This information is based on the HeadWise episode: Menstrual Related Migraine. Published July, 2020. Content Reviewed September, 2024.

What Is Menstrual Migraine ?

Menstrual migraine is a migraine that are directly related to changes in hormone levels, specifically fluctuations in estrogen.

Many people who experience migraine notice a pattern tied to their menstrual cycle, with migraine often occurring just before or during menstruation.

This is commonly referred to as menstrual migraine or menstrually related migraine. You might also hear your healthcare provider refer to this as hormone headache, period headache, or period migraine. 

Types of Menstrual Migraine

There are two primary types of menstrual migraine: 

Pure Menstrual Migraine: This migraine occurs exclusively during menstruation—within a window from two days before to three days after the onset of menstruation—without attacks at other times of the month. This migraine occurs in at least two out of three menstrual cycles. 

Menstrually Related Migraine: This migraine follows the same pattern as pure menstrual migraine but also occurs at other times of the month. The hormonal trigger still plays a significant role, but the person experiences migraine more frequently, not just during their menstrual cycle. 

Common Questions About Menstrual Migraine

What Causes Menstrual Migraine?

The primary cause of menstrual migraine is the fluctuation in estrogen levels during the menstrual cycle. Estrogen levels rise just before ovulation and then drop sharply as menstruation begins. These fluctuations can trigger migraine in individuals who are sensitive to changes in hormone levels. 

How Common is Menstrual Migraine?

At least 60% of people who have a period and experience migraine report migraine happening around the time of their menstrual cycle.  

How is Menstrual Migraine diagnosed?

Exam.   Your provider will want to learn more about your migraine-related symptoms. They may also order blood tests and imaging tests (such as a CT scan or MRI) to make sure there aren’t any other causes of your headache. 

What is the Location of Menstrual Migraine

Head pain usually affects one side of the head. It’s common to feel pain around your forehead, but it can also happen in other locations or move from one spot to another area. These are slightly different for each person.  

Tracking Your Migraine Patterns

Maintaining a migraine diary or journal is an essential tool for identifying patterns and assessing the effectiveness of treatments. Tracking the timing of your migraine, their severity, any associated symptoms, and what makes your migraine better or worse can help pinpoint whether hormonal fluctuations are a primary trigger and assist healthcare providers in recommending the most effective treatment options. 

Symptoms of Menstrual Migraine

Menstrual migraine shares many of the same symptoms as regular migraine, which may include:

  • Throbbing or pulsating head pain (often on one side of the head) 
  • Sensitivity to light, sound, or smells 
  • Nausea, vomiting, upset stomach, abdominal pain 
  • Aura: Some individuals may experience visual disturbances such as flashing lights or blind spots before the onset of the headache 
  • Loss of appetite 
  • Dizziness 
  • Feeling tired 

Treating Menstrual Migraine

Treatment strategies for menstrual migraine can vary based on whether the individual experiences migraine exclusively around their menstrual cycle or at other times as well. A healthcare provider may try one or a combination of different medications to see what works best. These medications work best when you take them on a schedule. Your provider can help you identify the right time to take these medications to prevent or manage symptoms. 

Therapeutic Lifestyle Options

Options that might be beneficial for controlling migraine include proper sleep hygiene, healthy nutrition, routine meal schedules, regular exercise, and managing migraine triggers such as stress, alcohol, weather, and, most commonly, hormones. 

Acute Treatment

For individuals who experience pure menstrual migraine, treatment often involves using acute migraine therapies that can be taken at the onset of symptoms. Common options include: 

  • Non-steroidal anti-inflammatory drugs (NSAIDs): High-dose NSAIDs like naproxen sodium can help alleviate the pain of menstrual migraine. 
  • Triptans: These migraine-specific medications are commonly prescribed and can be taken as a tablet, nasal spray, or injection, depending on the severity of the migraine. 
  • Antiemetics: For those who experience nausea with their migraine, anti-nausea medications can be added to the treatment plan. 

It’s recommended that treatment be started as soon as premonitory symptoms, such as food cravings or aura, appear to improve effectiveness. 

Short-Term Prevention

For individuals who experience regular and predictable menstrual migraine, short-term prevention can be a helpful approach. This involves taking preventive medications starting 2-3 days before the expected onset of a menstrual migraine and continuing for several days during the menstrual period. Medications used in short-term prevention include: 

  • Frovatriptan: A long-acting triptan with a longer half-life, making it effective for preventing menstrual migraine. 
  • Naratriptan: Another triptan with moderate evidence for preventing migraine during menstruation. 
  • Naproxen Sodium: NSAIDs can also be taken preemptively to prevent the onset of migraine during menstruation. 

Daily Prevention for Chronic Migraine

For individuals who experience migraine both during their menstrual cycle and at other times of the month, daily preventive medication may be necessary. This can include a variety of medications, such as: 

  • Beta-blockers (propranolol, candesartan) 
  • Antidepressants (amitriptyline, venlafaxine) 
  • Anti-seizure medications (topiramate, valproate) 
  • CGRP inhibitors (medications specifically targeting migraine pathways) 

Daily prevention may be supplemented by short-term prevention during the menstrual cycle if migraine is more severe during this time. 

Other medications may include:  

  • Metoclopramide 
  • Dihydroergotamine 
  • Serotonin 5-HT1F receptor agonist 
  • Supplements:  Magnesium oxide, Riboflavin 

Hormonal Therapies

Some women with menstrual migraine explore hormonal therapies to regulate estrogen levels and reduce the frequency of migraine. Options include: 

  • Oral Contraceptives: These can be taken continuously, skipping the placebo pills, to prevent the hormonal drop that triggers migraine. However, this option is more complex for individuals with migraine with aura due to an increased risk of stroke. 
  • Transdermal Estrogen: Estrogen gels or patches can be used to stabilize hormone levels during the menstrual cycle and may help prevent migraine. 

Considerations for Hormonal Therapy: While hormonal therapy can be effective for managing menstrual migraine, it is important to evaluate the risks, particularly for individuals with migraine with aura. There is an increased risk of stroke for individuals with aura, especially if they smoke or have other risk factors such as high blood pressure. In such cases, non-estrogen hormonal methods or transdermal estrogen are often preferred. 

Non-pharmacologic Options

For those looking for other options.   

  • Neuromodulators: Neuromodulation devices can help treat migraine by using electrical stimulation to block migraine signals. 
  • Nerve block: Sphenopalatine ganglion block or other might be considered 

When to See a Doctor

  • You get severe headaches with your period. 
  • The number or severity of your headache increases, or your headache pattern changes. 
  • You’re experiencing new or different side effects. 

If menstrual migraine is affecting your quality of life or occurs frequently, it’s important to seek medical advice. A healthcare provider can help determine the best treatment plan, including preventive medications and hormonal management options, to reduce the frequency and severity of your migraine. 

  • Call 911 (or your local emergency services number) or go immediately to an emergency room if: 
  • A headache comes on suddenly. 
  • You are experiencing the “worst headache of my life.” 
  • You are having symptoms that you’ve never had before, including speaking difficulty, balance problems, vision issues, mental confusion, seizures or numbing/tingling sensations 

You can find the full HeadWise episode: Menstrual Related Migraine here

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