can be confusing, but kids take to them quickly. The school I taught at bought some of this program and my first graders took to the number dots in less than a week. Because it's ideal for special-ed and for dyscalculia/dyslexia students and not necessary for regular ed, my school didn't use it for long. 

TouchMath offers traditional school packages and homeschool packages (as downloads), but let me warn you, they charge an awful lot for their materials--so much that it angered me, but I felt my girls really needed another option. My advice is to buy the supplemental workbooks rather than a whole-grade package, at least to start. They do have a money-back guarantee on their products.

Saxon first grade worksheet

Mary feels like crying when she sees this Saxon page. She can't remember the answers, and there are too many on the page for a frustrated dyslexic. And what's with the way Saxon writes 9's and 4's? I hate it. To a dyslexic, that 9 looks exactly like the 6. The Saxon four is featured on the Saxon hundred's chart above.

Paul works with Beth on her AWANA verses, and he likes to make up a dance for them, because Beth loves moving and dancing, being a tactile-kinesthetic learner. Here they are, working on a "routine" together.

This leftover chicken noodle, prepared the night after we had a whole chicken, was the only yummy lunch served this week. Just cheese sandwiches or PB&J the other days.

Last Saturday Daddy took the girls to a women's college basketball game. They wanted to know what it was like, and husband had free tickets from an elderly lady at work who can't use many of her season tickets. The games are super loud, which the girls didn't like. The band plays loudly, and there are other loud noises as well.

Thank the Lord for Teaching Textbooks Math! It leads to peace and harmony and learning each day without a glitch. Okay, so maybe it does over do the long division, but most kids need the repetition.

We checked out a Magic School Bus DVD, and afterwards the kids went crazy with catapults. They had a ball and tried out different styles and used different objects to catapult. It was a hoot.

Beth doing some personal reading practice.

Thank God for this little bottle, because Peter's OCD was rampant this week and my nerves and hormones were frazzled. My doctor says it is the caffeine in over-the-counter headache medicines that cause the rebound effect. She said coffee drinkers get rebound headaches too. I don't drink coffee and drink tea almost never. Do you get a headache if you don't have a morning cup of coffee (coffee drinker question)? It is hard to believe that every coffee drinker suffers awful headaches from missing a cup. Without the caffeine, the headache lasts far longer, so I can't quit these Excedrins just yet. Thank goodness they came out with a milder version, which has just regular strength acetaminophen and caffeine, nothing else.

While at the waiting room in the infusion center, Beth was delighted at this toy from the playroom.

There are computers in the waiting room as well, which kept the three older ones busy so I could go back with Beth and support her during this trying time. She hates these infusions.

She always starts with a drink to wash down the Benadryl, which prevents an allergic reaction to the Orencia (rheumatoid arthritis drug). Mom doesn't buy chocolate milk cartons, so she was delighted. They put patches on both hands to numb them for the IV insertion (takes 20 minutes to do the numbing) and then we need an hour and a half after that before we can go home. I make these appointments for 3 PM, but leading up to them Beth is out of sorts. If I make them in the morning, the Benadryl would make her too sleepy for school, so there's no easy solution. We will be doing them indefinitely once a month now.

I think she enjoys being alone with Mommy. The first couple times the other three children were in the room too and that was harder. The nurse said they were welcome to stay in the waiting room to use the computers and toys, so that will really work out for us. They do a little school work out there too, and Peter and Paul keep a sharp eye on Mary, who at eight years old is a little young to be in the waiting room without a parent.

Some good books to read:

Look at my Book: How Kids Can Write and Illustrate Terrific Books by Loreen Leedy

Kirkus Reviews: Kids can write, edit, illustrate, and bind their own books. Leedy answers every young author's questions in this abundantly illustrated how-to. Readers follow three authors, a boy, a girl, and a dog, from idea to storyboarding to editing to layout through illustration methods and finally to binding their creations. Most topics get a page; a few fill a two-page spread. Leedy's signature illustrations, bright and friendly, use vignettes to show each author thinking and working through the writing process with text of thoughts or speech in cartoon bubbles. The young authors instruct by doing and a list of tips complements each of the lessons. A page of further reading, resources, and publishing ideas completes the package. Most youngsters will need help with some vocabulary and ideas, but elementary teachers couldn't hope for a better invitation to the art and craft of writing. (Nonfiction. 4-10)

A Fine Dessert: Four Centuries, Four Families, One Delicious Treat by Emily Jenkins (Published February, 2015)

Goodreads Synopsis: In this fascinating picture book, four families, in four different cities, over four centuries, make the same delicious dessert: blackberry fool. This richly detailed book ingeniously shows how food, technology, and even families have changed throughout American history. 

