Menstrual Migraines: What Should I Know?

I have suffered from migraines for most of my life, but it wasn't until I started trying to conceive that I began experiencing menstrual migraines, also known as hormonal headaches.

I had gone quite a while between migraines in 2020 when I got slammed so hard with a five-day disaster migraine which landed me in the emergency room begging for help. It turns out that my migraine attack was triggered by menstruation, which was different than my usual, and, sorry for the TMI, extra heavy that time due to an early miscarriage I'd experienced a few weeks prior. It's possible that this is why I hadn't noticed or tracked menstrual migraines before or why they'd been treated via the oral prescription medication I had on hand at the time.

What is a menstrual migraine?

A menstrual migraine can start before or during a female's period and happen sporadically or every month. Common symptoms include a consistently throbbing headache (ranging from dull to severely pulsing), sensitivity to light and/or sound and/or smells, tender scalp, nausea, dizziness, and fatigue.¹

How is it different from a regular migraine?

Well, it may feel like a different type of headache, but it also may feel the same as your "routine" migraine experience. The difference here is the timing. If you find that more than three months in a row, you experience a migraine up to 3 days before or during your period, then you're likely dealing with menstrual migraine.

Often, we learn that headaches or migraines in women are related to changes in our level of estrogen and progesterone (hormones that change during our menstrual cycles). Notably, our estrogen levels are their lowest during our period.² This means the drop from the middle to the end of our cycle is predisposed to causing us premenstrual migraines. As such, many women find that higher levels of hormones during pregnancy improve regular migraine attacks.

What can impact the attacks?

The frequency or severity of menstrual migraines may be impacted by birth control pills, hormone therapy replacement, pregnancy, postpartum, or menopause - all things that can influence and change our hormone levels and fluctuations.

How can I manage them?

Menstrual migraines are most often managed by NSAIDs (non-steroidal anti-inflammatory medications) such as Advil and Motrin. If your menstrual migraines are predictable, NSAID treatment can begin 2-3 days before your period starts and be taken until your period ends. Other medications that may be used to prevent a menstrual migraine include regular migraine prevention medications at an increased dose when you're near your period. This option is especially important to discuss with your specialist.¹

Stronger acute medications for migraines may also be used to stop a menstrual migraine once it begins, including triptans, beta-blockers, and calcium channel blockers.¹

What have I learned?

1. If using birth control or medication to manage the menstrual cycle, you can ask for a pill or product with a lower dose of estrogen. You can also choose a pill or a medication that you can take continuously, rather than intermittently (thus skipping your period and your menstrual migraine).
2. Managing the symptoms is just as critical as the migraine itself. Figure out what works best for you in terms of eating, sleeping, caffeine, and relaxation techniques.
3. This isn't something you have to just "live with" - there are treatment options, both preventive and abortive, to help you manage your menstrual migraines. Make sure to discuss your symptoms and their correlation with your period/menstrual cycle with your neurologist or migraine specialist to learn all of your options.