Menstrual Migraine Headaches

Migraines and Your Period

USA, New Jersey, Woman having headache
Tetra Images/Getty

Do you have migraine headaches that occur just before or just after your period starts? Do your headaches also occur at other times during your menstrual cycle?

About 18 % of women in the US report suffering from migraines. Most of these women will report their first migraine before the age of 35. About half of these women say that there is an association between their migraines and their menstruation.

If you suffer from headaches that have some relationship to your period you have what is referred to as a menstrual migraine. These cycle related headaches can be further classified into:

Pure menstrual migraine

A migraine headache without aura that occurs ONLY on 1-2 days before or after the onset of your period and at no other times during your menstrual cycle in greater than 60% of your cycles

Menstrually-related migraine

A migraine headache without aura that occurs on 1-2 days before or after the onset of your period in greater than 60% of your cycles and that also occurs at other times during your cycle.

Most women with migraines will report the menstrually related variant. Pure menstrual migraines are less common with only about 10% reporting this type of migraine.

Before discussing your headache with your doctor it is a good idea to chart your headaches in relation to your period. 

If you don’t already have a menstrual cycle calendar, now is a good time to start one.

Keeping track of when you have headaches can help your doctor determine what type of headache you may have, including whether you have menstrually related migraines.

Menstrual migraines can occur in isolation or can be one of the complaints of Premenstrual Syndrome (PMS).  The other symptoms of PMS include:




Breast tenderness

Mood swings


Menstrual migraines can also be associated with painful periods.

The treatment of an acute migraine attack is the same for menstrual migraines as it is for non-menstrual migraines. The first strategy in managing a menstrual migraine is to rest in a cool and dark room. Some women will have great success with a strong cup of coffee or caffeine although how this works is somewhat unclear.

First line medications are the pain relievers and anti- inflammatory agents such as:



Ibuprofen and other NSAIDs

Some women will require stronger migraine-specific medications.

These include the ergot derivatives and the triptans.

Perhaps the most important reason to determine if you suffer from one on the menstrual migraine variants is that there are strategies to help eliminate or at least reduce the occurrence of these types of migraines.

It is thought that the cyclic changes in your hormone levels are a significant trigger for menstrual migraines.

  Medications that reduce these hormone fluctuations have been shown to improve menstrual migraines.

The most common of these strategies is the continuous use of the oral contraceptive pill. Not only does this inhibit ovulation, which is the trigger for the hormone changes it also maintains estrogen levels by eliminating the hormone free week associated with cyclic use of the birth control pill. 

If this does not improve your migraine your doctor may discuss with you other hormone medications such as estrogen supplementation during the luteal phase of your cycle or high dose progestins or GnRH to prevent ovulation. Your doctor may also discuss using a combination of hormones and analgesics or migraine-specific medications to interrupt the cyclic occurrence of your migraine.

As always, be sure to discuss any headaches or related symptoms that occur during your menstrual cycle.

Updated Andrea Chisholm, MD.

MacGregor,Anne;Menstrual Migraine:therapeutic approaches;Therapeutic Advances in Neurological Disorders,2009 2(5)327-336.

Continue Reading