In 1710, a girl and her mother in Lyme, England, prepare a blackberry fool, picking wild blackberries and beating cream from their cow with a bundle of twigs. The same dessert is prepared by a slave girl and her mother in 1810 in Charleston, South Carolina; by a mother and daughter in 1910 in Boston; and finally by a boy and his father in present-day San Diego. 

Kids and parents alike will delight in discovering the differences in daily life over the course of four centuries. 

Includes a recipe for blackberry fool and notes from the author and illustrator about their research.
My note: We loved, loved, loved this! A beautifully illustrated book and a very clever way to teach American history.

Make Your Mark, Franklin Roosevelt by Judith St. George

Goodreads Synopsis: Young Franklin Roosevelt grew up knowing the finer things in life— sailing, horseback riding, and foxhunts on his family’s large estate. Growing up wealthy meant he could live a gentleman’s life, like his beloved papa. Yet gentlemen weren’t supposed to go into politics, right? But why not? As young Franklin learns from a famous uncle and a famous mentor, there is more to the world than he thought. And about politics? Well, maybe there is more to that, too. Complete with lively illustrations by new illustrator Britt Spencer, this third book in Judith St. George’s Turning Point series reveals the turning point for the young man who would become one of America’s most honored presidents.

Anne Frank in Her Own Words by Caroline Hennon (Published September, 2014)

Goodreads Synopsis: Anne Frank's youthful optimism was a stark contrast to the terrible monstrosities of World War II. While Anne and her family hid from the world in a secret annex, she confided in her diary, nicknamed Kitty, providing the world with an inside view of what it was like to grow up fearing the wrath of Nazi Germany. This biography uses Anne's moving writings to highlight the events of her short life. Her diary is a powerful tool and reminder of the unjust hate that caused the Holocaust. Sidebars and fact boxes offer more information about this time period.

Up in the Garden and Down in the Dirt by Kate Messner (Published March, 2015)

Synopsis: In this exuberant and lyrical follow-up to the award-winning Over and Under the Snow, discover the wonders that lie hidden between stalks, under the shade of leaves . . . and down in the dirt. Explore the hidden world and many lives of a garden through the course of a year! Up in the garden, the world is full of green—leaves and sprouts, growing vegetables, ripening fruit. But down in the dirt exists a busy world—earthworms dig, snakes hunt, skunks burrow—populated by all the animals that make a garden their home.

How was your week? Has spring arrived in your town? My kids are aching to spend whole days outside.

Homeschool Mother's Journal 

Modeling Humility for the Children

Today was a long, hard day characterized by non-stop deep-cleaning of the bedrooms. We take better care of common areas than we do the bedrooms, so it was time to take a snow day and get busy. I rarely give my children snow days or cold weather days as the local school district does, so there was no guilt in this decision, but I definitely wanted it done in one day.

Thus, the non-stop pace. Being a very goal-oriented person and knowing my kids don't do well with too much time off, I put a lot of pressure on myself to finish by evening, working hard from 10 AM on, only stopping to eat a sandwich while standing up.

We got all the junk out from under the beds and off surfaces and processed all the paper, dust, and unneeded stuff.

Boy that's a good feeling, and it makes the bedrooms easier to dust and vacuum in a snap.

The master bedroom was the worst; that's where stuff is stashed when I don't have time to process clutter before guests arrive. I was so ashamed of that room, yet there was never a chunk of time to tackle it.

The kids did a share of the work, then had free time while I finished up--free time that led to more messes. I tried hard to curb my growing irritation, but near dinner a headache pounded, so off we went to the pharmacy for my Imitrex, as well as to Little Ceasar's.

