Does a migraine always seem to strike right around your time of the month? If so, you’re not alone. Around 6% of all women of reproductive age get migraine attacks near the time of their period.
These “menstrual migraines” tend to happen before or during your cycle and are worse than a typical headache. Your doctor may also call them hormonal headaches, hormonal migraines, period headaches, or period migraines.
Often, menstrual migraine pain happens on one side of your head. It can include throbbing or pulsing head pain, being sensitive to light or smell, nausea, and it can get worse when you move.
Fortunately, there are ways to help treat and even prevent these migraines.
The Hormone-Migraine Link
Researchers are still studying the link between hormones and migraine headaches, but the leading theory links migraine to the drop in estrogen that happens just before your flow begins.
There may also be a connection between having a heavy and painful period and having migraines. Having these types of cycles means you have higher levels of the hormone prostaglandin, which is also linked to menstrual migraine.
There’s no formal test to diagnose menstrual migraines. The best way to understand how – or if – your cycle is a trigger is to keep a record of your migraine attacks alongside a record of your period. You can get an accurate snapshot after about 3 months of data.
Typically, a migraine triggered by period hormone changes happens between 2 days before your period and 3 days into your period. It’s likely you have menstrual migraines if they happen at least two out of three consecutive cycles.
Treatment Options
Menstrual migraines can be challenging to manage because they may not respond to the same migraine medicine you take other times of the month. The reason for this isn’t clear, but researchers think it may have to do with how estrogen affects other chemicals.
These three approaches may help:
- Acute treatment that treats your migraine as it’s happening
- Mini-preventive treatment medication that you take around the time of your period to head off attacks
- Continuous preventive treatment that you take throughout the month
Acute treatment options
Doctors enhance typical acute treatment to combat your menstrual migraine with more strength than usual. It’s best if you’re able to take these early in your attack. The faster they get to work, the better.
Options include:
- Fast-acting prescription oral triptans you take in tablet form by mouth (almotriptan, eletriptan, rizatriptan, sumatriptan, zolmitriptan) combined with a nonsteroidal anti-inflammatory (NSAID) such as ibuprofen or naproxen
- An injectable triptan (sumatriptan) that bypasses your digestive tract for even faster action. This can be a good option if nausea or vomiting makes taking pills difficult. You can take it in a needle form, or in a needle-free auto-inject form. Another injectable medication option is dihydroergotamine (DHE). You can also combine these options with an NSAID for enhanced relief.
- Nasal spray triptans such as sumatriptan or zolmitriptan. These work slightly slower than injections but also help bring relief if you can’t swallow a pill.
Mini-preventive treatment
These options may help prevent a menstrual migraine.
- NSAIDs. Your doctor may recommend you try to keep migraines at bay by taking an oral NSAID twice daily in the 5-7 days around your period window. Studies show that taking 550 milligrams of naproxen twice a day can prevent hormonal migraines, and other NSAIDs should have the same effect.
- Hormone supplements. An estrogen pill, vaginal gel, or patch prescribed by your doctor can help prevent the pre-cycle drop in estrogen that can trigger migraines. This option is best if you have predictable, regular cycles.
- Triptans. Studies show that taking a long-lasting triptan medication such as frovatriptan or naratriptan twice a day in the 4- to 5-day window of your period can work well as a preventive measure for menstrual migraines. This option may not be a good choice if you take triptans other times in the month, because you risk medication overuse.
- Magnesium. In one trial, starting magnesium supplements 15 days after the start of a period helped prevent menstrual migraine. This can be a good option if you don’t have regular periods.
Continuous preventive treatment
If you have irregular periods, or mini-prevention methods don’t work, your doctor may recommend continuous prevention treatments you take throughout the month. Typically, this involves shifting the dosing of your birth control pills or vaginal ring insertion so that there are no breaks in treatment.
Usually, when you take birth control pills, there are 3 weeks of active pills and 1 week of placebo, which triggers your period. With continuous prevention treatment, you skip the week of placebo so that your period doesn’t start.
Similarly, when using the vaginal ring, you insert a new one right after you take out the previous one instead of waiting for your period.
Living With Menstrual Migraine
Along with medication or supplement treatment to help relieve or prevent menstrual migraines, there are some other ways to help keep them at bay. These include:
- Try acupuncture. This complementary method involves tiny needles inserted into specific points on your body to help you relax and ease your migraine symptoms.
- Stay cool. Ice can offer soothing relief for your migraine pain.
- Keep your blood sugar steady. Instead of three large meals a day, stick with smaller, more frequent meals to avoid sugar spikes or crashes. Eat a mini snack before bed, and don’t skip breakfast.
- Set helpful sleep patterns. Go to bed and get up at the same time each day to create a predictable pattern for your body.
- Work to lower stress levels. Stress can trigger migraine headaches. If cutting certain stresses out of your life isn’t possible, find reliable ways to relax your body such as regular exercise, biofeedback, or meditation.
