What Causes Menstrual Migraines?

Migraines During Your Period
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 For women during that “time-of-the-month,” the stomach cramps, food cravings, irritability, and fatigue associated with a monthly period can be a major lifestyle setback. Add a migraine to this mix, and you have a recipe for a day in bed.

The good news is we have a better understanding of what causes menstrual migraines and what you can do to treat them.

Estrogen and Menstrual Migraines

The majority of migraine sufferers are female, and of this group, about 20 to 30 percent have attacks triggered by the menstrual cycle, according to a 2010 article in Current Pain and Headache Reports. Researchers have found a strong connection between estrogen hormones and migraine headaches, which is why women tend to be more impacted by migraines than men.

Typically, higher estrogen levels will prevent migraine headaches, whereas lower estrogen levels will result in a migraine headache. But it may be more the fluctuation or change in estrogen that triggers a migraine, not simply the fact that the level is low. That said, because a woman’s estrogen levels drop to their lowest point when she is menstruating, this is usually the time that migraine headaches are most likely to occur.

Even so, it's important to note that every woman reacts differently to hormones, so a woman may have hormone-related migraines, even when she does not have her period. Remember, there are multiple potential triggers for migraines like certain foods or a change in your sleep regimen.

Migraines and Menopause

In addition to the menstrual cycle, there are other times in a woman’s lifetime when her hormone levels change drastically, and this can impact hormone-related migraines. For instance, many women find that their migraines are greatly reduced or even disappear during pregnancy due to steady levels of estrogen. It’s thought that this may “protect” the brain against migraines. A dip in estrogen levels after the birth of the baby can trigger migraines once again.

Perimenopause and menopause also impact hormone levels. During this time, the body’s hormones levels tend to rise and drop dramatically, and this fluctuation can trigger migraine headaches. Likewise, many women notice their migraines disappear when they enter menopause and no longer get their period.

Lastly, some women take hormone therapy to treat symptoms of menopause, and this can also result in an increase or decrease of migraine headaches, depending on how the woman’s body responds to the hormones taken.

Preventing a Menstrual Migraine

Because menstrual migraines are caused by lower hormone levels, taking birth control pills that maintain the body’s hormone levels may help ease a woman’s menstrual migraines. Birth control pills that give a woman a menstrual period seasonally may reduce menstrual migraines by eliminating the woman’s period and thus the associated migraines.

Keep in mind, though, that every woman’s body responds to hormones differently, so a woman may need to try a few different birth control methods before finding one that reduces or eliminates her menstrual migraines. This is why some physicians advise using birth control with fewer placebo days, using estrogen birth control patches during the placebo week, or using progestin only birth control to prevent menstrual migraines.

Women can also take a preventive migraine medication like Frova (frovatriptan) a few days before her period and during the first few days of her period. Learning to recognize other migraine triggers, such as stress, lack of sleep, or irregular eating, can also help to prevent menstrual migraines.

Treating the Pain of a Menstrual Migraine

Menstrual migraines are treated in the same way as typical migraines. This includes using a pain reliever, such as acetaminophen or ibuprofen. Furthermore, your doctor may prescribe you a migraine medicine if over the counter pain relievers are not effective, like a triptan.

Other care methods that may work to relieve the pain include massage, application of ice, and resting in a dark, quiet room. If you are still not getting relief with these simple measures or with a triptan, be sure to consult with a headache specialist (for example, a neurologist) for treatment methods that might work best for you.

A Word From Verywell

The bottom line here is that we know estrogen changes are likely involved in migraine pathogenesis for women, but we do not know exactly how, and it may vary from woman to woman.

Remember, too, migraines can be unique experiences for people, so what works for one person may not work for another. Try to be patient during your trial and error process when combating your menstrual migraines. Most women can obtain relief, but it may take some time.

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Article Sources
  • MacGregor EA. Prevention and treatment of menstrual migraine. Drugs. 2010 Oct 1;70(14):1799-818.
  • Russell MB. Genetics of menstrual migraine: the epidemiological evidence. Curr Pain Headache Rep. 2010 Oct;14(5):385-8.
  • Tepper, DE. (2013). American Headache Society. Headache Toolbox: Menstrual Migraine.