If you're a mom, you know what it's like. Sometimes you just have to stop everything and deal with clutter to get your sanity back. And when you've knocked yourself out and the rooms look smashing and ultra-organized, you probably expect some praise or at least a thank-you.

My kids were very grateful and full of praise, knowing how hard I worked. They went to bed in very nice looking rooms, happily. I'd even made special places for their stuffed animals, which thrilled them.

But hubby? It wasn't good. 

The pharmacy didn't have my prescription ready so we returned with me still sporting a pounder, already having tried the over-the-counters.

Hubby got home and went into the bedroom to get something. He paused more than usual, surveyed the room, and only came out to say, "Where are my CD's?"

Oh, man. That didn't go over too well for me. That room looked superb, after looking like trash for weeks, and that's all he has to say? Did he even have a clue how much paperwork and clutter I went through to thoroughly clean in there?

Exhausted and head-achy and mad, I could only think of how much he's becoming like his father. Mean-spirited, never praising, never appreciating anything...or so it seems.

In front of the kids I told him he's becoming just as mean as his dad and why couldn't he at least say the room looks nice?

When I'm mad he says nothing, always waiting for a calm wife to address anything that was said. He's amazing that way and I love him for it. Because of it, we aren't fighters. The Lord works on me, and him, separately, and then we move on easily, understanding each other without many words. I always apologize humbly for carelessly thrown words or wrong attitudes, and he always sees where he might be wrong, without me having to explain anything further.

As soon as the belittling comment left my lips I was horribly ashamed, but too shaken and exhausted to do anything about it just then. I went off by myself to finish the vacuuming while they ate pizza. Then, because I was still mad about being overworked and under-appreciated, I let loose some anger on the kids for their messes during the day, which still lay unattended.

So, that was my day. Productive yet shameful, and too much pressure on myself.

They're all in bed now and I'm just sitting here, feeling oh-so-humbled, analyzing it all in the quiet of the night.

I don't know what I would do without this time alone in the quiet of the night to process my day, my feelings, my shortcomings and my sins. It's a time to pray and process Scripture and listen to the Holy Spirit, before writing out what He wants from me.

My husband's love language is quality time and mine is affirming words, though these days I do fine as long as people aren't hurtful with their words; I no longer need much affirming, as long as there isn't a lot of criticizing.

Despite understanding love languages, I'm not very good about spending time with him and he's not very good about being appreciative or affirming. Somehow, the marriage grows in grace nevertheless, with the commitment unwavering. We need to be educated in love languages to understand where a spouse is coming from, but we don't learn new tricks easily.

My husband's father was a critical man who never praised his wife for anything, no matter how hard she worked at home. My husband is an improved version of his father--not generally critical, but he does take my work for granted most of the time, which I'm used to and handle fine on typical days. As he gets older I see more of his father in him and I wonder how I'll handle it.

I'm afraid to ask if he sees my mother in me, but he's spent very little time with her, so I think I'm safe for now, even though I must admit my temper to myself and to God.

That's got to be a pretty universal thing among spouses, I would think...or maybe it's just me. You think you're seeing the worst of your father-in-law in your husband. Or a husband sees the worst of his mother-in-law in his wife. Probably true, but probably exaggerated in our minds as well.

Some time ago I realized I would never become the perfect, submissive wife. My kids would never see in me the biblical model of womanhood...or at least not consistently. So I began to pray about my weaknesses in front of them. I wanted them to understand that marriage is about continually praying you'll get better. Better at respecting your husband. Better at loving your wife. Better at forgiving. Better at being kind to an overtired, overworked spouse. Better at turning the other cheek. Better at praying for the marriage, for the spouse, for one's own humility before God.

At the end of the day, the message is the same from the Holy Spirit. I don't have to be the perfect wife or mother. I just need to be a humble wife and mother who leads her children to Jesus by going ahead of them, to His loving, redeeming arms, asking yet again for His forgiveness and blessing.

In the morning during devotions with the kids, I'll apologize and confess my impatience and harsh words, and ask that the Lord make me a submissive, loving wife, and a kindly, gentle mother.

