If you experience migraine attacks, you may have noticed an increase during your period. This isn’t unusual — and it may partly be due to the drop in the hormone estrogen that happens before you menstruate.
Migraine triggered by hormones can happen during pregnancy, perimenopause, and menopause.
Learn why this happens and how it can be prevented.
Menstrual migraine symptoms are similar to other types of migraine without aura, or other sensory symptoms. They usually occur within 1 or 2 days after the onset of your period.
Menstrual migraine if often separated into two forms:
- Menstrual-related migraine: This more common form can come with or without aura symptoms such as vision disturbances. You may experience migraine attacks at other times of the month.
- Pure menstrual migraine: This type occurs exclusively around the onset of or after your period.
Here are some typical menstrual migraine symptoms:
- throbbing head pain, usually on one side of the head
- sensitivity to light and loud sounds
Premenstrual syndrome (PMS) symptoms such as bloating, breast tenderness, nausea, and mood changes may accompany menstrual migraine attacks.
There are several ways to relieve migraine attacks or prevent pain from migraine.
Menstrual migraine is often considered a separate disease than other types of migraine, and not all medications have FDA approval to treat both.
Over-the-counter (OTC) drugs
Your doctor may recommend you try an over-the-counter (OTC) pain medication, such as ibuprofen (Advil, Midol). They may advise you to take these on a scheduled basis, before the onset of pain.
If your sodium levels are found to be high during a physical exam, your doctor may also recommend that you take a diuretic.
Many prescription drugs are available to help relieve and prevent general migraine pain.
People living with migraine are often started on both preventive and abortive medications. Abortive medications are taken to stop an acute migraine attack.
Some examples used to treat migraine in general include the following:
- onabotulinumtoxinA (Botox)
- CGRP antagonists
Note that for menstrual migraine specifically, frovatriptan is the only triptan approved for prevention. Speak with your doctor to find the right medication for your needs.
- calcium channel blockers
- ergotamine drugs
- triptans and serotonin receptor agonist (SRA)
For acute menstrual migraine attacks, some
If you’re on hormonal birth control, your doctor may also recommend that you switch to a method with a different hormone dose.
If you aren’t on hormonal birth control, your doctor may recommend that you try a method such as the pill to help regulate your hormone levels.
Certain vitamins and supplements have shown some promise for staving off migraine triggered by hormones.
Note that none of these remedies have been specifically studied for menstrual migraine:
- vitamin B2, or riboflavin
- coenzyme Q10
Always check with your doctor before trying any new treatments, even OTC drugs or supplements, due to medication interactions.
Regular exercise may help relieve migraine triggered by hormones. Other people may find that exercising makes their symptoms worse.
Stay hydrated, eat a high-protein meal before exercising, and warm up your muscles before exercise to maximize benefits.
Stress and even a swift reduction of stress may be a trigger for migraine attacks.
A 2014 study suggested that a reduction in stress from one day to the next could be more likely to cause migraine attack. This is known as the “let-down” effect.
Keeping stress down in general and managing it as soon as you realize it’s happening may help.
Lowering stress and anxiety may sound easier said than done, but there are simple steps you can incorporate into your daily life. Try a few minutes of meditation or yoga after waking up in the morning or before going to bed.
Practice deep breathing exercises during difficult situations.
Migraine attacks can occur when hormone levels are in flux. They can also be caused by some medications, such as birth control pills.
According to the National Headache Foundation, approximately 60 percent of women who have migraine get menstrual migraine attacks. This can happen anywhere from 2 days before the start of menstruation to 3 days after menstruation ends.
Migraine may begin when those who menstruate get their first period, but they can start at any time. Your attacks can continue throughout the reproductive years and into menopause.
Perimenopause and menopause
Dropping levels of estrogen and other hormones, such as progesterone, can cause migraine attacks during perimenopause.
On average, perimenopause starts 4 years before menopause, but it can begin as early as 8 to 10 years before menopause.
Those who are on hormone replacement therapy may also develop migraine.
Hormone headaches during pregnancy are most common during the first trimester. This is because blood volume increases and hormone levels rise.
Pregnant people can also experience common headaches during pregnancy. These have many causes, including caffeine withdrawal, dehydration, and poor posture.
Migraine attacks are different than common headaches. They typically cause severe levels of throbbing pain and usually occur on one side of the head. Migraine is categorized as “with aura” or “without aura.”
If you have migraine with aura, you may experience one or more of the following symptoms in the 30 minutes before your attack:
- seeing flashes of light
- seeing unusual lines or spots
- a temporary loss of vision
- numbness in the hands or face
- tingling sensations in the hands or face
- changes in speech
- unusual changes in smell, taste, or touch
The symptoms of migraine with aura can also include:
- sensitivity to light or sound
- pain behind one eye or one ear
- pain in one or both temples
Common headaches are never preceded by an aura and are typically less painful than migraine.
There are different kinds of headaches, including:
- Tension headaches. High levels of stress and anxiety can cause tension headaches. They may also be caused by muscle tension or strain.
- Cluster headaches. These headaches are often mistaken for migraine. They typically cause pain on one side of the head and may include other symptoms such as watery eyes, runny nose, or nasal congestion.
Certain risk factors, such as age and family history, can play a role in whether you get migraine or menstrual migraine. Simply being a woman puts you at increased risk.
Of course, you can’t control your sex, age, or family tree, but it may help to keep a migraine diary. This can help you identify and avoid triggers.
Triggers may include:
- poor sleeping habits
- alcohol consumption
- eating foods high in tyramine, such as smoked fish, cured or smoked meat and cheese, avocado, dried fruit, banana, aged food of any kind, or chocolate
- drinking a lot of caffeinated beverages
- exposure to extreme weather conditions or fluctuations
- exposure to extreme, intense levels of light or sound
- breathing in strong odors from pollution, cleaning products, perfume,
car exhaust, and chemicals
- ingesting artificial sweeteners
- consuming chemical additives, such as monosodium glutamate (MSG)
If you’re experiencing symptoms of migraine, your doctor will often first start with a physical exam and ask about your family health history to determine if there are any potential underlying conditions.
If your doctor suspects something other than hormones to be causing your migraine attacks, they may recommend additional tests, such as a:
- blood test
- CT scan
- MRI scan
- lumbar puncture, or spinal tap
Identifying your triggers and experimenting with different treatments can help you reduce or manage your migraine symptoms.
If OTC medications aren’t working for you, reach out to your healthcare provider. They may be able to recommend alternative treatments, prescribe a stronger medication, or adjust your treatment plan in some other way to help alleviate your symptoms.