What is a Menstrual Migraine?

Why Migraines Occur During Menstruation

Migraines During Menstruation. SCIEPRO Science Photo Library/Getty Images

If you find that your migraines occur most frequently right before or at the start of menstruation - and that these migraine attacks last longer, are more severe and are less responsive to typical migraine pain-relief medications, you are not alone.

There are two types of menstrual-related migraines:

  • pure menstrual migraine without aura
  • menstrually-related migraine without aura.

If you suffer from pure menstrual migraines without aura, your attacks occur exclusively during the perimenstrual period – starting two days prior to the menstrual cycle up until 3 days after the onset of menstruation.

These migraine attacks must occur in 2 out of 3 menstrual cycles and at no other time.

Similar to a pure menstrual migraine without aura, a menstrually-related migraine without aura occurs during the perimenstrual period in at least 2 out of 3 menstrual cycles. But with this type of migraine, a woman can also have migraines without auras during other times in her cycle - like during ovulation for example.

How Common are Menstrual Migraines?

According to the American Headache Society, the prevalence of pure menstrual migraine without aura occurs in 7 to19 percent of women with migraines. A menstrually-related migraine without aura occurs in  35 to 51 percent of females with a migraine. In other words, menstrual migraines are common.

Why Do Menstrual Migraines Occur?

The most likely reason has to do with the decline in estrogen that occurs just prior to menstruation. The presence of estrogen is associated with increased levels of serotonin in the brain.

So a decline in estrogen implies a decrease in serotonin. There is a complicated link between serotonin and the trigeminovascular pain pathway - which is believed to play a vital role in migraine formation and is linked to both the blood vessels that surround your brain and the trigeminal nerve (a cranial nerve that is involved in chewing and provides sensation to the face).


Another theory about menstrual migraines involves the way women perceive pain, which may vary throughout the course of the menstrual cycle. This may be especially true in women who suffer from chronic pain disorders. In one study, pain perception was higher during the premenstrual and menstrual part of the cycle, as opposed to the mid-menstrual or during ovulation.

How Are Menstrually-Related Migraines Treated?

The triptans, sumatriptan, and rizatriptan, have been found to be effective in alleviating menstrually-related migraines. 

Mefenamic acid (Ponstel), a non-steroidal anti-inflammatory (NSAID), was also found to effective in a study in European Journal of Medical Research. In this study, mefenamic acid, at a dose of 500mg three times daily, was given at the start of a menstrual migraine and then taken for the duration of the menstrual cycle.

Please note that mefenamic acid is an NSAID. NSAIDs have several potential adverse effects and should be avoided by some individuals, particularly those with a history of stomach bleeding, kidney disease, and/or heart disease.

Always discuss any medication you take beforehand with your doctor.

How Are Menstrual Migraines Prevented?

If you get menstrual migraines frequently, your doctor may recommend a preventive medication. Long-acting triptans, like frovatriptan or naratriptan, taken for 5 to 6 days (dosed twice daily) in the perimenstrual period are shown to be effective in decreasing the number of menstrually-related migraines - however, no triptan is FDA approved for migraine prevention at this time. NSAIDs like Aleve (naproxen) take twice daily during the perimenstrual period may also be useful in preventing or reducing the severity of a menstrual migraine.

Magnesium starting at day 15 of your cycle and continuing until menses begins may also be effective. In addition, estrogen supplementation or continuous birth control may also be used to prevent menstrual migraines.

There are contraindications to both triptans and estrogen therapy, so please be sure your headache specialists consults your primary care physician to be certain they are safe for you.

The Bottom Line

It's not uncommon for your migraines to occur at certain times in your cycle, especially in the peri-menstrual period, so don't feel alone - and they can be treated effectively, it may just require a bit of patience and trial and error. Speak with your doctor if you notice this pattern as it may affect your treatment plan. 


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