We can't be good, so we better be humble. Once we realize we'll never be good, we grow in grace.

Do you have days like that? When you try to please everyone, only to end up making a fool of yourself?

A Marathon of Thanks

Psalm 136:1 Give thanks to the Lord, for he is good, for his steadfast love endures forever.

Some long over-due thanks. This isn't all, but it's a start. More from the children tomorrow, when cooking isn't occupying our time.

~ Peter's had several opportunities for leadership, and he's doing me proud. He's a verse teacher at AWANA for the 3rd and 4th graders, and he's my assistant at Sunday school with the 4 year olds every other week. He prepares for and teaches the girls' science several times a week, including setting up and conducting the experiments once a week. The Lord's grace and blessing is shining upon my boy, I just know it!

~ Peter has also become a real worker, some days doing more honey-dos than he can count. He rather likes being my main assistant, since Daddy is gone so much. He's resembling a man more and more.

~ My boys are in that stage where they stop and really listen to my discipling, especially Paul, who is the better listener with the longer attention span. They especially love to talk about life and the Lord at night, when they're supposed to be falling asleep. :)

~ Dyslexia is scary for the parent/teacher to deal with, but I'm understanding it better all the time. When Mary would ask, after 3 years of trying to learn the teen numbers: "How do you write a 16 again?"--I would feel a serious wave of anxiety with even a tinge of nausea. How is it possible she doesn't know this yet? How will she ever get a job? What am I doing wrong? But now, I get it. Dyslexia is a problem with automaticity. They hesitate, think, then write--it doesn't mean they don't know it. They're just slower. I no longer panic (except when Beth asks me how to write a 10, which makes me wonder if she too will struggle).

~ Mary's reading speed and fluency are picking up! All About Reading Level 2 has been such a blessing for us. And Beth is excelling at Level 1 as well. This has been the year with the most curriculum changes. We just switched from Winston Grammar to Easy Grammar and that is working far better as well.

~ Sheila, our sponsor child from Uganda, is doing very well earning her required high school credits. Her writing amazes me; English is her best subject. Compassion kids don't typically graduate and think primarily of themselves and how they can maximize their own futures. Instead, they focus on giving back and making a success of the communities they started in. Their stories always inspire me to keep giving, and keep praying for Compassional International. Their work is just phenomenal. I pray Sheila will get into the Leadership Development Program Compassion runs, so her college fees and living expenses will be paid for while she attends higher education. I will keep mentioning this possibility to her.

~ We used to have just one older vehicle, which we shared. Then about 4 years ago my husband obtained a 24-year-old vehicle from a PA friend, whose mother has passed away and left it in poor body shape, but with relatively low miles. It was embarrassing to drive and of course as with all older cars, we had to put money into it, but it worked for us. Still, my husband didn't love driving such an ugly, old car, and he quietly prayed. He cleans a church where he is well-liked, and one of the employees, in her seventies, along with her husband, was obtaining a brand new vehicle and they decided to give our family their 2000 Toyota Sienna van for free. So for the first time we now drive two vehicles from the 21st Century--a 2003 Windstar van and a 2000 Toyota Sienna van. We have been car loan free since moving to Ohio from CA in 2005--a situation allowing me to be home with the children and homeschool. We used to have a Sienna van and we drove it to well over 200,000 miles before someone hit me and totaled it, leading to us getting the 2003 Windstar. This newer Sienna van has only 124,000 miles, so we'll likely have it another 100,000 miles or more. Yippee! The Lord is good!

~ I wrote over a week ago about hormones and migraines, and indicated I that was trying Naproxen this month post ovulation to day four of cycle, to try to prevent menstrual migraine (200 mg every 12 hours). Wow! What a difference. I highly recommend this for anyone struggling with menstrual migraine or PMS. Not only did this eliminate menstrual migraine, but it eliminated PMS and bloating as well. I only felt a tinge of nervousness a couple days before day 1 of cycle, which is a miracle. The NSAID inhibits the release of prostaglandins, the hormone leading to all the trouble. I'm not sure why Naproxen works better than ibuprofen, but possibly because it comes in a 12-hour dosing, ensuring that there are no break-through symptoms? The stubborn headaches I had were when I missed the dose by a few hours. (I write this all casually but this has been a many-years prayer request and I'm grateful for the opportunity to research the Internet, because my doctors haven't helped.)

Note: I should add that younger women would probably only need Naproxen 3 or 4 days before menses to 3 or 4 days into menses. My headache cycle is longer due to perimenopause. The idea is to prevent the onset of symptoms, so start the regimen just before you normally would become symptomatic, and continue through one day past the usual duration of symptoms.

Happy Thanksgiving, Friends! Bless you.

Fertility, Hormones, Headaches, Oh My

A little endometriosis and fertility advice below, but otherwise, this is a perimenopause & migraine post.

Did you know there are entire blogs devoted to perimenopause and menopause? That's how big an issue it is in a woman's life. Mine is a small blog with mostly anonymous readers; I can't even guess how many of you are in your forties, but if you are one of those lovely ladies, read on.

My research taught me that a woman will start skipping periods after a big hormone surge--kind of a last hurrah. Last month was my worst headache experience yet, so I thought "The last hurrah. It's here!"

But alas, on day 13 my ovaries performed as usual--something which used to be a blessing to me (feeling that familiar pain in my side). This time I only dreaded the headaches to follow. (At this phase, I do not ovulate every month now, but the cycles come at regular intervals, still.)

Researchers have recently pinpointed the one symptom that signals the start of perimenopause--perimenopause being a phase that, on average, lasts four years. That symptom is a change in flow--usually heavier. Some women begin this phase in their late thirties, and some women not until their late forties or early fifties.

I had endometriosis in my teens and twenties, characterized by heavy, painful periods, but a couple years after I married and started my family, I was either pregnant or nursing and experienced few to no periods for 10 full years, during which my endometriosis disappeared.

If you have endometriosis I recommend you nurse as long as possible and try to conceive your next baby as soon as signs of ovulation return, so as not to allow the disease to make a comeback. Monthly periods allow endometriosis to continue to grow. Continue this sequence--pregnancy, long-term nursing, pregnancy--until you've completed your family.

I actually think a women is very fertile in the window right after her ovulation resumes during nursing, which can be anywhere from 6 months to 18 months, or sooner for some women. You can nurse while you are pregnant for as long as your baby is interested, as long as you monitor your diet for adequate nutrition.

In my forties--around forty-five I think--I thought endometriosis had returned, but in fact, those symptoms were the start of perimenopause. Around that same time, I began to get powerful mood swings and surprisingly strong anger flashes, but those are gone now.

The next phase was these migraine headaches that go for days and days. Now I can't wait for the whole thing to be over, although when hot flashes come I might feel differently. I imagine those will add some laundry and much aggravation. I get hot and cold sometimes during the winter, but it seems to be more related to patterns of inactivity while schooling the kids, mixed with frenzied chore time.

I nursed my last child until I was 47, so my experience with estrogen levels in the forties was probably unusual. My youngest daughter has an autoimmune disease, so she needed the antibodies from breastmilk longer than most children do.

On Migraines and Hormones

I've perused many articles to find headache answers, but most focus on hormone replacement therapy, which is dangerous, in my view. My mother had a small cancerous breast lump removed in her sixties, partially because she was on hormone replacement therapy for over 10 years. She also has been a heavy drinker and smoker for years, and has been sedentary but not overweight. The hormone therapy is known to cause breast cancer. My mother has had no recurrence since, thank God. She has five sisters all older than her, none of whom have any breast cancer. Her mother was also clear, and lived free of any cancer up until her death at 88.

Headache/Hormone Connection: Female migraine sufferers typically get more headaches before and after periods begin. That is when hormone levels are falling. Again in perimenopause, estrogen levels are falling, so headaches are present more days per month.

My research has led me to a few remedies, some of which might bring hope to you:

~ Focus on other migraine triggers, since you can't do much about the hormone trigger: adequate sleep, same wake and bedtimes, keep blood sugar levels steady, avoid hunger, avoid stress (ha ha), exercise regularly, stay hydrated, don't smoke, cut back on caffeine and alcohol

~ Dietary supplements: feverfew (not during pregnancy or nursing), butterbur, B-2 (riboflavin), co-enzyme Q-10, and magnesium

~ Try naproxen (Aleve) during the days you get the worst hormone headaches. This has been proven to cut back on the headaches because it inhibits the release of hormone (same reason NSAID's like ibuprofen work best for menstrual cramps). It is typically prescribed for 2 days before the flow and for 3 days into the flow, Of course NSAID's come with side effects, but doctors say for this small window we aren't to worry. My window of headache days would be higher than the five mentioned above, but I plan to try this for this month and see what happens.

Here is an excellent summary from the American Headache Society on treating Menstrual Migraine:

If you've had no success with your headaches, I recommend you take this article to your doctor for discussion. In reading it, I discovered that my doctor didn't prescribe Topomax for me correctly. In both the first and second attempts, the dose was too low. Here is the full article, most of which I've pasted below--but do go to the link for the rest of it, so you can read about preventative methods and print it out for your doctor. And if your headache status changes because of anything on this article, could you share that with me, please? It might just help me and others. Thank you!

Menstrual migraine is divided into 2 types:

1. Pure Menstrual Migraine: migraine without aura that occurs exclusively
during the 5-day perimenstrual window of -2 through +3. This affects
approximately 14% of female migraineurs.

2. Menstrually Related Migraine: migraine without aura that occurs during
the 5-day perimenstrual window of -2 through +3 but occurs at other times
of the cycle as well. This is present in approximately 50% of female
migraine patients.

ACUTE TREATMENT

Treatment for acute menstrual migraine is similar to non-menstrual migraine acute treatment. However, many women report that their menstrual migraines are more difficult to treat. The clinical desired end-point of headache-free in 2 hours is a reasonable treatment goal for evaluating the effectiveness of acute therapy. The following is a list of commonly used treatment options: 

1. Acetaminophen-Aspirin combinations with and without caffeine (e.g. brand name Excedrin; the caffeine can potentiate the analgesic effect)
2. Naproxen (Aleve) 250 mg 1-2 every 8-12 hours prn
3. Ibuprofen (Advil/Motrin) 800 mg every 8-12 hours prn
4. Naproxen (Naprosyn) Rx strength 500 mg every 12 hours prn
5. Ketorolac (Toradol) 30-60 mg IM prn to rescue (NSAID)
6. Triptans-oral; nasal spray; injectable.
a. Almotriptan (Axert) 12.5 mg every 2 hours; max 25 mg in 24 hrs
b. Naratriptan (Amerge)2.5 mg every 4 hours; max 5 mg in 24 hours
c. Frovatriptan (Frova ) 2.5 mg every 2 hours; max 7.5 mg in 24 hours
d. Sumatriptan (Imitrex) 50-100 mg every 2 hours; max 200 mg in 24 hours
e. Rizatriptan (Maxalt) 10 mg every 2 hours; max 30 mg in 24 hours
f. Eletriptan (Relpax )40 mg every 2 hours; max 80 mg in 24 hours
g. Zolmitriptan (Zomig)) 2.5-5 mg every 2 hours; max 10 mg in 24 hours
h. Sumatriptan (Imitrex) 20 mg nasal spray 1 spray 1 nostril; may repeat in 2 hours to max of 40 mg in 24 hours
i. Zolmitriptan (Zomig) 5 mg nasal spray 1 spray 1 nostril; may repeat in 2 hours to max of 10 mg in 24 hours
j. Sumatriptan (Imitrex) 4-6 mg injectable; may repeat in 1 hour to max of 12 mg in 24 hours
7. Triptan/NSAID combination such as Sumatriptan (Imitrex) 100 mg & Naproxen 500 mg (Naprosyn)
8. DHE/dihydroergotamine (Migranal)1 spray each nostril; repeat in 15 minutes
9. Butalbital-containing products with or without codeine such as Fiorinal plain or Fiorinal with codeine; not a good choice unless patient can’t tolerate the triptans and the ergots/ergot alkaloids which are more migraine specific
10. Narcotic such as Hydrocodone (Vicodin) sparingly to rescue only: 1-2 of the 5 mg every 6 hours prn severe migraine only (suggest limit max 15/month)

Recommendations: 
1. Mild-moderate menstrual migraine: OTC NSAID/combination product; Rx NSAID, e.g. Naproxen 500 mg prn
2. Moderate-severe: triptan +/- NSAID
3. Rescue: Sumatriptan 4-6 mg sq; Ketorolac 30-60 mg IM; DHE .5 mg NS each nostril; repeat in 15 minutes; DHE-45 .5-1 mg IM or IV every 8 hours


SHORT-TERM PREVENTIVE STRATEGIES 

This treatment approach is ideal for many women who suffer from menstrual migraine. The majority of women report they have migraines outside of the menstrual window; however, their non-menstrual migraines are often easier to treat. Many may report that their normal acute treatment for migraine does not work for menstrual migraine. Additionally, many are afraid they will take the full allotted amount of triptan medication for their menstrual migraine which can last 3-7 days. An effective short-term preventive approach should lessen both the severity and duration of the menstrual migraine. Common short-term preventive strategies:

1. Magnesium 360-400 mg during the luteal phase of the cycle; i.e. begin around day 14 of the cycle. Limiting potential side-effect: diarrhea.
2. Naproxen 500 mg twice a day; begin several days before the anticipated onset of menstrual migraine; continue until at least day 3 of cycle. Advantage: low cost. Potential side-effect: nausea/GI.
3. Triptan (one of the 7) dosed in a bid fashion. Begin several days before anticipated onset of menstrual migraine. Use the highest dose of the triptan. May combine with a NSAID such as naproxen 500 mg. Use for 5 days in most cases. Be aware, this extended duration use of triptans is not FDA-approved and information on long-term safety is not available for triptans when dosed in this mini-prophylaxis manner. 
4. Increase does of daily preventive that the woman is already on; e.g. if on topiramate (Topomax) 50 mg hs to prevent headache, increase to 75-100 mg during her vulnerable menstrual migraine time of cycle. Advantage: the patient does not feel they are taking an unnecessary dose of their preventive during their non-menstrual time of month.
5. Estradiol patch .1 mg (name brand Climara .1 mg; Vivelle dot .1 mg) to wear for at least 1 week to prevent the drop in estradiol that is often a catalyst for the menstrual migraine; the women should apply the patch on approximately day -3 and stop when menses complete. This can be done
in conjunction with an oral contraceptive if the contraceptive is taken cyclically. The transdermal estradiol patch can also be used in women who don’t take contraception as it will help prevent the natural endogenous drop in estradiol.
6. Oral estradiol tablets the week of menses. However, they don’t give as even a level of estradiol as the transdermal patch and are only recommended if women can’t tolerate the transdermal estradiol patch. Dose: Estradiol 1 mg dose dosed qd or bid.

Recommendations: 
1. Magnesium 360-400 mg qd; Naproxen 500 mg bid; begin day 14 of cycle; continue through completion of menses
2. Triptan for 5-6 days; e.g. Frovatriptan (Frova) 5 mg loading dose followed by 2.5 mg bid for 5 days; begin -2 of cycle
3. Alternative triptan: Naratriptan (Amerge) 2.5 mg bid or ½ tablet bid for 5 days

PREVENTIVE TREATMENT --see link for the rest of this portion

This approach is ideal for women who suffer from a lot of non-menstrual migraine as well asmenstrual migraine or for women who are suffering despite optimal acute and short-term treatment. Preventive treatment can be broken into 2 categories: traditional daily preventive medication and hormonal manipulation.

Most common preventive treatment (traditional): 
1. AED’s (Anti-epileptic) medication such as topiramate (Topomax) and divalproex sodium (Depakote). For Topamax, start with 25 mg qd; increase by 25 mg/week until 100 mg or until clinical desired end-point. If necessary increase up to 200 mg daily dose. Dose bid or all at bedtime if sedation noticed. Most common side-effects: paresthesias (usually mild and transient); sedation; word-retrieval problems; appetite suppression and weight-loss.